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DOI Number: 10.5958/j.2320-5962.2.1.

016
Indian Journal of Contemporary Dentistry, January-June 2014, Vol. 2, No. 1 81

Musculoskeletal Disorders among Dentists - A Review

Pallavi Yaduka1, S P Saravana Dinesh2, Aarthy Viswanath3


1
Student, 2Senior Lecturer, Department of Orthodontics, 3Senior Lecturer, Department of Prosthodontics, Saveetha
Dental College and Hospitals, 162, Poonamallee high road, Chennai

ABSTRACT

Musculoskeletal disorders are one of the major problems affecting health care professionals and IT
professionals. 20-30% of the world population is affected by work related musculoskeletal disorder
at any given time. This review gives a detailed discussion regarding musculoskeletal disorders among
healthcare professionals especially dentists. Research studies and literature reviews that report
musculoskeletal disorders in dental professionals have been reviewed. Most developed countries
report a prevalence of musculoskeletal disorders of more than 50% which is still lesser compared to
that in developing countries probably due to better ergonomic factor and less number of working
hours in developed countries. Dentists usually report with neck, shoulder, back pain. Endodontists
and Orthodontists are most commonly affected whereas Oral pathologists and Oral medicine
specialists are least commonly affected. Musculoskeletal disorders can be prevented by adopting
preventive measures and by knowing the ill effects of incorrect positioning and ergonomics. At present
scenario, there is a need for more research work and awareness among dentists regarding
musculoskeletal disorders and better ergonomics. Emphasis must be given on its prevention rather
than its cure.

Keywords: Musculoskeletal Disorders, Dentists, Ergonomics and Specialist Dentists

INTRODUCTION Saudi Arabia (59.2%) 2 , United States (53%) 3 and


Denmark (50%)3. Back and neck are commonly affected
Work Related Musculoskeletal disorders are
in dentists4 followed by shoulder, wrist and hand pain.
injuries or disorders of the muscles, nerves, tendons,
Therefore, measures for educating the dentists about
joints, cartilage, and spinal discs due to micro traumatic
the adverse effects of incorrect posture and ergonomic
events that accumulate in the body as a result of
are necessary to prevent decline in work performance
workplace and work characteristics1. It can affect the
and the incidence of work related musculoskeletal
performance of work and can become worse if not paid
disorders among dentists1.
attention to. Tissue healing is never complete because
tissue injury repeatedly occurs 1. These are most
MATERIALS AND METHOD
common in IT professionals and healthcare
professionals especially dentists. In dentistry Extensive search was done in PubMed and Google
musculoskeletal problems often arise due to incorrect scholar using the keywords musculoskeletal disorders,
standing or sitting posture or due to standing in the dentists, ergonomics and specialist dentists. Articles
same posture for long time. Prevalence rate of work that were published in English language from 1991 to
related musculoskeletal disorders among dentists is 2013 were searched. Of all the articles listed only 25
almost 100% in India1 as compared to a much lesser most relevant articles were chosen and the prevalence
rate in developed countries such as Australia (87.2%)2, of musculoskeletal disorders among dental
professionals around the world is discussed in detail.
Corresponding author:
Pallavi Yaduka Prevalence and Incidence of Work Related
Student Musculoskeletal Disorders among Dentists
Saveetha Dental College and Hospitals
162, Poonamallee high road, Chennai- 600077 Various studies have been conducted across the
Email: pallavi.yaduka@gmail.com world in different populations and the incidence of

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82 Indian Journal of Contemporary Dentistry, January-June 2014, Vol. 2, No. 1

musculoskeletal disorders in dentists was found to be disorders followed by Endodontists, Prosthodontists,


