848137
research-article2019
WHSXXX10.1177/2165079919848137Workplace Health & SafetyWorkplace Health & Safety
vol. 67 ■ no. 9
The Prevalence of Musculoskeletal Pain of Dental
Workers Employed in Slovenia
Darija Šćepanović, MSc1, Tina Klavs, BSc1, Ivan Verdenik, PhD1, and Čedomir Oblak, PhD, DMD2
Abstract: Work-related musculoskeletal (MS) disorders
are considered one of the most frequent occupational
diseases among dental workers. Dental work consists of
static, demanding tasks that involve repeated gripping of
small-sized instruments. The purpose of this study was to
investigate the prevalence of MS pain, the areas of pain,
and the risk factors for MS pain in dental workers. A self-
administrated questionnaire was used as a data collection
instrument for dental workers who voluntarily responded
to the invitation. To determine the prevalence and
severity location of MS pain, the Cornell Musculoskeletal
Discomfort Questionnaire was administered among 87
dental workers, with a total of 79.8%, who reported at
least one MS complaint. MS pain occurred in 82.6% of
general dentists, 75.0% of dental specialists, 66.7% of
dental assistants, and 33.3% of dental technicians. Pain
most frequently occurred in the neck (60.7%), upper
back (52.4%), right shoulder (44.0%), lower back (41.7%),
hips/buttocks (29.8%), and the right wrist (23.8%). The
prevalence of pain among dental workers could be
reduced by ergonomic working environment, regular
breaks, maintenance of health, and performing specific
exercises designed to dental workers.
Keywords: musculoskeletal pain, dental workers,
prevalence
Introduction
Work-related musculoskeletal (MS) disorders are considered
one of the most frequent occupational diseases among dental
workers (Hayes, Cockrell, & Smith, 2009; Melhorn, 2000). Prior
studies reported the frequency of MS disorders among dental
workers, ranging from 63% to 93% (Isper Garbin, Barreto
Soares, Moreira Arcieri, Saliba Garbin, & Siqueira, 2017; Nasl
Saraji, Hosseini, Shahtaheri, Golbabaei, & Ghasemkhani, 2005;
DOI: 10.1177/2165079919848137. From 1University Medical Center Ljubljana, and 2University of Ljubljana. Address correspondence to: Darija Šćepanović, Department of Obstetrics and
https://doi.org/
Gynaecology, University Medical Center Ljubljana, 1000 Ljubljana, Slovenia; email: darija.scepanovic@kclj.si.
For reprints and permissions queries, please visit SAGE’s Web site at http://www.sagepub.com/journalsPermissions.nav.
Copyright © 2019 The Author(s)
Workplace Health & Safety
Article
Rabei, Shakiba, Shahreza, & Talebzadeh, 2011). MS disorders are
defined as inflammatory and degenerative diseases or disorders
of muscles, ligaments, tendons, nerves, blood vessels, bones,
and joints that can result in pain (Hayes et al., 2009; Melhorn,
2000). They can be defined as neuromuscular impairment,
which develops increasingly or repeatedly at low-intensity loads
(Duff, 2004; Gauthy, 2007).
The MS disorders are influenced by various factors, including
physical characteristics (height and weight), and occupational
and sociopsychological agents, such as overuse of a body
region, uncomfortable posture, high work intensity, and
insufficient breaks (T. S. Cho, Jeon, Lee, Seok, & Cho, 2014;
Morse et al., 2007; Punnett & Wegman, 2004; Ylipää, Arnetz,
Benko, & Rydén, 1997). One repetition does not cause
inflammation or pain, but in case of overuse, the tissue does not
have a sufficient amount of time to regenerate, resulting in the
development of micro-injuries for specific body parts
(Colombini et al., 2001; Novak & MacKinnon, 1997, 2002). MS
disorders in dentistry can cause lower productivity due to
absence from work, with some experiencing career-ending
disability (Valachi & Valachi, 2003a).
Dental work consists of static, demanding tasks that involve
repeated gripping of small-sized instruments that require
precision. This and other risk factors contribute to dentists being
among other professionals with the highest risk of developing
MS disorders (Sanders & Michalak-Turcotte, 2004).
Prolonged incorrect working posture is the major contributor
to MS problems among these workers. Constant repositioning
(sitting/standing position, rotation of the spine), as well as
frequent and repetitive static positions, can cause pain and MS
and peripheral nervous system disorders (Szymańska, 2002).
Static work includes long-term isotonic muscle contraction,
where muscle fibers stand static for extended periods of time.
During static muscle contraction, compression of blood vessels
occurs in the muscle tissue, which results in reduced blood flow
and ultimately reduced oxygen to the muscles. Furthermore,
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Dental team workers are predisposed to pain in different

