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Backache and Dentistry - A survey in Baghdad - Iraq

Article · March 2002

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Journal of the College of Dentistry _____ Vol. 12, 2002 _____________ Backache and dentistry…

Backache and Dentistry

A survey in Baghdad - Iraq

Prof. Dr. Mohammed S. Al-Casey B.D.S., M.Sc.

Dr. Raid Faisal Al-Huwaizi B.D.S., D. C.D.
Dr. Akram Faisal Alhuwaizi B.D.S., M.Sc., Ph. D.
Department of Pedodontics, Orthodontics and Prevention.
College of Dentistry, University of Baghdad.

Abstract
A questionnaire was given to each of 242 dentists working in the city of Baghdad, of
whom 150 were males and 92 were females. Back pain was reported by 125 dentists
(51.7%), more frequently in the lumber area (48%). No statistically significant sex differences
were found, while back pain tended to increase with age especially in the cervical area.
Significant associations were found between back pain and sitting down working position and
the number of patients the dentist treats per day. (J Coll Dentistry 2002; 12: 38-42)

Introduction considered in the choice of an operating

During most of the dentist’s working day,
he or she is either sitting or standing for
prolonged periods of time. Both positions
detract from the health of the musculo-
skeletal and circulatory systems. The
dentist is often twisted, causing
asymmetrical strain on joints and
asymmetrical muscle contractions, as well
as added wear and tear on the body. (1)
There is evidence in the literature of the
connection between bad posture and the
event of such conditions as cervical
ankylosing spodilitis, prolapse of one or
more inter-vertibral discs and variety of
skeleton-muscular disabilities. (2)
Of the most frequent distortions
occurring in the posture of the dentist
during working are: the head is bent
downwards so that the cervical spines are
almost at right-angles to the vertical axis,
the trunk is bent causing an over-flexion of
the lumbar spines, and lateral twisting of
the torso producing torque on the spinal
column. (3)
It would appear likely that through trial
and error we have come to discover what
seems to be a good working position for
ourselves. Four principle factors are
position for use in conservative dentistry:
1- The need for the dentist to carry out the
treatment satisfactory.
2- The comfort of the dentist.
3- The comfort of the patient.
4- The need for the dental assistant to
carry out her duties efficiently and in
reasonable comfort.
The best position will be a compromise
between these four needs since no one
position will be ideal for all. (4)
This investigation was carried out to
study the occurrence of backache among
dentists in Baghdad – Iraq.
Materials and Methods
A questionnaire was given to each of
242 dentists working in the city of Baghdad;
of whom 150 were males and 92 were
females (Table 1).
The questionnaire included besides age
and sex the following questions:
1- What is your matrimonial status?
2- How long have you been practicing
dentistry, including the two final years of
dental studies (in years)?
3- How many days per week do you work?
4- How many hours per day do you
practice dentistry?

