Original article
Prevalence of musculoskeletal disorder symptom in dentists in
Davangere, Karnataka – A cross sectional survey
Contributors
1. D.J. VEERESH, *
MDS. Professor.
Department of Public Health Dentistry, Bapuji Dental College and Hospital,
Davangere
2.YUNUS G.Y
MDS. Assistant Professor.
Department of Public Health Dentistry, Bapuji Dental College and Hospital,
Davangere
3. DEEPTA RAMARAO A
MDS. Postgraduate student.
Department of Public Health Dentistry, Bapuji Dental College and Hospital,
Davangere
Address for Correspondence:
Dr. D.J. Veeresh,
Department of Public Health Dentistry, Bapuji Dental College and Hospital,
Davangere - 4
Phone number: 9448352326
E-mail address: dr.veereshdj@gmail.com
1
ABSTRACT
Background: Dentistry is a profession is highly rewarding but not without
consequences. Dentists are exposed to number of occupational hazards of which the
most common is musculoskeletal disorder (MSD). The aim of the study was to
investigate the prevalence of musculoskeletal disorders symptoms among the dental
practitioners in Davangere and the prevalence of pain in different anatomic location.
Material and methods: A cross sectional survey was conducted among 70 dental
practitioners residing in Davangere city. A self-designed questionnaire containing eight
questions was self administered to all the available dentists at their place of work. The
data collected was analyzed using descriptive statistics and chi square test.
Results: The prevalence of at least one musculoskeletal disorder symptoms among the
dentists was found to be 34.71% and they reported a higher frequency of pain in the
neck region (71%).
Conclusions: Among the study population of dentists practicing in Davangere, there
was relatively lower prevalence of at least one musculoskeletal disorder symptoms and
the most common site of pain was neck region.
Key words: Musculoskeletal diseases, Dentists, India
2
Text
INTRODUCTION
Health is a state of complete physical, mental, and social well-being and not
merely the absence of disease or infirmity, which leads to a socially and economically
productive life1. Healthy body helps us be more productive. However, in today’s world,
health takes a backbench due to work stress.
Dentistry is a highly rewarding profession, but it is a very demanding job with
high degree of concentration and precision in work. Dentists require good visual acuity,
hearing, depth perception, psychomotor skills, manual dexterity, and ability to maintain
occupational postures over long periods 2. Uncomfortable positions frequently adopted
by dentists lead to excessive tightening of some tissues and the straining of other
tissues. Apart from the physical strain, dental professionals are predisposed to a number
of occupational hazards. These include exposure to infections, percutaneous exposure
incidence, dental materials, radiation, respiratory disorders, and eye insults.
Nevertheless, the most common subtle disorder existing among the dentist is the
musculoskeletal disorder.
Musculoskeletal disorders (MSDs) are described as disorders of the muscles,
nerves, tendons, ligaments, joints, cartilage, or spinal discs 3. They result from one or
more of these tissues having to work harder than they are design to 4. Musculoskeletal
disorders may be caused due to improper working posture, repeated unidirectional
twisting of the trunk, working in one position for prolonged period, operators not
knowing how to properly adjust ergonomic equipment, and physiological damage or
pain. Estimates have shown that musculoskeletal disorder contributes to about 40% of
all costs towards the treatment of work related injuries 2.
3
Thorough exploration of available literature resources revealed no studies
conducted in Davangere to determine the prevalence of musculoskeletal disorders
among general dental practitioners. This study will help to take preventive measures in
future to control the occurrence of the musculoskeletal disease. Hence, this study was
conducted with the aim to determine the prevalence of musculoskeletal disorders
among general dental practitioners in Davangere city and factors associated with its
prevalence. The objectives of the study were to know the prevalence of pain in different
anatomic location and to investigate association between musculoskeletal disorders and
demographic
and
clinical
4
details.
MATERIAL AND METHODS
This study was a cross sectional survey. Ethical clearance for the conduction of the
study was obtained from the Institutional Review Board, Bapuji Dental College and
Hospital, Davangere. Written, voluntary informed consent was obtained from the study
participants prior to the start of the study.
Study Population:
The list of practicing dentists was obtained from the Indian Dental Association
(IDA), Davangere branch. The list contained totally of 97 dentists who were the
sampling frame of the study. Of the 97 dentists, 85 dentists participated in the main
study and 12 in pilot study.
Questionnaire designing:
A structured, close – ended, self- designed questionnaire containing eight questions was
developed by modifying the Standardized Nordic Questionnaire 5. The questionnaire
was divided into three sections. The first section included the informed consent and
demographic details such as age, sex, height, weight and the qualification of the
study participant. The second section included the work experience of the dentists,
duration of the working hours, the patients examined in a day, hand dominance
and type of dentistry. The third section contained the details regarding the location and
the frequency of pain in each anatomic location. The locations of pain included neck,
low back, shoulder, forearm, hand and wrist, elbow, upper back, one or both hip or
thighs, one or both ankle or feet, one or both knees. For frequency, the options
given here were often, occasionally and never.