Applying Research to Practice areas of their bodies (Valachi & Valachi, 2003a). Hayes et al.
(2009) conducted a study on MS disorders and symptom
Work-related MS disorders are considered one of the most
severity among dentists, dental assistants, and dental medicine
frequent occupational diseases among dental workers, which
students, who reported pain most frequently occurred in the
have been attributed to prolonged incorrect working
back (36.3%-60.1%) and neck (19.8%-8.05%) areas. It was noted
postures. Our study among Slovenian dental professionals
that pain in the hands and wrists generally occurred among
showed a high prevalence of MS pain, especially among
dental assistants (60.0%-69.5%), and that female dentists and
general dentists. Their MS pain can be reduced by proper
dental assistants had a higher prevalence of symptoms of arm
positioning of both patient and dental worker, periodic
(Leggat & Smith, 2006), wrist, shoulder, and neck MS disorders
breaks and stretching, health promotion and good general
relative to their male counterparts (Szymańska, 2002).
health, as well as targeted and tailored physical activity. It is
The aim of the study was to present the extent of MS pain as
necessary to introduce prevention programs into dental
an occupational-related issue among dental workers who
education programs to prevent MS discomfort.
resided and practiced in Slovenia. The main goal was to
examine the prevalence of MS pain among all dental workers
employed in dental offices and dental laboratories. We also
waste products accumulate in the muscles and result in fatigue sought to examine associations of working conditions, gender,
and muscle pain, and the blood flow is reduced in proportion the use of magnifying glasses or loupes, and physical activity on
to the intensity and duration of the burden (Kroemer & the reporting of different types of MS pain.
Grandjean, 1997; Luopajärvi, 1990).
The method of work and/or body position may affect the Method
area where the pain occurs. In sitting positions, dentists
The sample of this cross-sectional study was obtained at the
reported pain in the spine, as well as in the neck, shoulders,
Densafe Congress attended by 400 Slovenian dental workers. All
and upper limbs (Valachi & Valachi, 2003a). This same study
attendees were invited to participate in the study, which was
reported that while working in the standing positions, lumbar
described as a self-administrated questionnaire on specific
pain, as well as varicose veins, poor posture, and flat feet may
health problems of dental workers. They were given the
also occur.
questionnaire, which they completed and returned. Dental
Research among Slovenian dentists conducted from 1977 to
workers who participated in the study were general dentists,
1978 showed a high incidence of professional diseases (Rode,
dental specialists, dental assistants, and dental technicians. The
Sušec-Michieli, & Vrbošek, 1978). It was established that 73.6%
term dentist denotes a dentist in a general dental office who
of the dentists experience chronic spine conditions (e.g.,
performs all the common dental procedures in a patient’s
deviation, low back pain, cervicobrachial neuralgia, and
mouth. A specialist only performs certain special procedures.
thoracic deviation); 60% of those surveyed presented with
Within dentistry, there are periodontists, orthodontics,
varicose veins of the legs, 30% reported dyspnea upon
endodontics, prosthetics, and oral surgeons. They each perform
exertion, and almost 20% reported edema of the arms and
the same special procedures during their working day. Assistants
legs. Among them, only 6.8% reported that they are regularly
in a dental office, on the contrary, help dentists during their
physically active. Kumar, Kumar, and Baliga (2013) conducted
provision of dental care of a patient. Dental technicians work in
a study on the prevalence of MS disorders among dentists in
dental laboratory prosthetic restorations (artificial teeth) for a
India. They found out that all 536 dentists included in their
dental office.
study had at least one work-related MS symptom in the
A written informed consent of voluntary participation was
previous year with an overall period prevalence rate of 100%.
obtained from all the participants prior to commencing the
The types of symptoms reported included pain (99.1%),
study. The participants were provided with sufficient details
stiffness (3.4%), fatigue (8.39%), discomfort (12.9%), clicks/
about the purpose of the study, the expected duration and
sounds (4.1%), and other neurological deviations (20.1%). The
procedures of the study, and the information on their right to
regions of symptoms were the neck (75.7%), wrist/hand
decline or withdraw. The study was approved by the Slovenian
(73.1%), lower back (72.0%), shoulder (69.4%), hip (29.9%),
National Medical Ethics Committee, which is responsible for the
upper back (18.7%), ankle (12.3%), and elbow (7.5%). Studies
ethical aspects of all medical research in the Republic of
among dentists in Australia (Leggat & Smith, 2006) and
Slovenia.
Taiwan, Lin et al. (2012) reported similar results with most
participant dentists (87.2%) in the Australian study. Both
studies indicated that a high proportion of dentists reported Data Collection
pain in the shoulders, lower back, and neck, while Lin et al. The survey questions were designed on the basis of a
(2012) also reported that participants from Taiwan reported a questionnaire developed by Kim-Fine, Woolley, Weaver, Killian,
lower prevalence (13%-15%) of pain in their hips/thighs/ and Gebhart (2013), who investigated the work-related MS
buttocks, knees, and ankles/feet. disorders of surgeons. The questionnaire was adapted to the

