WMSD Dentist 2566

WORK RELATED MUSCULOSKELETAL
DISORDER IN DENTISTS
Lect. Tiwa Kosol

Faculty of Physical Therapy and Sport Medicine
Rangsit University
WMSD’s is very important problem
 Big cost of country for manage problem
 “A disorder of muscle, tendons, peripheral

nerves or vascular system not directly
resulting from an acute or instantaneous
event (e.g., slips or falls)” Defined by WHO
WMSD’s is very important problem
 The United States National Institute of

Occupational Safety and Health (NIOSH)
 Over 600 epidemiological studies of

occupational MSD’s (In 1997)
 Etiological mechanisms are still poorly

understood.
Posture-based methods
 Widely used to detect WMSD’s
 Observational, direct and self-reporting

How to assess the risks of WMSD’s?
 RULA
Wijsman, Paul & Molenaar, Lennert & van ‘t Hullenaar, Casper & Vugt, Bas & Bleeker, Wim & Draaisma, Werner &
Broeders, I.A.M.J.. (2019). Ergonomics in handheld and robot-assisted camera control: a randomized controlled trial.
Surgical Endoscopy. 33. 10.1007/s00464-019-06678-1.
Try to predicting WMSD’s in
dentists
Bhornsawan Thanathornwong, Siriwan Suebnukarn & Kan Ouivirach (2014) A

System for Predicting Musculoskeletal Disorders Among Dental
Students, International Journal of Occupational Safety and
Ergonomics, 20:3, 463-475, DOI: 10.1080/10803548.2014.11077063
Categories of risk factors
Individual
Psychosocial
Physical Work
What are mechanisms
of WMSD’s in dentist?
Muscle activity during
(electromyography)
Muscle activity during
(electromyography)
Right upper trapezius
Right infraspinatus
Right extensor carpi radialis
Right pectoralis major

Basic of muscle contraction
 Isotonic
 Concentric (contraction- muscle shorten)
 Eccentric (contraction-muscle elongation)
 Isometric (contraction-same muscle length)

 Ca++
 ATP (very
importance)
 Zone of
structural
connection
What are popular
WMSD’s in dentist?
Factors of body damage
 Prolong load and/or over stretch
 Lack of circulation
 Trauma
 Imbalance of muscle function
From: https://www.dentaleconomics.com/science- From: https://www.insofe.edu.in/insights/handling-

tech/article/16391665/taking-the-backache-out-of- class-imbalance-an-ensemble-majority-voting-on-
practicing minority-samples/
Concepts of balance function
Locked short VS Locked long
Interrelationships of human body
Nerve linkage Lymph system
Muscular linkage
Postural Chains
Postural analysis in Dentist
 What’s happen?
Relationships between MSD and posture
 Round shoulder and flexed neck position

 Flexed neck position
Shortening of lower neck Lengthening of lower neck

flexors extensors
Myofascial Pain syndrome (MPS), Muscle strain

- More of muscle
contraction
- Compression force to
cervical facet joint
What is neutral position of neck?
 Neck muscle force related to neck position

What is neutral position of neck?
 The neutral position is about 35% forward from

the fully retracted position
Muscle for neck stabilization
Global stabilizer Local stabilizer

- Affect subclavian artery

- Weakness of upper limb
- Numbness
- Cold hand
 Round shoulder position
Rotator cup more

activation
Big muscle, big force

 Round shoulder
- Decrease of inferior gliding

- Humeral head shift to anterior
- More activation of infraspinatus
muscle
Myofascial connection
Shoulder abduction and neck pain
 Wrist flexion with forearm pronation
 Wrist flexion with ulnar deviation
 Wrist flexor shortening and wrist
extensor lengthening
Tennis elbow
or
Epicondylitis
 Wrist flexion
 Trigger finger  pain and difficult to move

finger especially for extension
Real nodule at A1
Pseudo dysfunction
of finger tendon
Finger tendons in
grasp function
Plane of thumb
Type of grip and pinch

