Physical & Postural Determinants of Musculoskeletal Disorders among Dental Healthcare Professionals

Background: According to World Health Organization, work-related health deals with all facets of health and determinants of one’s health may vary in different occupations. Identifying those determinants may be crucial for primary prevention of risks and adverse health conditions. Objective: To identify the physical and postural determinants of musculoskeletal disorders among dental healthcare professionals. Methodology: A cross-sectional descriptive study was carried out amongst public and private sector dentists of Hyderabad. The data was collected through pre-tested questionnaire from 132 Original Research Article Humayun et al.; JPRI, 33(16): 37-41, 2021; Article no.JPRI.66238 38 participants. Participants’ socio-demographic characteristics, personal information, work-related factors, physical load related factors and prevalence of different musculoskeletal pain sites were analyzed through frequencies. Associations were assessed using Pearson’s coefficient the strength of association was determined via Chi-square test. Results: Females (39.4%) as compared to males (60.6%) were more affected and most subjects falling in the age group of 24-28 years with +0.66 SD. The postgraduate (77.3%) individuals were more affected as compared to their graduate counterparts. Furthermore, majority complained of neck pain (65.8%) followed by back (64%) & shoulder (59.6) pain. The study also found out that majority of the dentists (95.6%) have a reduction in activity due to MSDs. The only significant association (P value = 0.039) was found between sleeping hours/day and occurrence of MS disorders. Conclusion: Musculoskeletal disorders amongst dentists were found in remarkably high number. Wrong posture and poor physical ergonomics of workspace are attributed to higher incidence of MSDs.


INTRODUCTION
According to World Health Organization, workrelated health deals with all facets of health and safety in the place of work and has a sturdy focus on primary prevention of risks. Worker's health has several determinants, which includes risk factors at the workplace that could lead to various adverse health conditions, such as musculoskeletal disorders (MSD), respiratory & circulatory diseases, cancers, accidents, hearing loss, stress induced disorders etc [1,2].
Dentists experience a distinctive set of complications such as demanding procedures, time allied pressure, fearful patients, team problems and the monotonous nature of the skilled work. It is said that dental surgeons had lower comfort in comparison to selected general population due to the increased professional demands. The MSDs related studies on dentists are very less in number. A survey was conducted on 2000 U.S dentists suggested that 60% respondents experienced MS pain, in which highest incidence was of lower back pain and after that, it was of neck pain [3,4].
MSD comprise of a complete set of disorders of muscle, nerve, tendons, ligaments, joints, cartilage or spinal disc. They tend to aggravate with time and worsen due to repetitive work type [work related musculoskeletal disorders (WRMSDs)]. WRMSD's have a harmful impact on work ability which may result in early retirement. A dentist may have almost 50% chances for retirement due to ill health [5].
There are number of symptoms reported to be associated with musculoskeletal disorders including weakness, paresthesia and pain. It is estimated that approximately more than 2 million are affected by the musculoskeletal disorders. The personnel involved in dentistry are also at high risk of developing these disorders [6]. MSDs develop due to overdoing work in fixed postures and in uncomfortable physical ergonomics. The damage thus never actually properly heals since re-injury occurs because of repeated exposure to same factors.
Work related musculoskeletal disorder is a major public health issue and the common MSD in dental healthcare professional include tenosynovitis, bursitis, synovitis, tendinitis and pronator teres syndrome, [7] while physical and postural determinants may be the repetitive continuous motion, vigorous exertions, uncomfortable body postures, and shaking. If an association between the aforementioned, or other conditions and determinants is identified, appropriate preventive steps may be taken [8]. The need is high since MSDs affect not only the general health of dental practitioners but also affect their quality of life.

METHODOLOGY
A cross-sectional descriptive study was carried out amongst public and private sector dentists of Hyderabad. The data was collected through pretested questionnaire from 132 participants. The questionnaire included the socio-demographic characteristics, personal information, workrelated factors; physical load related factors and prevalence of different musculoskeletal pain sites were analyzed through frequencies by using SPSS 21. Associations were assessed using Pearson's coefficient the strength of association was determined via Chi-square test.

RESULTS
The sample comprised of a majority of males, with aging falling with the age bracket of 29-33 years and most practitioners had a post-graduate qualification.
The physical load was rather intense, with many complaining of the physical work environments to be unsuitable.
Females (39.4%) as compared to males (60.6%) were more affected and most subjects falling in the age group of 24-28 years with +0.66 SD. The postgraduate (77.3%) individuals were more affected as compared only graduate counterparts. Furthermore, majority complained of neck pain (65.8%) followed by back (64%) & shoulder (59.6%) pain. The study also found out that majority of the dentists (95.6%) have a reduction in activity due to MSDs.

DISCUSSION
The profession of dentistry is considered one of the most vulnerable for the development of workrelated musculoskeletal disorders [9]. Dental surgeons face a set of unique problems such as: difficult procedures, time related pressure, fearful patients, staff problems and the repetitive nature of the skilled job [10]. The elaborated results appear to be powerful and robust. Findings from this study are in line with the literature on similar studies, conducted to confirm what is already known or what other studies may have reported in similar settings.
The results of this study showed that overall frequency of MSDs among dentists practicing in Hyderabad is high (87%). A similar kind of study carried out in Brazil by De Carvalho et al. [11] revealed that around 76% of the dentists working face musculoskeletal disorders during their practice [11]. Another, cross sectional survey carried out in KPK Pakistan by Kahlid Rehaman et al. [12] in 2013 found out MSDs in 47% of respondents [12]. Another comparative study conducted by T Rambabu et al. [13] among physicians, surgeons and dentists in India revealed that the dentistry was the profession with highest frequency of musculoskeletal disorders that was 61% [13].
Majority that is 65% of the dentists with musculoskeletal disorders were found to be in age group of 24-28 years in our study, with decrease in frequency of MSDs with age. This trend might be attributed to the fact that old practitioners take less number of patients as compared to the young practitioners who  need to develop and sharpen their skills with as much practice as possible. A cross sectional study carried out by Ahmed AS et al. [14] in Egypt revealed some contrasting results with majority of the older age dentists suffering from musculoskeletal disorders, this might be due to socio-demographic differences in the study population of two countries [14].
Awkward posture is also considered one of the major risk factor for the development of MSDs among dentist, as working for long duration in same posture creates pressure on the muscles and development of muscle stiffness [15,16]. The current study found out that the frequency of MSDs was high among the dentists who were practicing the combined dentistry as compared to sitting and standing positions alone. The findings are contrasting with the study carried out by Ahmed AS et al. [14] in Egypt reveled that awkward sitting positions are more likely develop MSDs as compared to standing positions [14].

CONCLUSION
After careful consideration, it can be concluded that the Musculoskeletal disorders amongst dentists were found in remarkably high number. Wrong posture and poor physical ergonomics of workspace are attributed to higher incidence of MSDs.

CONSENT
As per international standard or university standard, Participants' written consent has been collected and preserved by the author(s).

ETHICAL APPROVAL
The ethical approval was taken from the Ethical committee of Liaquat University of Medical and Health Sciences Jamshoro.