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work conditions and risk factors specific to dental health care

providers. To determine the prevalence, severity, location of MS
pain, and discomfort, the Cornell MS Discomfort Questionnaire
was used (Hedge, Morimoto, & McCrobie, 1999). The
questionnaire was anonymous, covering 29 questions. It
contained 23 closed-ended questions, where 11 offered the
option of choosing “another,” enabling the respondents to write
an additional response or provide certain data.
The questionnaire initially inquired about demographic
characteristics of the respondents, such as age, sex (male/
female), and education level. Work-related questions included
field of work, number of years of active professional practice,
work duration per day and per week, the dominant arm
(right/left), and the method of dental care delivery (two-
handed/four-handed, direct/indirect, sitting/standing position,
use of dental loupe—often/occasionally/never). Health-related
question included the frequency of physical activity (never,
once a week, 2-3 times a week, 4 times or more per week),
intensity of physical activity (low to no sweating and no
breathlessness, medium–moderate sweating and
breathlessness, high–strong sweating and breathlessness),
duration of physical activity (less than 30 minutes, 30-60
minutes, or more than 60 minutes), and type of physical
activity (walking, swimming, running, aerobics, yoga, dance,
fitness, cycling, work in the garden, cross-country skiing,
mountaineering, tennis/other).
The last part of the questionnaire included two body maps.
The first body map indicates the symptom sites in the
dominant arm (anterior view of six regions—A: index finger,
middle finger and first half of ring finger; B: second half of
ring finger, little finger; C: thumb; D: palm area; E: thenar area;
F: hypothenar area), and the second was the posterior view of
a human figure, which was subdivided into nine anatomical
regions to indicate the symptoms in the neck, shoulders,
upper back, elbows, low back, wrist/hand, hips/thighs, knees,
and ankles/feet. Subjects were also asked to report the
frequency and intensity of pain in these areas and the impact
of MS discomfort on their work performance. The respondents
were asked to mark an affirmative or negative response (Yes
or No) with an “X.”
Data Analysis
Descriptive statistics were employed for purposes of
describing the demographics of the study population. The
relationship between gender, type of work, and physical
exercise to MS pain was analyzed using chi-square testing (p <
.05, considered significant). The data were analyzed using IBM
SPSS Statistics v21.
Results
The study included 87 (21.8%) of 400 dental workers,
including 68 (78.1%) of which were women and 19 (21.8%)
were men (Table 1). The age of the participants ranged from
26 to 72 years, with the mean age of 45.4 ± 10.2 SD years.
Table 1. Dental Workers and Prevalence of Musculoskeletal
Pain
Participants Musculoskeletal pain
n (%) n (%)
Total workers 87 (100) 71 (79.8)
General dentists 69 (79.3) 57 (82.6)
Dental specialists 12 (13.8) 9 (75.0)
Dental assistants 3 (3.4) 2 (66.7)
Dental technicians 3 (3.4) 1 (33.3)
Gender
Male 68 (78.1) 56 (82.8)
Female 19 (21.8) 13 (68.4)
The sample consisted of general dentists (79.3%), dental
specialists (13.8%), dental technicians (3.4%), and dental
assistants (3.4%).
The majority of the respondents (79.8%) had experienced
MS pain, while only 20.2% experienced no MS pain (Table 1).
Most commonly, the MS pain occurred among general dentists
(57/70; 82.6%), followed by dental specialists (9/12; 75%),
dental assistants (2/3; 66.7%), and dental technicians (1/3
participant; 33.3%). The study findings indicated that MS pain
occurred more frequently in women than in men (56; 82.8%
and 13; 68.4%, respectively), but gender-related differences
were not statistically significant.
Figure 1 presents the impact of standing and sitting
working positions on the prevalence of MS pain among the
participants. The difference between sitting and standing
groups was not statistically significant. MS pain most
frequently occurred in dentists who occasionally used a
dental loupe. Relative to those who did not use the dental
loupe, the difference, however, was not statistically
significant (Figure 2).
Physical activity and its influence on the occurrence of MS
pain was answered by 71 out of 87 dental care providers. The
MS conditions were most common in those participants who
were physically active 2 to 3 times a week (83.3%), but similar
to those workers who were physically active only once a week
or less (82.1%). The prevalence of MS pain was lower (72.2%)
among participants in the highest physical activity group
(physically active 4 times a week or more; 72.2%). Higher
frequency of physical activity was not significantly related to
the lower risk of MS pain.
With regard to intensity of physical activity and MS pain, it
was established that 14 (16.1%) respondents usually
performed low-intensity exercises (which were characterized

