|Year : 2020 | Volume
| Issue : 3 | Page : 354-357
|Work-related musculoskeletal pain and its self-reported impact among practicing dentists in Puducherry, India
Kuldeep Singh Shekhawat1, Arunima Chauhan2, S Sakthidevi3, Basavaraj Nimbeni4, Shruthi Golai4, Lincy Stephen5
1 Department of Public Health Dentistry, Century International Institute of Dental Sciences, Poinachi, Kasaragod, Kerala, India
2 Department of Oral Biology, Melaka Manipal Medical College (Manipal Campus), Manipal Academy of Higher Education, Manipal, Karnataka, India
3 Department of Periodontics, Indira Gandhi Institute of Dental Sciences, Sri Balaji Vidyapeeth, Puducherry, India
4 Department of Pedodontics, Agmal Ebtsama Dental Clinics, El-Eskan, King Salman Road, Buraidah, KSA
5 Department of Orthodontics, Anoor Dental College and Hospital, Muvattupuzha, Ernakulam, Kerala, India
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|Date of Submission||20-Apr-2018|
|Date of Decision||24-May-2019|
|Date of Acceptance||31-May-2019|
|Date of Web Publication||06-Aug-2020|
| Abstract|| |
Background: Work-related musculoskeletal pain (MSPs) is not uncommon among dentist and often limits their work efficiency impacting their quality of life. Aim: The present research was conducted to identify site-specific pain resulting from musculoskeletal disorders (MSDs) among practicing dentists and determine its impact on their quality of life. Setting and Design: A cross-sectional questionnaire study conducted among practicing dentists of Puducherry Taluk, Puducherry, India. Method and Materials: A closed-ended, self-administered questionnaire was distributed to 95 practicing dentists to identify site-specific MSP from the study subjects. Data on pain due to MSDs, frequency of pain, its impact on quality of life, relieving factors, patients attended per day, working hours per day, and awareness on ergonomics were also recorded. Statistical Analyses: The data were analyzed for descriptive statistics, and Chi-square tests was used for proportions. Results: Almost all respondents experienced pain due to MSDs. Approximately, 11.1% “always” experienced elbow pain; 5.6% “always” experienced pain in neck and back. Approximately, 83% “sometimes” experienced pain in the back. Pain in elbow was significantly associated with gender (P = 0.036), qualification (P = 0.029), and years of practice (P = 0.032). Approximately, 36% reported having an impact on their life. Conclusion: The magnitude of the problem is slowly shifting from “sometimes” to “always.” Although small in proportion, pain due to MSDs has an impact on dental practitioners' quality of life, and elbow pain was reportedly higher in the study setting. Measures need to be implemented before MSD becomes a career limiting occupational hazard.
Keywords: Dentists, lower back pain, musculoskeletal pain, occupational hazard, posture, prevalence, quality of life, shoulder pain
|How to cite this article:|
Shekhawat KS, Chauhan A, Sakthidevi S, Nimbeni B, Golai S, Stephen L. Work-related musculoskeletal pain and its self-reported impact among practicing dentists in Puducherry, India. Indian J Dent Res 2020;31:354-7
|How to cite this URL:|
Shekhawat KS, Chauhan A, Sakthidevi S, Nimbeni B, Golai S, Stephen L. Work-related musculoskeletal pain and its self-reported impact among practicing dentists in Puducherry, India. Indian J Dent Res [serial online] 2020 [cited 2020 Nov 29];31:354-7. Available from: https://www.ijdr.in/text.asp?2020/31/3/354/291482
| Introduction|| |
Practicing dentistry is a challenging task, which among other things involve the ability to maintain static postures over a prolonged period. Studies have shown that dentists report more frequent and worse health problems, particularly musculoskeletal pain (MSP). Musculoskeletal disorders (MSDs) are the most common occupational illnesses in the world affecting about one million people a year in countries like Great Britain. They include problems such as low back pain, joint injuries, and repetitive strain injuries of various sorts. In China, about 83.8% of dentists experience neck pain. In the Indian subcontinent, relatively higher prevalence's of MSP have been reported by different authors in different study settings.,,,
Dentists often work in limited areas, and most of the time, their work is usually long and requires concentration. At times, dentists also endure pain to complete their work, highlighting the high job demand that comes with this profession. The higher prevalence of work-related MSDs result in lowered productivity owing to missed work schedule, inability to perform daily activities, and at times lead to career-ending injury.
