Mechanisms leading to musculoskeletal disorders in dentistry - ScienceDirect 11/11/2023, 11:01 AM

The Journal of the American Dental Association

Volume 134, Issue 10, October 2003, Pages 1344-1350

Mechanisms leading to musculoskeletal disorders in

dentistry
BETHANY VALACHI M.S., P.T., C.E.A.S. 1, KEITH VALACHI D.D.S. 2

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ABSTRACT

Background
The authors reviewed the implications of prolonged, seated working postures on dental operator health and the
potential development of musculoskeletal disorders, or MSDs.

Types of Studies Reviewed

The authors reviewed studies to assess the mechanisms associated with the development of musculoskeletal pain and
MSDs among dental operators. Some studies investigated work duration, operator positioning and the physiological
effects of various static sitting postures. Others explored the relationships between prolonged muscle contraction and
muscle imbalances, as related to the development of pain and MSDs.

Results
This review advances the idea that the causes of musculoskeletal pain and disorders common to dental operators are
multifactorial. Physiological changes that accompany these disorders can be related to practices used by today’s
operators—primarily being seated for prolonged periods. Studies associated such postures with increased disk
pressures and spinal hypomobility, which are factors that may lead to degenerative changes within the lumbar spine
and low back pain or injury. There is a relationship shown between prolonged, static (motionless) muscle contractions
and muscle ischemia or necrosis. Weak postural muscles of the trunk and shoulder may lead to poor operator posture.
As muscles adapt by lengthening or shortening to accommodate these postures, a muscle imbalance may result,
leading to structural damage and pain.

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Clinical Implications
A significant number of today’s dental operators experience musculoskeletal pain and are at risk of developing serious
MSDs. A thorough understanding of the underlying physiological mechanisms leading to these problems is necessary
to develop and implement a comprehensive approach to minimize the risks of a work-related injury.

Section snippets

PROLONGED STATIC POSTURES

The human body was designed for movement. Over thousands of years, the human body has depended on movement
for its survival; for example, if early humans did not hunt and gather food, they died. Human physiology has evolved
around movement for thousands of years. In the last 250 years, with the onset of the Industrial Revolution, increasing
numbers of workers have performed stationary tasks. More recently, with the advent of computers and as the number
of sedentary jobs have increased, the…

MUSCLE IMBALANCES

The delivery of modern clinical dentistry means that practitioners regularly maintain static postures. During treatment,
however, operators should strive to maintain a neutral, balanced posture (Figure 2). Even with the best ergonomic
equipment, operators can find themselves in sustained awkward postures. These postures often consist of forward
bending and repeated rotation of the head, neck and trunk to one side (Figure 3). Over time, the muscles responsible
for rotating the body to one side…

MUSCLE ISCHEMIA AND NECROSIS

Low back strain is a common diagnosis among workers who must sit in a slightly flexed forward position. One study
showed that static prolonged contractions of the low back extensor muscles (lumbar erector spinae), which occur
while sitting, significantly decreased oxygenation levels in the muscle.26 This occurred while people performed as little
as 2 percent of the maximum voluntary contraction of the muscle. In dentistry, these muscles must maintain eccentric
contractions (lengthening while…

HYPOMOBILE JOINTS

Each time a joint moves, a viscous liquid called synovial fluid is produced; it is a lubricant that is essential for optimal
joint functioning. During periods of PSPs or when joints are restricted due to muscle contractions, synovial fluid
production is reduced dramatically, and joint hypomobility may result. Operators who continually lean forward toward
patients may have excellent or excessive spinal flexion, but over time, the ability of the spine to extend is diminished.
The loss of mobility …

SPINAL DISK HERNIATION AND DEGENERATION

Spinal disks provide movement between the vertebrae for spinal flexibility and sustain and transmit pressure between
them. Disks are composed of a tough, outer layer (the annulus fibrosus) and a gellike mass in the center (the nucleus
pulposus). When weight is applied to the disk, the nucleus pulposus acts similar to a water balloon and expands
outward, exerting pressure on the annulus fibrosus. In unsupported sitting, pressure in the lumbar spinal disks

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increases 40 percent over pressure from…

MUSCULOSKELETAL DISORDERS

The World Health Organization defines an MSD as “a disorder of the muscles, tendons, peripheral nerves or vascular
system not directly resulting from an acute or instantaneous event (e.g., slips or falls). These disorders are considered to
be work-related when the work environment and the performance of work contribute significantly, but are only one of
a number of factors contributing to the causation of a multifactorial disease.”31

The most common MSDs that result from PSPs in dentistry…

CONCLUSIONS

PSPs are inherent in dentistry. Serious detrimental physiological changes in the body can result from these abnormal
postures, including muscle imbalances, muscle necrosis, trigger points, hypomobile joints, nerve compression, and
spinal disk herniation or degeneration. These changes often result in pain, injury or MSDs.

Preventing chronic pain in dentistry may require a paradigm shift within the profession regarding clinical work habits,
including proper use of ergonomic equipment, frequent…

Recommended articles

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Ms. Valachi is a physical therapist, a certified ergonomic assessment specialist, and co-founder of Posturedontics,

Portland, Ore.

Dr. Valachi is in private family practice, St. Helens, Ore., and is co-founder of Posturedontics, Portland, Ore.

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