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Figure 1. The prevalence of musculoskeletal (MS) pain by working posture.

Figure 2. The prevalence of musculoskeletal (MS) pain by the use of dental loupe.

by no sweating or shortness of breath), 59 (67.8%)
respondents reported that they performed medium-intensity
exercises (moderate sweating and shortness of breath), and
only 15 (17.2%) performed high-intensity exercises (sweating
heavily and strong shortness of breath). The participants who
regularly performed low-intensity exercises were found to
experience the least pain (nine participants; 64.3%), followed
by those who performed high-intensity exercises (12
participants; 80%). The highest percentage of pain (49
participants; 83.1%) was reported in the respondents who
perform medium-intensity exercises.
The prevalence of MS pain in different body regions is
shown in Table 2. The body region where workers most
experienced pain occurred in the neck (60.71%), followed by
the upper back (52.38%), the right shoulder (44.04%), the lower
back (41.66%), the hip and buttocks (29.76%), and the right
wrist (23.81%).
Table 3 presents sites and frequency of MS pain in the
dominant hand of the participants. According to the site of the
hand, 32.14% of the respondents experienced pain in the thenar
area (E area) and 23.8% in the thumb area (C area).
Discussion
This study investigated the extent of work-related MS pain
among dental professionals employed in Slovenia and found
that most of the participants suffered from pain. The study

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Table 2. The Prevalence of Musculoskeletal Pain by Body Regions Among Dental Workers (n = 87)