The present study was conducted to identify work-related MSDs in terms of perceived pain among practicing dentists in Puducherry (Union Territory, India) with a secondary objective to determine its impact on their daily lives.
| Methods|| |
Study setting and design
The study was conducted in the month of September 2015. MSDs were identified from responses to a self-administered, closed-ended questionnaire to any complaint of pain in the neck, back, shoulder, wrist, elbow, and hip. Questions related to impact on daily life, relieving factors, and an additional question on awareness of ergonomics was also included. Frequency of pain was recorded as “always,” “sometimes,” and “never.” In addition, background data on age, gender, qualification (Bachelor of Dental Surgeon/Master of Dental Surgery), experience in years (0 – 5, 6 – 10, and above 10), working hours per day (0 – 6, 7 – 10, and above 10), and average patients attended per day (0 – 6, 7 – 10, and above 10) was also obtained. Prior to being finalized, the questionnaire was distributed to 10 staff members of the institute to ensure the clarity and content of the questionnaire. Certain questions were rephrased and/or modified to suit the comprehension level of survey subjects.
Permission was obtained from the concerned authorities. The study was conducted within the parameters of Declaration of Helsinki. Administratively, Puducherry Union Territory (a state in India) has four districts; Puducherry, Mahe, Yanam, and Karaikal. Puducherry district comprises of four taluks (Bahoor, Ozhukarai, Puducherry, and Villianur). The present study was conducted among private dental practitioners of Puducherry taluk. With the precision of 1.96, prevalence of 6.6%, and alpha error of 0.05, a sample size of 94.7 (rounded to 95) was conveniently selected for the present study. The study participants were approached in the evening because most of the dentists were employed in various teaching institutions from morning till early evening. Every participating dentist was approached twice (owing to their busy schedule). Those with systemic diseases that may influence the musculoskeletal system and with MSDs unrelated to dental practice were excluded from the study. Once contacted, the nature of the study was explained to them with the assurance of anonymity and confidentiality of their responses. The nature of the study was explained to them, and only those dentists providing informed consent were included as study participants. The study participants were requested to fill the questionnaire in the presence of investigator within a timeframe of 10 min after which the questionnaires were collected by the investigator. Incomplete questionnaires were excluded. The responses were transferred in excel sheet (Microsoft Windows 2010), and the data obtained were analyzed using Statistical Package for Social Sciences (SPSS version 16.0.; SPSS Inc, IL, Chicago, USA) for frequency distribution. Perceived pain with demographic variables was assessed using the Chi-square test with P < 0.05 as level of significance.
| Result|| |
Responses of 72 practitioners were included for analysis. The response rate was 75.7% (72/95). The mean age was 33.2 years [(33.2 ± 7.4) 25.8 – 40.6], and females were found to be more in proportion than males. Approximately, 65% of respondents were specialist (Master's degree), and the majority of the respondents were into private practice for the last 5 years. More than 50% of respondents reported an inflow of 7 to 10 patients per day and an equal percentage age worked on an average of 7 to 10 h per day (inclusive of institutions, consultations, and private practice) [Table 1].
Almost all the respondents experienced pain in their neck, back, elbow, shoulder, wrist, and hip. Frequency of pain was “always” present among 5.6%, 11%, and 3% in neck and lower back, elbow, and hips, respectively. Eighty-three percent and 79.2% of dentists, “sometimes” reported experiencing back pain and elbow pain, respectively [Table 2]. The association between frequency of pain and select demographic variables is presented in [Table 2]. Pain in the elbow was more experienced by females (P = 0.036). Significant association was found between pain in elbow with qualification and years of practice (P = 0.02 and P = 0.03) [Table 3].
|Table 2: Self-reported frequency of musculoskeletal pain in different anatomical locations|
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|Table 3: Association of site-specific musculoskeletal pain with select demographic variables|
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Thirty-six percent (26/72) of the respondents reported its impact on their daily life with 11 respondents reporting their inability to drive/ride a motor vehicle [Table 4]. To relieve themselves from musculoskeletal pain, 43% preferred taking rest after clinic hours, 23.6% did some stretching after clinics, and 19.4% corrected their postures soon after the onset of pain during their (clinic) practice hours. More than 50% of the respondents had an idea regarding the concept of ergonomics, but only about 9% reported attending any workshop for the same [Table 5].