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Journal of the College of Dentistry _____ Vol. 12, 2002 _____________ Backache and dentistry…
5- How many patients do you treat per day,
on average?
6- Do you do physical exercises? If yes,
how many days per week?
7- What is your position during working:
always sitting, always standing or both?
8- Do you complain of back pain?
* If yes:
9- Where is its location: higher, middle or
lower part of the back?
10- Did you consult a physician about the
back pain?
11- Do you use analgesics for it?
Chi square tests were applied on the
data to find any significant differences or
associations between the various variables.
‘P values’ of less than 0.05 were regarded
as insignificant.
Results and Discussion
Of the 242 dentists who answered the
questionnaire 125 dentists reported having
back pain which comprised almost half
(51.7%) of the sample as shown in table 2.
This prevalence is close to the results of
other studies (2), but is lower than the
findings of several investigations. (5,6)
It is clear from table 2 that the
prevalence of back pain among these
dentists increases with age from the
twenties to the late forties for both sexes.
However, in agreement with Al-Naimi (5)
male dentists of 50 years or above of age
present a lower prevalence of back pain
which may be due to these dentists treating
less number of patients than the younger
dentists do (Table 3). On the other hand,
there was only one female in the fifties of
age and hence the prevalence of back pain
in females of this age group is not reliable.
Since, there was no statistically
significant sex difference in the prevalence
of back pain, the data of both sexes will be
pooled together in the following analyses.
Concerning the location of the back
pain, it was noticed that the lumber area
(the lower part of the back) was the most
frequently affected site (Table 4). This is in
contrast to the findings of Katevuo (7) in a
comparative study between Finnish
dentists and farmers which was that the
prevalence of back pain was mostly in the
cervical region.
However, in this study cervical back
aches significantly (p<0.05) increased with
age indicating the cumulative hazardous
effect of dentistry on the back.
Regarding working position, 90 dentists
(37.2%) reported working standing up, 37
(15.3%) reported working sitting down, and
117 dentists (48.3%) reported working in
both standing and sitting positions (Table
5). A significant (p<0.05) association was
found between sitting down position and
the presence of back pain that may be
because some of these dentists after
having back pain were advised to work in a
sitting position as found by Katevuo (7) that
dentists who worked sitting down did not
have significantly fewer spondylosis
changes than the other dentists. This
finding was in contrast to the findings of Al-
Naimi. (5)
Of those dentists who reported back
pain, 51% visited their physicians for the
complaint and 55% used analgesics to
reduce the pain (Table 6). Visiting the
physician and use of analgesics also peeks
at the 40-49 years age group then drops in
the 50 years and above group similar to the
prevalence of back pain.
A significant association (p<0.05) was
found between back pain and the number
of patients the dentist treated per day.
Of those who reported having back pain,
more dentists did not perform exercises
than those who did; while of those without
pain, more performed exercises than those
who did not (Table 8). This fact points to
the beneficial effect of physical exercise in
the prevention of back pain. However, the
difference was statistically significant.
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Journal of the College of Dentistry _____ Vol. 12, 2002 _____________ Backache and dentistry…

Table 1: Age and sex distribution of the sample.

Age group Males Females Total

20-29 years 49 50 99
30-39 years 31 35 66
40-49 years 11 30 41
≥50 years 1 35 36
Total 92 150 242

Table 2: Number and percentage of the dentists reporting back pain.

Age group* Males Females Total

20-29 years 22 (44%) 19 (38.8%) 41 (41.4%)
30-39 years 20 (57.1%) 20 (64.5%) 40 (60.6%)
40-49 years 18 (60%) 8 (72.5%) 26 (63.4%)
≥50 years 17 (48.6%) 1 (100%) 18 (50%)
Total 77 (51.3%) 48 (52.2%) 125 (51.7%)
* Percentages given in parenthesis are from the totals of the respective groups given in table 1.

Table 3: The distribution of sample according to age and the number of

patients they treat per day.

Patients per day

Age group*
1-10 ≥11 Total
20-29 years 72 (72.7%) 27 (27.3%) 99
30-39 years 41 (62.1%) 25 (37.9%) 66
40-49 years 30 (73.2%) 11 (26.8%) 41
≥50 years 30 (83.3%) 6 (16.7%) 36
Total 173 69 242
* Percentages given in parenthesis are from the totals of the respective age groups.

Table 4: The distribution of the dentists with back pain according to age and
the location of the back pain.

Location of back pain

Age group* Total
Upper part Middle part Lower part
20-29 years 15 (36.6%) 20 (48.8%) 20 (48.8%) 41
30-39 years 19 (47.5%) 14 (35%) 19 (47.5%) 40
40-49 years 14 (53.8%) 9 (34.6%) 17 (65.4%) 26
≥50 years 10 (55.6%) 9 (50%) 4 (22.2%) 18
Significance p<0.05 N.S. N.S. N.S.
Total 58 (46.4%) 52 (41.6%) 60 (48%) 125
* The numbers sum to more than the total because some dentists rep pain in more than one location.