nearly 100%1 after the age of 45 years2. Oral surgeons and then Periodontists. Doctors
specialized in oral pathology and oral medicine are
A systematic review of musculoskeletal disorders least affected. Prevalence of neck pain was 43%,
among dental professionals by Hayes M et al says that followed by back pain 38%, shoulder and wrist pain
most commonly pain occurs in the back (36.3-60.1%) 25%. Work related musculoskeletal pain was more
and neck (19.8-85%)4. common in dentists after 35-50 years of practice.7.
In a study conducted in China, female students are A study of all liscensed dentists of Lithuania
shown to present higher risk of musculoskeletal concluded that fatigue and musculoskeletal problems
disorders than male, especially those who specialize had a negative impact on their work performance.
in alveolar surgery. Shoulders (50.8%-65.1%), neck 84.9% of the affected population were females and
(47.5%-69.8%), upper back (25.6%-46.5%) and lower 15.1% were males. Prevalence of musculoskeletal
back (27.1%-51.2%) were the regions most commonly disorders was 86.5% among general dentists. Their
reported with musculoskeletal disorders. mean work experience was 21.41 years. 91% dentists
Prosthodontists suffer more of wrist disorders than suffered from back pain. Chronic headache manifested
other specialities and surgeons suffer more of knee in 88.7% of the dentists8.
disorders due to standing for long hours. Periodontists
reported more severe symptoms in neck, upper back Melanie J Hayes et al did a study on
and lower back compared to others. Neck, shoulders musculoskeletal disorders and symptom severity
and upper back are more commonly affected in among Australian dental hygienists. The study showed
Endodontists. Risk of developing musculoskeletal that the victims to musculoskeletal disorders were
disorders is higher in Endodontists and Orthodontists predominantly females (96.1%). The dental hygienists
at an earlier age5. in Australia reported neck pain (85%) more frequently,
followed by shoulder pain (70%) and lower back pain
According to another study conducted in Alberta, (68%)9.
Canada, among Orthodontists, 59% of them had lower
back pain, 56% had neck pain, 47% had problems in Prevalence and correlates of musculoskeletal
the shoulder. 52.4% were affected at the time of study. disorders among Australian dental hygiene students
No correlation was found between age, sex, years of by Hayes MJ et al showed that the neck ( 64.29%) was
work or number of hours of work6. most commonly affected followed by back (57.94%)
and shoulder regions (48.41%). Working 6-10 hours
In another study conducted in Andhra Pradesh, long was a risk factor10.
India, results showed that 52% neck disorders, 26%
wrist disorders, 29% shoulders and 41% of lower back Another study done by Omid Aminian et al on the
problems occurred.68% males were affected. 90% of musculoskeletal disorders in female dentists and
them were less than 45 years. 100% incidence of pharmacists showed that the female dentists were at
musculoskeletal disorders was found in Orthodontists higher risk of developing musculoskeletal disorders
and Oral physicians. 28% Prosthodontists were particularly in the neck, upper back and upper
affected and 60% of general dental practitioners were extremities. The incidence is higher in young dentists11.
affected2.
Study by Anna Kierklo et al in Poland, showed that
Study by Vijaya K Kumar et al showed an overall majority of the dentists who suffered from
one year period prevalence rate of 100% for work musculoskeletal disorders didn’t have an assistant.
related musculoskeletal disorders among Indian 33% worked without any break, 36.4% of the dentists
dentists. The symptoms present were pain (99.06%), had one break and only 8% had a short rest break. Over
stiffness, fatigue. The regions affected were neck 92% of the dentists suffered from musculoskeletal
(75.74%), wrist/hand (73.13%), lower back (72.01%), disorders especially in the neck (47%), lower back
shoulder (69.4%), hips (29.84%), upper back (18.65%), (35.1%), discomfort in hands and fingers (29%), hip
ankle (12.31%) and elbow (7. 46%). Recurrent joint disorders (23.3%), shoulders (20.1%), wrists
symptoms were present in 76.11 %1. (18.3%), pain in knees, feet and elbows (15-16%). More
females experienced pain in the fingers and more males
Studies in Iran showed that the operative dentists experiences pain the lower back region. Most disorders
have the highest incidence of musculoskeletal were reported after 9-10 years of practice12.