Several times
Never 1-2 times/week 3-4 times/week Once a day per day Total
% (n) % (n) % (n) % (n) % (n) % (n)
Neck 21.43 (18) 25 (21) 14.29 (12) 4.76 (4) 16.66 (14) 60.71 (51)
Right shoulder 39.29 (33) 26.19 (22) 5.95 (5) 5.95 (5) 5.95 (5) 44.04 (37)
Left shoulder 63.09 (53) 11.9 (10) 2.38 (2) 1.19 (1) 4.76 (4) 20.24 (17)
Upper back 30.95 (26) 23.8 (20) 8.33 (7) 5.95 (5) 14.29 (12) 52.38 (44)
Right upper arm 70.24 (59) 7.14 (6) 2.38 (2) 1.19 (1) 2.38 (2) 13.09 (11)
Left upper arm 73.81 (62) 3.57 (3) 2.38 (2) 1.19 (1) 2.38 (2) 9.52 (8)
Lower back 41.66 (35) 22.62 (19) 5.95 (5) 4.76 (4) 8.33 (7) 41.66 (35)
Right forearm 69.05 (58) 5.95 (5) 4.76 (4) 0 (0) 3.57 (3) 14.29 (12)
Left forearm 78.57 (66) 1.19 (1) 1.19 (1) 0 (0) 2.38 (2) 4.76 (4)
Right wrist 57.14 (48) 16.66 (14) 2.38 (2) 1.19 (1) 3.57 (3) 23.81 (20)
Left wrist 72.62 (61) 7.14 (6) 0 (0) 0 (0) 2.38 (2) 9.52 (8)
Hips/buttocks 53.57 (45) 13.09 (11) 5.95 (5) 3.57 (3) 7.14 (6) 29.76 (25)
Right thigh 72.62 (61) 5.95 (5) 4.76 (4) 0 (0) 0 (0) 10.71 (9)
Left thigh 73.81 (62) 3.57 (3) 3.57 (3) 1.19 (1) 1.19 (1) 9.52 (8)
Right knee 69.05 (58) 8.33 (7) 3.57 (3) 0 (0) 2.38 (2) 14.29 (12)
Left knee 72.62 (61) 7.14 (6) 1.19 (1) 1.19 (1) 1.19 (1) 10.71 (9)
Right lower leg 75.00 (63) 5.95 (5) 1.19 (1) 0 (0) 1.19 (1) 8.33 (7)
Left lower leg 77.38 (65) 2.38 (2) 2.38 (2) 0 (0) 1.19 (1) 5.95 (5)
Right foot 71.43 (60) 3.57 (3) 4.76 (4) 1.19 (1) 2.38 (2) 11.9 (10)
Left foot 73.81 (62) 1.19 (1) 5.95 (5) 1.19 (1) 1.19 (1) 9.52 (8)

findings were similar to several previous research studies that
reported MS disorders ranging from 63% to 93% (K. Cho, Cho,
& Han, 2016; Estrich, 2014; Hayes et al., 2009; Kierklo, Kobus,
Jaworska, & Botuliński, 2011; Leggat & Smith, 2006;
Muralidharan, Fareed, & Shanthi, 2012; Nasl Saraji et al., 2005;
Rabei et al., 2011; Simu, Bocănet, Mesaroş, & Borzan, 2014). A
slightly lower prevalence of MS disorders in dentists (62%) was
reported in a cross-sectional study conducted by Alexopoulos,
Stathi, and Charizani (2004).
The results of the current study indicated that MS pain
among dental practitioners most commonly occurred in the
neck, upper back, shoulder, and the right lower back. Quite
frequently, the pain also developed in the hip, buttocks, and the
right wrist, which is similar to prior studies (Aminian,
Alemohammad, & Sadeghniiat-Haghighi, 2012; K. Cho et al.,
2016; Estrich, 2014; Hayes, Smith, & Taylor, 2013; Kierklo et al.,
2011; Muralidharan et al., 2012; Rafeemanesh, Jafari, Kashani, &
Rahimpour, 2013; Rucker & Sunell, 2002; Shrestha, Singh, &
Niraula, 2008; Tirgar, Javanshir, Talebian, Amini, & Parhiz, 2015).
The present research results indicate that MS pain is most
common in general dentists, followed by dental specialists,
dental assistants, and dental technicians. According to Leggat
and Smith (2006), the MS pain, especially in the neck, most
commonly occurred in general dentists among all dental care
providers in Australia. Rice, Nindl, and Pentikis (1996),
however, concluded that dental practitioners had a lower risk
of developing MS diseases relative to dental hygienists and
dental assistants. The latter were found to develop pain in

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Table 3. The Prevalence of Musculoskeletal Pain by Area in the Dominant Hand