5
Reliability and Validity of Questionnaire:
The face validity of the questionnaire was checked by the Head of the
Department of Public Health Dentistry. The reliability of the questionnaire
was
assessed by distributing the questionnaire to 12 practitioners who were not
included in the study. The data was collected and subjected to analysis. The reliability
of the questionnaire was 0.76 (Cronbach’s alpha) which was considered good.
Data collection:
The data was collected from June to July 2013. The questionnaire was selfadministered. Questionnaires were distributed to 85 practitioners, of which 70 were
returned. The questionnaires were distributed in the colleges (Bapuji Dental College
and
College
of
Dental
Sciences)
and
in
dental
clinics.
The
questionnaires were collected on the same day. Time taken by each participant to
fill the questionnaire was approximately 8- 10 minutes.
Statistical analyses:
The data was analyzed using SPSS Version 17 (SPSS Inc. Chicago). Descriptive
statistics were used to represent the data in frequencies and percentages. Chi square test
was done to check the association between the socio-demographic variables, clinical
demographic variables and the location of pain.
6
RESULTS
The response rate for the survey was 82.35%. The sample consisted of totally 70
participants of whom 44 participants were male, 63 participants had a MDS degree, and
57 participants practiced their branch exclusively (Table 1). The total mean age, height
and weight of the participants were 35.61 ± 6.37 years, 168.83 ± 8.81 cm, and 69.59 ±
10.52 kg respectively (Table 2). Fifty six percent of dentists were practicing for five
years or less. Approximately half of dentists were practicing for 3 – 6 hours per day
(53%) and saw less than five patients per day (50%). Eighty five percent of practicing
dentists were associated with dental institutions. Equal number of dentists practiced
right and left-handed dentistry and 51 % of dentists practiced fourhanded dentistry
(Table 3).
For the analysis of prevalence of pain according to the anatomic locations, the
options often and occasionally were combined together as the percentage of
participants who answered the option often was meagre. The prevalence of
musculoskeletal disorders among the dentists was found to be 34.71%. Low back pain
(70 %) was found to occur with higher frequency followed by shoulder pain (44 %),
and hand and wrist pain (43 %) among the dentists (Table 4). A statistically significant
association was found between weight and forearm pain (p = 0.036), weight and upper
back pain (p = 0.015), weight and one or both ankle/feet (p = 0.003), years of practices
and one or both hip/thighs (p = 0.035) and association to dental institution and elbows
pain (p = 0.004). Other associations were not statistically significant though an
association between height of the dentist and upper back pain can be considered to
marginally significant (p=0.052) (Table not provided).
7
TABLES
Table 1: Characteristics of participants
Frequency (N= 70)
Percent
Male
44
62.9
Female
26
37.1
MDS
63
88.6
BDS
7
11.4
General practitioners
13
18.6
Specialized
57
81.4
8
Table 2: Age, height and weight of participants
MALE
FEMALE
TOTAL
Mean age (years)
35.93 ± 6.37
35.08 ± 6.46
35.61 ± 6.37
Mean height (cm)
173.64 ± 6.41
160.69 ± 5.86
168.83 ± 8.81
Mean weight (kg)
74.48 ± 8.59
61.31 ± 8.08
69.59 ± 10.52
9
Table 3: Clinical characteristics of participants
QUESTIONS
Years of practice
OPTIONS
FREQUENCY
PERCENT
0-5 years
39
55.7
6-10 years
15
21.4
>10 years
12
17.1
>20 years
4
5.7
< 3 hours
26
37.1
3-6 hours
37
52.9
> 6 hours
7
10
Number of patients seen per
<5
35
50
day
5-10
28
40
> 10
7
10
Associated to any dental
Yes
60
85.7
institution on full time basis
No
10
14.3
Right handed dentistry
35
50
Left handed dentistry
35
50
Two handed dentistry
34
48.6
Four handed dentistry
36
51.4
Hours of practice/day
Hand dominance
Type of dentistry
Number of dentists prevented
Often
1
1.4
from doing their practice
Occasionally
13
18.6
Never
56
80
10
Table 4: Pain distribution in different anatomic locations
ANATOMICAL
OFTEN
OCCASIONALL
AREAS OF PAIN
NEVER
Percent
Y
of
dentists
N
%
N
%
N
%
having pain
Neck
6
8.6
44
62.9
20
28.6
71.42
Low back pain
8
11.4
41
58.6
21
30
70
Shoulder pain
6
8.6
25
35.7
39
55.7
44.28
Forearm pain
2
2.9
15
21.4
53
75.7
24.28
Hand and wrist pain
4
5.7
26
37.1
40
57.1
42.85
Elbows pain
1
1.4
10
14.3
59
84.3
15.71
Upper back pain
5
7.1
15
21.4
50
71.4
28.57
One or both hip/thighs
1
1.4
7
10
62
88.6
11.42
One or both ankle/feet
3
4.3
11
15.7
56
80
20
One or both knees
3
4.3
10
14.3
57
81.4
18.57
11
DISCUSSION
To our limited knowledge, this is the first study to assess the prevalence of
musculoskeletal disorder symptoms among the dentists of Davangere, Karnataka. MSD
is prevalent worldwide and is one of the commonest causes of long-term pain and
disability affecting hundreds of millions of people 2. World Health Organization and
United Nations have recognized this fact with their endorsement of the Bone and Joint
decade 2000–2010 6. MSD is characterized by presence of discomfort, disability or
persistent pain in the joints, muscles, tendons, and other soft parts, caused or
aggravated by repeated movements and prolonged awkward or forced body postures 7.