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Indian Journal of Contemporary Dentistry, January-June 2014, Vol. 2, No. 1 83

Study by Kwai Yee Chew et al in a dental school in hygienists showed that 75.2% of general dental
Malaysia, showed that 93% of the clinical year students practitioners and 40.5% of dental specialists suffered
reported with work related musculoskeletal disorders. from musculoskeletal disorders. 70.2% of dental
Among the 93%, higher number of females reported specialists were orthodontists. Their mean age was 30-
with pain. The neck and lower back pain were more 39yrs. Excessive hand scaling and removal of heavy
frequently reported with prevalence rate of 82% and calculus was associated with hand and shoulder
64% respectively. Majority of them (92%) did not symptoms19.
participate in workshops related to ergonomics in
dentistry and around 77% of them did not know about Karmen et al in his study showed that 79.8%
the treatment for work related musculoskeletal dentists in Barcelona (Spain) experienced
disorders13. musculoskeletal disorders. Women were more severely
affected. Only 34% took preventive measures20.
Dajpratham et al conducted a study on the
prevalence and associated factors of musculoskeletal Study in Colombia, South America showed that
pain among the dental personnel in a dental school in 63% of female dentists were affected and 37% males
Bangkok and concluded that cervicobrachial type of were affected. 80% of them were in clinical practice.
musculoskeletal pain was most common among dental 89% of them varied the working posture, 67%
personnel in Bangkok with the mean age of 33+/- 9 frequently changed positions, 13% did stretching
years old. The results were as follows: shoulder pain exercise. 15% reported with neck pain, 13% cervical
72.2%, neck pain 70.3%, lower back pain 50.6%14. dorsal pain, 6% arm and forearm pain21.

A study by Abiodun solanke et al in Nigeria Dayakar et al showed that 93.87% of the dentists
showed that in males the prevalence of neck pain was reported with atleast one symptom of musculoskeletal
83.2% and back pain was 86.9%. In females the disorders. Limitations to work were caused by 45.83%
prevalence of neck Pain was 80.6% and back pain was of males. The prevalence of back pain was 67.34%, neck
89.3%. Working hours of females were more affected (59.81%), hand (34.69%), shoulder (32.65%), wrist
than that of males due to musculoskeletal disorders15. (30.61%), hip/thigh (20.40%), ankle (18.36%) and knee
(16.32%) 3.
A study conducted on the prevalence of
musculoskeletal disorders in dentists in Greece The prevalence of musculoskeletal disorders
showed that lower back pain was most frequently among dentists in Denmark is (50%)3, United States is
reported (46%). Complaints of neck and shoulder pain (53%)3, Saudi Arabia is (59.2%)2, Australia (87.2%)2,
were less prevalent than back pain. The dentists had Lithuania (86.5%)2,8 and Turkey (94%)2 .
worked for 18.5 years approximately. Age was not a
factor and females were more affected as they CONCLUSION
commonly took leave from work16.
Musculoskeletal disorders are one of the major
Rundcrantz BL, in his study, pain and discomfort problems affecting health care professionals. 20-30%
in the musculoskeletal system among dentists showed of the world population is affected by work related
that female dentists were more commonly affected musculoskeletal disorders 1 and the prevalence of
than male dentists. Only 17% of dentists reported with musculoskeletal pain ranges from 64% - 93% in
no pain or discomfort17. general4,22,23. Musculoskeletal disorders are the most
common reason for early retirement age (29.3%) of
A five year follow up study on musculoskeletal dentists throughout the world24. The prevalence of
disorders among female dental personnel showed that shoulder pain is 20.1%-72.2%, neck pain 15%-85%,
dentists commonly reported with shoulder, wrist and upper back pain 18.65%-46.5%, lower back pain 35.1%-
hip pain. People who left the profession showed 91%, wrist and arm pain 6%-73.13%, hip discomfort
higher prevalence of combined symptoms from several 20.40%- 29.84% and ankle and feet pain is 12-15%
body regions. Those who remained in the profession approximately from the above reviewed articles.
had increased risk of developing symptoms in
shoulders and hands18. Endodontists and Orthodontists are most
commonly affected whereas Oral pathologists and Oral
Review by S J Booyens et al on the musculoskeletal medicine specialists are least commonly affected7. It
disorders among practicing South African oral can affect the performance of work. In dentistry