Never 1-2 times/week 3-4 times/week Once a day Several times per day Total
% (n) % (n) % (n) % (n) % (n) % (n)
Area A 60.71 (51) 10.71 (9) 5.95 (5) 0 (0) 1.19 (1) 17.86 (15)

Area B 66.66 (56) 7.14 (6) 2.38 (2) 1.19 (1) 1.19 (1) 11.9 (10)

Area C 53.57 (45) 15.48 (13) 2.38 (2) 0 (0) 5.95 (5) 23.8 (20)

Area D 67.86 (57) 7.14 (6) 3.57 (3) 0 (0) 0 (0) 10.71 (9)

Area E 46.43 (39) 21.43 (18) 3.57 (3) 1.19 (1) 5.95 (5) 32.14 (27)

Area F 63.09 (53) 10.71 (9) 0 (0) 1.19 (1) 2.38 (2) 14.29 (12)

Note. A = index finger, middle finger, and first half of ring finger; B = 2nd half of ring finger and little finger; C = thumb; D = palm area; E = thenar
area; F = hypothenar area.

the upper limbs and lumbar spine. Similar results were
reported by Åkesson, Johnsson, Rylander, Moritz, and
Skerfving (1999) and Lalumandier and McPhee (2001), who
found that dental hygienists in comparison with other dental
workers had a higher risk of developing pain in the neck,
shoulder, arm, and wrist.
The results of this study identified a slightly higher
prevalence of MS symptoms and potential risk factors in
women, but the gender-related differences were not statistically
significant. In contrast, Rundcrantz, Johnsson, and Moritz (1991);
Kerosuo, Kerosuo, and Kanerva (2000); and Marshall,
Duncombe, Robinson, and Kilbreath (1977) reported that the
prevalence of MS disorders was higher in female than in male
dental workers. Aminian et al. (2012) reported that 91.6% of
female dentists had symptoms of pain in at least one part of the
body. These findings support the results of other studies, which
have shown that the occurrence of symptoms in the arm, wrist,
shoulder girdle, neck, spine, hip, and thigh were higher among
female relative to male dental health workers (Alexopoulos
et al., 2004; Leggat & Smith, 2006; Simu et al., 2014; Szymańska,
2002; Tirgar et al., 2015). Kim-Fine et al. (2013) reported that
female surgeons had more frequent and more severe MS
disorders in the neck, dominant shoulder, and upper back than
their male colleagues.
The current study found no associations between the
frequency of MS pain and the work position while sitting in
a dental chair. These findings are in agreement with the
results obtained by Shrestha et al. (2008), who found no
difference in the prevalence of MS disorders between the
dentists working mainly in a sitting position, and the dentists
adjusting sitting and standing positions. Ratzon, Yaros,
Mizlik, and Kanner (2000) reported that dentists who worked
in a sitting position had more severe pain in the lumbar
spine. Rafeemanesh et al. (2013) conducted a study on job