Tip to tip pinch VS Pad to pad pinch

Extensor hood of finger

 Asymmetrical sitting
 Prolong sitting
Musculature of thoracolumbar
Need for good

sitting
How to hold prolong sitting?
Different?
Ergonomics: Bad sitting posture
Ergonomics: Good sitting posture
Good sitting posture
 Sit up with back straight and buttock

touch the chair back
 Back support or pillow : maintain lordotic
curve of lower lumbar spine
 Neck flexion < 30 degrees
 90 degrees hip, knee and ankle joints
flexion
 Feet flat on the floor (adjust height seat)
 90 degrees elbow flexion, arm by side and
keep shoulder relax
 < 20-30 degrees wrist extension
From:http://www.dentistrytoday.com/ergonomics/1110--sp-645085653
Good sitting posture
 Keep frequently used objects within reach
 Try to avoid sitting in the same position for more than 30
minutes.
 Avoid twist trunk
From:http://www.dentistrytoday.com/ergonomics/1110--sp-645085653
How to prevent MSD in Dentist?
 Adjust optimal equipment and work station
 Keep good posture
Self awareness
Set new brain

program
 Change bad habit (Daily activity and working)
Bad standing posture
Good standing posture
 Head up straight, don’t tilt head

forward, backward or sideways and chin
in.
 Shoulders are back and down slightly,
even and relaxed.
 Abdominal muscles are tightened and
buttocks are tucked in.
 Knees should be slightly bent, avoid
locking knees.
 Feet should be about shoulder width,
pointing slightly outward, flat on the
floor, not on tiptoes.
Lying posture
Posture
 Change bad habit (Daily activity and working)
 Prepare good body health
Exercise
Assessment tools
Assessment tools
Exercise for prevention
 Adjust spinal alignment
 Increase flexibility
 Increase muscle strength and endurance
 Increase postural stabilizer
Exercise for spinal adjustment
Shoulder exercise Infraspinatus and scapular retractor
 Stretching
 Strengthening
Upper trapezius Pectoralis major

Strength – middle trapezius
Release – pectoralis major
Hand exercise
 Stretching
Grasp strengthening and control
 Strengthening
Long finger and wrist

flexor stretching
wrist extensor
stretching
Hand exercise
 Supinator strengthening exercise
 Decreased problem from
De quervain’s disease and tennis
elbow
wrist extensor, supinator, shoulder external

rotator, scapular retractor
Back and hip exercise
 Stretching
 Strengthening
ช่วยให้ควบคุมการทรงท่าในท่าหลังตรงได้งา่ ยึ้น
Muscular Chains
Erector spinae muscle
Gluteus maximus and

lattisimus dorsi
(cross side)
Leg exercise
 Stretching
 Strengthening
Quadriceps muscle
Calf muscle
Breathing exercise
Diaphragm muscle

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WORK RELATED MUSCULOSKELETAL

Lect. Tiwa Kosol

 Big cost of country for manage problem

 “A disorder of muscle, tendons, peripheral

 The United States National Institute of

 Over 600 epidemiological studies of

 Etiological mechanisms are still poorly

 Widely used to detect WMSD’s

 Observational, direct and self-reporting

Bhornsawan Thanathornwong, Siriwan Suebnukarn & Kan Ouivirach (2014) A

Right extensor carpi radialis

Right pectoralis major

 Isometric (contraction-same muscle length)

From: https://www.dentaleconomics.com/science- From: https://www.insofe.edu.in/insights/handling-

Nerve linkage Lymph system

 Round shoulder and flexed neck position

Shortening of lower neck Lengthening of lower neck

Myofascial Pain syndrome (MPS), Muscle strain

 Neck muscle force related to neck position

 The neutral position is about 35% forward from

Global stabilizer Local stabilizer

- Affect subclavian artery

Rotator cup more

Big muscle, big force

- Decrease of inferior gliding

 Trigger finger  pain and difficult to move

Type of grip and pinch

Tip to tip pinch VS Pad to pad pinch

Extensor hood of finger

Need for good

 Sit up with back straight and buttock

Set new brain

 Head up straight, don’t tilt head

Upper trapezius Pectoralis major

Long finger and wrist

wrist extensor, supinator, shoulder external

Gluteus maximus and

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