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Journal of the College of Dentistry _____ Vol. 12, 2002 _____________ Backache and dentistry…

Table 5: The distribution of the sample according to working position and the
presence or absence of back pain.

Working or standing With pain Without pain Total

Standing 36 (47.4%) 40 (52.6%) 76
Sitting 33 (67.3%) 16 (32.7%) 49
Both 56 (47.9%) 61 (52.1%) 117
Total 125 (51.7%) 117 (48.3%) 242

Table 6: The distribution of the dentists with back pain according to physician
visiting and use of analgesics.

Visited physician Used analgesics

Age group Total
Yes No Yes No
20-29 years 41 13 (31.7%) 28 (68.3%) 17 (41.5%) 24 (58.5%)
30-39 years 40 24 (60%) 16 (40%) 25 (62.5%) 15 (37.5%)
40-49 years 26 20 (76.9%) 6 (23.1%) 18 (69.2%) 8(30.8%)
≥50 years 18 6 (33.3%) 12 (66.7%) 9 (50%) 9 (50%)
Total 125 63 (50.4%) 62 (49.6%) 69 (55.2%) 56 (44.8%)

Table 7: The distribution of the sample according to presence of back pain and
the number of patients they treat per day.

Patients per day With pain Without pain Total

1-10 81 (46.8%) 92 (53.2%) 173
≥11 46 (66.7%) 23 (33.3%) 69
Total 127 (52.5%) 115 (47.5%) 242

Table 8: The distribution of the dentists according to the pr of back pain and
performing exercises.

Have back pain?

Do exercise? Total
Yes No
Yes 50 (43.1%) 66 (56.9%) 116
No 73 (57.9%) 53 (42.1%) 126
Total 123 119 242

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 Journal of the College of Dentistry _____ Vol. 12, 2002 _____________ Backache and dentistry…
Conclusions
Some important notes on proper
working position can be summarized as the
following:
• It is better to have the dental chair in the
horizontal position than at the 30˚ since
better posture is achieved; and the
patient’s head should be facing forward
and not rotated to the left or right,
although for some individual cavities
rotation may be desirable. (3)
• It is desirable to change position
frequently to help avoid circulatory
sluggishness as well as stiffness and
tightness of muscles. (1)
• The dentist’s feet should be placed firmly
on the floor and the lower part of the legs
should be vertical but able to be moved
forwards or backwards 45˚ from the
vertical through the rotational axis of the
knee joint with the upper borders of the
thighs at approximately 15˚ to the
horizontal and splayed no more than 30˚.
• The long axis of the torso should be
vertical. (8)
• The head should be tilted no more than
45˚ to the horizontal plane. (4)
• Because certain dental procedures could
not be carried out without some postural
distortion, although these must be kept
minimal, some remedial exercises should
be performed every day by the practicing
dentist. (2)
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• To have the least discomfort in sitting
position, one should use a stool that has
a comfortable padded seat, large enough,
to encompass the coverage of the
operator’s buttock and two thirds of the
thigh.
References
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problem. Posture-related backache.
Dent Surv 1973: 49(3): 26-8.
2. Jeffrey I, Butchart D. The use of
television in studying postural operative
positions. Br Dent J 1975;123(5): 193-5.
3. Ellis J. Are you sitting comfortably?
Dent Update 1981; 8(8): 559-66.
4. Eccles J, Davies M. A study of
operating positions in conservative
dentistry. The Dent Practit Dent Record
1971; 21(7): 221-5.
5. Al-Naimi KD. The dentist and back pain.
Iraqi Dent J 1995; 17: 26-30.
6. Korber E. Dentists working position and
occupational diseases. Dent Abstracts
1962; 7: 42-3.
7. Katevuo K, Lehtinen R, Pietila J.
Skeletal changes in dentists and
farmers in Finland. Comm Dent Oral
Epidemiol 1985; 13(1): 23-5.
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student. Quintessence Int 1983; report
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