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postures and MS disorders in dentists, and concluded that
maintaining balance in a standing position during surgery
presented the greatest risk of developing MS symptoms.
These findings are supported by those of Kierklo et al.
(2011), who reported that standing work position is a risk
factor for pain in knees and feet.
In recent years, some authors offered recommendations
on the use of dental loupe to maintain correct position of the
lumbar spine. Proper selection, adjustment, and the use of
dental loupe have been associated with decreased pain in the
neck and lower back as they enable the dentists to maintain
healthier postures (Chang, 2002; Valachi & Valachi, 2003b). In
contrast, the results of the current study indicate that
frequent use of dental loupe did not significantly reduce the
risk for MS pain. However, with a small sample size using
dental loupe, these findings should be interpreted with
caution. However, prior study findings have been mixed with
a higher prevalence of MS symptoms among dental
practitioners regularly using dental loupe was reported by
Estrich (2014), while Maillet et al. (2008) reported a
significant improvement of posture when dental workers
used dental loupe.
In most studies, strong and significant correlations
between physical activity and the reduced risk for MS pain
were affirmed. Regular and frequent practice of activity
reduced the number of affected body parts (Simu et al.,
2014). Dental practitioners who do not regularly perform
physical activities have a significantly higher number of MS
pain areas than those who regularly perform physical
activities. Droeze and Jonsson (2005) reported that workers
who were not physically active were at risk of developing
MS disorders, due, in part, to a reduced flow of nutrients
and oxygen to the muscles. For this reason, 20 minutes of
aerobic exercise 3 to 4 times a week is recommended for
dental workers (Valachi & Valachi, 2003a).
The goal of our study was also to determine whether the
intensity of exercise increased or reduced the risk for MS pain,
which we found to be associated but did not reach statistical
significance. In contrast to these findings, the study by
Chatzitheodorou, Kabitsis, Malliou, and Mougios (2007)
observed that high-intensity aerobic exercise reduces pain,
inability of movement, and psychological stress among workers
with chronic MS pain in the spine.
The findings of the study prompted us to develop guidelines
and instructions to avoid MS pain in dentistry. To reduce
multifactorial risk factors, certain preventive measures and
ergonomic principles must be applied. Improper and prolonged
static or constrained postures may result in gradual damaging
physiological changes, leading the muscle imbalances, joint
stiffness, muscle damage, and degeneration of spinal discs. The
incidence of MS diseases and their risks can be reduced by
proper positioning of both patient and dental worker, periodic
breaks and stretching, health promotion and good general
health, as well as targeted and tailored physical activity (Gupta,
Ankola, & Hebbal, 2013).
Workplace Health & Safety
Implications for Occupational Health Nursing
Practice
Dentistry does not lend itself to good posture; however, it is
possible with instruction and consistent practice to correct the
harmful postural habits that may be the cause of such stress and
pain. Dental professionals are prone to unique muscle
imbalances and require special exercise and ergonomic
interventions to maintain optimal health during the course of
their career. It is important to not only know what are effective
interventions but also in what sequence to implement them.
Proper body mechanics and ergonomics are essential to
dental workers throughout their working life. To reduce
multifactorial risk factors, certain preventive measures and
ergonomic principles must be applied. For personnel working in
dentistry, the most important guidelines and instructions to avoid
MS disorders relate to correct body position, changing sitting and
standing positions during the workday, positioning patients in a
position conducive to safe work practices, having ergonomically
designed working stations, taking regular breaks, performing
stretching exercises during and after work, utilization of a dental
loupe, as well as engaging in physical activity. Dental workers
benefit from adapting to the use of proper working postures,
maintaining sufficient lighting, and ensuring easy access to the
required instrumentation and materials for different working
practices, clinical procedures, and patient types.
Conclusion
This study found a high prevalence of MS pain among
Slovenian dental professionals, which was most common among
general dentists, followed by specialists, dental assistants, and
dental technicians. The most frequent areas of MS pain among
dental workers occurred in the neck, upper back, right
shoulder, lower back, hip, buttock, and right wrist. It was
established that standing work position did not significantly
reduce the risk for MS pain. Statistically significant correlation
between the occurrence of MS pain and use of a dental loupe,
female gender, frequency, and intensity of physical activity was
not confirmed. It is necessary to introduce prevention programs
into dental education to prevent MS discomfort during
educational and professional years.
Ethical Approval
The study protocol was approved by the National Medical
Ethics Committee of Slovenia (No 113/02/15). Anonymity and
confidentiality were guaranteed to participants in the study.
Conflict of Interest
The author(s) declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research,
authorship, and/or publication of this article.
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Author Biographies
Darija Šćepanović, MSc, is a physiotherapist specialized in
women’s health at the University Medical Center Ljubljana,
Department of Obstetrics and Gynaecology, and senior lecturer
at the Faculty of Health Sciences of the University of Ljubljana,
Slovenia.
Tina Klavs, BSc, is a physiotherapist of respiratory care at
Clinical Department for Anesthesiology and Intensive Care at
University Medical Center Ljubljana, Slovenia.
Ivan Verdenik, PhD, is a researcher and a statistician at the
University Medical Center Ljubljana, Slovenia, with expertise in
gynecology and obstetrics.
Čedomir Oblak, PhD, DMD, is an assistant professor at the Medical
Faculty of the University of Ljubljana and the specialist of
prosthodontics of the University Medical Center Ljubljana, Slovenia.
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