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84 Indian Journal of Contemporary Dentistry, January-June 2014, Vol. 2, No. 1

musculoskeletal problems arise due to incorrect lacking. Dentists must be educated about the
standing or sitting posture or due to standing in the importance of ergonomics, correct posture, prevention
same posture for long time. The victims to and treatment of musculoskeletal pain. “Prevention is
musculoskeletal disorders were predominantly always better than cure”.
females. Majority of the dentists who suffered from
musculoskeletal disorders didn’t have an assistant and ACKNOWLEDGEMENTS
worked without any break12. Most disorders were
reported after 10 years of practice. The number of We would like to thank Dr. N.M. Veeraiyan,
hours spent on work is directly proportional to the Cancellor, Saveetha Dental College and Hospitals and
severity of musculoskeletal pain23. Diabetes mellitus, Dr. Deepak Nallaswamy, Director of Academics,
rheumatoid arthritis, recent pregnancy, hormonal and Saveetha Dental College and hospitals for their
anti-inflammatory medications can contribute to early encouragement and support in completion of this
development of musculoskeletal disorders19. The use article.
of hand piece and vibratory instruments with pinch
Conflict of Interest: There is no conflict of interest as
grip, force, number of patients treated per day, number
this is a review article.
of years of experience, monotonous work, visual
fixation, posture, psychological stress, ergonomic Source of Funding: There is no source of funding as
factors, presence or absence of assistants are this is a review article.
predisposing factors to musculoskeletal disorders19.
Necks flexed to 60 degrees or more, trunk flexed to 30 Ethical Clearance: Ethical clearance is not required as
degrees or more and one shoulder abducted caused a this is a review article.
mechanical disadvantage of muscles with respect to
their joints as they required high muscle force to hold REFERENCES
these positions19.
1. Kumar VK, Kumar SP, Baliga MR. Prevalence of
Ergonomic factors such as supports for upper limb, work related musculoskeletal complaints among
adjustable backrest, instruments with long handles, dentists in India: A National Cross Sectional
mechanically adjustable chair, indirect vision and Survey. Indian J Dent Res. 2013 Jul-Aug; 24(4),
proper illumination can help to prevent 428-38.
musculoskeletal disorders20. The successful application 2. Murlidharan D, Fareed N, Shanthi M.
of ergonomics ensures high productivity, increased Musculoskeletal disorders among dental
satisfaction among workers and avoidance of illness practitioners: Does it affect practice?
and injuries22. Unsuccessful application of ergonomics Epidemiology Research International. 2013.
can lead to work related musculoskeletal disorders22. volume 2013, article ID 716897, 6 pages.
Good ergonomic design of tools, processes and 3. Dayakar MM, Gupta S, Philip G, Pai P. Prevalence
furniture improves personal comfort, health, morale, of musculoskeletal disorders among dental
productivity and readiness22. practitioners. ASL Musculoskeletal diseases.
2013, Volume 1, Issue 1, Pages 22-25.
Prevention and rehabilation is recommended by 4. Hayes M, Cockrell D, Smith DR. A systematic
regular physical exercise, stretching and aerobic review of musculoskeletal disorders among
exercises20. Stretching of muscles is helpful in relieving dental professionals. Int J Dent Hyg. 2009
pain20. Improvements of functional parameters and Aug;7(3):159-65.
increase in work productivity were recorded in dentists 5. Jianru YI, Hu X, Yan B, Zheng W, Li Y, Zhao Z.
who followed physical therapy25. The prevalence and High and speciality related musculoskeletal
severity of musculoskeletal disorders decrease by disorders afflict dental professionals even since
performing regular exercises23. There is an increasing early training years. J Appl Oral Sci, 2013, July-
trend of dentists being treated by physiotherapists for Aug, Volume 21, no.4, 376-82.
musculoskeletal disorders23. The physical therapy 6. Newell TM, Kumar S. Prevalence of
advice included posture correction, ergonomic advice, musculoskeletal disorders among orthodontists
stretching exercises23. in Alberta. International Journal of Industrial
Ergonomics. 2004, Feb, Vol 33, issue 2, pages
Awareness among dentists about these and
99-107.
following the correct preventive measures is still