|Table 4: Self-reported impact of musculoskeletal pain on their quality of life|
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|Table 5: Factors relieving musculoskeletal pain and dentists' knowledge regarding ergonomics|
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| Discussion|| |
The present study found that almost all the dentists had some MSP owing to their professional work in the last 6 months. Dentists commonly experience MSP during the course of their careers, and particularly, back pain has been found to be a major health problem among dental practitioners. However, in the present study, it was found that elbow pain was “always” reported more than neck or back pain among study participants. This is rather a deviation from routinely reported findings in literature, where MSP is more common in other anatomical sites.,,, This could be attributed to work positions that require either frequent bending and/or static posture of the elbow joint, which in turn are thought to initiate pain/injuries. A major proportion of dentists also “sometimes” experienced back, elbow, and neck pain in the descending order. Similar findings have also been reported in the literature.
Dentists do report various types of MSP, and the present study highlights the significant association of site-specific perceived pain (elbow pain) with females, specialist dentist, and those in first 5 years of private practice. This is contrary to findings reported in literature where MSP in the neck, shoulder, wrist, and lower back is significantly associated with the female gender., MSP (elbow pain) was also significantly observed more among those with Master's degree. The study also revealed the association of elbow pain with years of practice. Less experienced practitioners reported more MSP than their more experienced colleagues. This can be attributed to practicing better working positions and techniques to avoid MSP and/or simply having developed more coping strategies to deal with MSP.
We also made an effort to determine the impact of MSP on their quality of life. Various authors have reported the impact of MSP, which include leave from work, difficulty in sleeping, and reduction in working hours. On an international arena, one in ten dentists reported taking an annual mean leave of 11.5 days because of MSDs.,,
The approach in preventing and managing dental related MSP is to adopt a proper sitting posture and engage in periodic stretching. Increased variation in work posture has been presumed to reduce the risk of overload spine, upper, and lower limbs. However, in the present study, only 23.6% engaged in stretching and 19.4% made a conscious attempt to correct their postures. It was found that only 9.7% of respondents' preferred taking breaks during their practice hours. Taking breaks during clinic hours enables dentists to mobilize their bodies and relieve themselves from the stress of work. It is established that dentists who take more breaks in between suffer less from back pain. With elbow pain being reported more than neck or back pain in our study, nevertheless, we assume taking breaks and stretching might reduce overburden on musculoskeletal system.
It is reported that MSD accounts for 29.5% of dentists to retire earlier than usual. Bad working habits and repetitive tasks contribute greatly to MSDs, stress, and loss of productivity. The key objective for clinicians is to find a position that allows them to achieve optimum access, visibility, comfort, and control at all times. From the present study, we realize that majority of the participants “sometimes” experienced pain in the back, elbow, and neck. There is an urgent need to rectify the growing epidemic among dental professionals. The concept of ergonomics is an inseparable component of dental practice that seems to be losing its identity among practicing dentists. On a positive note, more than 50% of dentists knew regarding the concept of ergonomics, which is similar to a study conducted in 2014, but unfortunately, less than 10% made an attempt to update and reinforce the same by attending workshops.
This study has several limitations: (a) the intensity of pain was not measured; (b) responses for MSP were not categorized according to demographic variables; (c) other variables like average time spent on single patient, whether pain on specific dental procedure, leave from work because of MSP, and time/break between every patients were not recorded; and (d) no attempt was made to further evaluate the knowledge/practice of ergonomics.
| Conclusion|| |
It can be concluded that in the present study all the participants reported MSP. A section of participants “always” had musculoskeletal pain in their neck and back, elbow, and hip region. Elbow pain was experienced more by females, specialist, and who are in the first 5 years of practice. MSP also had an impact on the quality of life with majority of participants unable to ride or drive their motor vehicles. MSP is an inherent occupational hazard associated with dental profession having its impact on the quality of life and this might be just the tip of the iceberg.
Financial support and sponsorship
Conflict of interest
There is no conflict of interest.
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Dr. Arunima Chauhan
Department of Oral Biology, Melaka Manipal Medical College (Manipal Campus), Manipal Academy of Higher Education, Manipal, Karnataka
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]
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