Dentists frequently assume static postures, which require more than 50% of the
body’s muscles to contract and hold the body motionless while resisting gravity. The
static forces resulting from these postures have been shown much more taxing than
dynamic (moving) forces 8. When the body is repeatedly subjected to such prolonged
static postures, it results in pain, injury, or career ending MSD. MSD has an impact not
only on the physical but also on the psychological and social aspects of the
practitioners. Work-related MSD in severe cases results in frequent absences and
finally to early retirement.
In the present study, 34.71% of the dentists reported at least one musculoskeletal pain
which is lower when compared to the studies reported by Rabiei et al (73%) 9,
Muralidharan D et al (78%) 2, Kumar VK et al (100%)
10
, Saxena P et al (83%)
11
,
Leggat PA (87%) 12 and Rehman K et al (46.7%) 13. The descending order of frequency
of pain in the anatomical sites was neck, lower back, shoulder, and hand/wrist. Neck
12
was the most common site of pain (71%) which is in accordance with studies reported
by Rabiei et al (43%) 9, Hayes JM et al (85%) 3, Muralidharan D et al (52%)
2
and
Szymanska J (56%) 14. Next to neck, the second most frequently occurring site of pain
was found to be lower back, which was, reported 70% in our study. Similar prevalence
rate was reported by Hayes MJ et al (68%) 3 and Kumar VK et al (72%) 10. Conflicting
prevalence rates were reported by Muralidharan D et al (41%) 2, Leggat PA (53.7%) 12,
Rehman K et al (57.8%) 13, Saxena P et al (57.5%)
Shaik AR et al (83.3%)
15
11
, Szymanska et al (60 %)
14
and
. The frequency of shoulder pain in our study was found to
be 44% which contrasting when compared to Rabiei et al (25%) 9, Hayes JM et al
(70%) 3, Muralidharan D et al (29%) 2, Shaik AR et al (6.6%)
15
, Kumar VK et al
(69.4%) 10, Leggat PA et al (53.3%) 12 and Rehman K et al (29.6%) 13. Hand and wrist
pain was found in 42.85% of dentists in the present study which is more when
compared with studies reported by Rabiei et al (25%) 9, Muralidharan D et al (26%) 2,
Saxena P et al (17.8%) 11 and less when compared to study reported by Kumar VK et al
(73.13%)
10
. The reasons for conflicting reasons could be that most of the dentists in
the present study have had less years of clinical practice, practice majorly three to six
hours per day and on an average see only five patients per day. Therefore, there might
not be much strain.
Only the dentists registered with Indian Dental Association were part of this study,
which may not be a representative sample. The reporting of pain was a self-reported
measure, which is subjective. An objective measure of validating the pain would have
been better. Therefore, there might be over or under estimation of the prevalence.
Further studies must be conducted by overcoming the limitations of the study.
13
CONCLUSIONS
Thus from the present study, it can be concluded that the prevalence of MSD among
the dentists practicing in Davangere was found to be low. However, majority of the
dentists reported a higher frequency of neck pain when compared to other anatomical
locations. To prevent the occurrence of pain in future dentists, more emphasis must
be placed on prevention strategies and proper work positioning in the undergraduate
and postgraduate curriculum. Continuing dental education programs can be
conducted for practicing dentists to update their knowledge.
14
ACKNOWLEDGEMENTS
We are grateful to Dr. Bhagyajyothi and Dr. Nagesh.L for their support in framing the
questionnaire. We thank all the dentists who participated in our study.
15
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