17. Pallavi --81--.pmd 84 4/19/2014, 2:24 PM


Indian Journal of Contemporary Dentistry, January-June 2014, Vol. 2, No. 1 85

7. Rabiei M, Shakiba M, Shahreza HD, Talebzadeh 17. Rundcrantz BL. Pain and discomfort in the
M. Musculoskeletal disorders in dentists. musculoskeletal system among dentists. Swed
International journal of occupational hygiene, Dent J Suppl, 1991;76:1-102
2012 Jan, Vol 4, no.1, pages 36-40. 18. Akesson I, Johnsson B, Rylander L, Moritz U,
8. Puriene A, Aleksejuniene J, Petrauskiene J, Skerfving S. Musculoskeletal disorders among
Balciuniene I, Janulyte V. Self-reported female dental personnel- clinical examination and
occupational health issues among Lithuanian a 5 year follow up study of symptoms. Int Arch
dentists. Industrial health 2008, 46, 369-374. Occup Environ Health, 1999 Sep; 72(6);395-403
9. Hayes MJ, Smith DR, Taylor JA. Musculoskeletal 19. Booyens SJ, Wyk PVJ, Postma TC. Review:
disorders and symptom severity among Musculoskeletal disorders amongst practicing
Australian Dental hygienists. BMC Research South African oral hygienists. OHASA Journal.
Notes. 2013,6: 250 2012, Vol 13, no.2, 2nd qtr.
10. Hayes MJ, Smith DR, Cockrell D. Prevalence and 20. Harutunian K, Albiol JG, Figueiredo, Escoda CG.
correlates of musculoskeletal disorders among Ergonomics and musculoskeletal pain among
Australian dental hygiene students. Int J Dent postgraduate students and faculty members of
Hyg. 2009, Aug;7(3);176-81 the school of dentistry of the University of
11. Aminian O, Alemohammad ZB, Haghighi KS. Barcelona (Spain). A cross sectional study. Med
Musculoskeletal disorders in female dentists and Oral Patol oral cir bucal 2011 May 1;16(3):
pharmacists: A cross sectional study. Acta Medica e425-29.
Iranica. 2012;50(9) : 635-640 21. Diaz-Caballero AJ, Gomez- Palencia IP, Diaz-
12. Kierklo A, Kobus A, Jaworska M, Botulinski B. Cardenas S. Ergonomic factors that cause the
Work related musculoskeletal disorders among presence of pain muscle in students of dentistry.
dentists- a questionnaire survey. Ann Agric Med Oral Patol oral cir bucal 2010 Nov 1:15 (6):e
Environ Med 2011, 18, 79-84. 906-11.
13. Khan SA, Chew KY. Effect of working 22. Gupta S. Ergonomic application to dental
characteristics and taught ergonomics on the practice. Indian journal of dental research. 2011,
prevalence of musculoskeletal disorders amongst 22(6); 816-822.
dental students. BMC Musculoskeletal Disorders 23. Sharma P, Golchha V. Awareness among Indian
2013, 14:118 dentist regarding the role of physical activity in
14. Dajpratham P, Ploypetch T, Kiattavorncharoen S, prevention of work related musculoskeletal
Boonsiriseth K. Prevalence and associated factors disorders. Indian journal of dental research. 2011,
of musculoskeletal pain among the dental 22(3); 381-384.
personnel in a dental school. J Med Assoc Thai. 24. Madaan V, Chaudhari A. Prevalence and risk
2010 June;93(6);714-21 factor associated with musculoskeletal pain
15. Abiodun- Solanke IM, Agbaje JO, Ajayi DM, among students of MGM dental college: A cross
Arotiba JT. Prevalence of neck and back pain sectional survey. Journal of Contemporary
among dentists and dental auxiliaries in South Dentistry. 2012, May-August; 2(2):22-27.
Western Nigeria. Afr J Med Sci. 2010 Jun;39 (2); 25. Nemes D, Amaricai E, Tanase D, Popa D, Catan
137-42 L, Andrei D. Physical therapy Vs medical
16. Alexopoulos EC, Stathi IC, Charizani F. treatment of musculoskeletal disorders in
Prevalence of musculoskeletal disorders in dentistry- A randomized prospective study. Ann
dentists. BMC Musculoskeletal Disorders. Agric Environ Med. 2013;20(2):301-306.
2004;5:16.

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