Wrong postural hygiene and ergonomics in dental students of the University of Valencia (Spain) (part I)

Assessment of dental ergonomics among dental students: A retrospective study

INTRODUCTION

Musculoskeletal (MSK) disorders account for 11%-98% of occupational health issues for dental professionals, with an onset as early as in dental school. Dental ergonomics is among the risk factors; thus, a prompt assessment is crucial in preventing future MSK pain. The aim of this study was to retrospectively assess dental ergonomics of second-year dental students after dedicated lectures were introduced in the predoctoral curriculum.

METHODS

Three cohorts of second-year dental students were evaluated during preclinical activity in July 2019, January 2022, and December 2022 by an Occupational Therapy (OT) faculty and calibrated OT students. Dental ergonomics was assessed with the Rapid Upper Limb Assessment (RULA). Dental student cohorts were compared with one-way analysis of variance (ANOVA).

RESULTS

The average RULA final score of 409 participants was 5.1 ± 0.9, with no difference between the three cohorts (p = 0.676). The January 2022 cohort scored significantly lower in wrist-arm score than that of 2019 (p = 0.001) and December 2022 (p = 0.046). Neck and lower limb posture were significantly higher in January 2022 cohort than in 2019 (p = 0.001 and 0.013) and December 2022 (p = 0.001 and 0.005) cohorts. The December 2022 cohort revealed a medium, high and extremely high risk of developing MSK of 40.2%, 37.1%, and 21.6%, respectively, with no difference between sexes.

CONCLUSION

The risk of developing MSK pain was medium-high in predoctoral dental students and was not related to sex. The overall dental ergonomics required attention and rapid change. Further implementation of varied forms of teaching and monitoring of dental ergonomics from the early years of education is recommended to prevent development of MSK pain at young age and foster better postural habits.

Effect of finger rest positions on upper limb muscle activity during pre-clinical procedures

Objectives

This study aimed to observe the effect of different finger rest positions on the muscular activity of the hand, forearm, arm, shoulder, thorax, and neck, as well as on the angular deviation from the neutral position of the neck, trunk, upper arm, and forearm on the working side during pre-clinical procedures.

Methods

An experimental laboratory study was performed. Response variables were muscle activation of the abductor pollicis, brachioradialis, biceps brachii, deltoid, pectoralis major, and right sternocleidomastoid muscles and angular deviation from the neutral position of the neck, trunk, arm, and forearm during simulated clinical procedures. Independent variable was finger-rest position during cavity preparation (no finger rest, usual rest, and ergonomic rest). Class I cavity preparations (N = 120) were performed on artificial first molars (16, 26, 36, and 46) (N = 120). Muscular activation was assessed by surface electromyography and angular deviations using Software for Postural Assessment (SAPO) version 0.69. One-way analysis of variance and Tukey's or Games-Howell's post-hoc tests were performed (α = 0.05).

Results

For the sternocleidomastoid muscle, there was no statistically significant difference between the different rest positions. For the deltoid muscle, work with no finger rest resulted in greater muscle activation (p < 0.001) during work on tooth 36. Regarding the pectoralis major and right brachioradialis muscles, we observed that for both teeth 16 and 26, working with ergonomic rest showed less muscle activation. Muscle activation of the right biceps brachii was higher for work with no rest in both the upper and lower arches, differing significantly only from the usual rest in tooth 16 (p < 0.001), usual rest and ergonomic rest in teeth 26 and 46 (p < 0.001), and only ergonomic rest in tooth 36 (p = 0.044). In the right abductor pollicis muscle, work with ergonomic rest resulted in less muscle activation for cavity preparation in teeth 16, 26, and 36, which was significantly different from work with no rest (p = 0.029, p < 0.001, and p = 0.013, respectively). Regarding angular deviation, it was observed that for tooth 16, there was a greater angular deviation of the arm when performing cavity preparations with no finger rest. For teeth 26 and 46, the ergonomic finger rest provided lower angular deviation from the neutral position of the right arm. For tooth 36, ergonomic rest provided less angular deviation from the neutral neck position.

Conclusion

In general, the use of non-active finger rest during simulated cavity preparations, regardless of the type of rest, provided less muscle activation and angular deviation from the neutral position of the body's upper extremity when performing pre-clinical procedures.

The Ergonomic Knowledge and Practice of Dental Students in a Tertiary Institution in South Africa

Proper ergonomic practices are crucial practices to be considered when working on dental patients, and are often neglected during the dental students' training. We aimed to assess the dental students' knowledge of ergonomics as well the prevalence of their musculoskeletal pain. Methods. A cross sectional analytical study was conducted at a dental school in South Africa. The sample included all senior dental, and dental hygiene students registered in the 2021 academic year. A modified questionnaire using an online platform assessed the student's level of practical and theoretical knowledge of ergonomics; their personal assessment of their competency in implementing ergonomics; and their prevalence of musculoskeletal pain. The knowledge scores were calculated to determine the overall scores. Data was analysed using the Statistical Package for the Social Sciences (SPSS). Ethical clearance was obtained from the Faculty Ethical Committee and all information was anonymous. Results. The response rate was 52% (n = 106), the mean knowledge score was 68%, and 53% reported to be able to successfully implement their ergonomic knowledge practically. The prevalence of musculoskeletal pain increased from 32% prior to entering dental school to 78% during dental school. Pain was most commonly reported to be on the back (77%), neck (51%), and shoulders (51%). Conclusion. The majority of students had an average level of knowledge regarding ergonomic principles, however, the practical application was poor. Many students reported to have suffered from back pain which seemed to have started since treating patients. The supervisors should educate and assist students to practice healthy ergonomic postures during clinical and pre-clinical sessions.

Effectiveness of Ergonomic Training to Decrease Awkward Postures during Dental Scaling Procedures: A Randomized Clinical Trial

Studies demonstrate that there is a lack of effective ergonomic principles for adopting a neutral posture during the execution of dental procedures. ISO 11.226:2000 Standard, Corr. 1:2006 has been thoroughly evaluated and adapted to the way that dentists work by the European Society of Dental Ergonomics (ESDE). However, after 15 years, no studies that showed strong evidence of effectiveness in reducing the prevalence of awkward posture in applying its parameters within the scope of dental practice were found. The aim of this study was to verify the effectiveness of applying the ergonomic parameters proposed by the European Society of Dental Ergonomics (ESDE) and ISO 11226 in reducing the prevalence of the main awkward postures adopted by female dental surgeons during the execution of dental scaling on a dental mannequin. A randomized clinical trial was carried out with sixty dental surgeons randomly assigned to two groups: the intervention group, who received instructions and theoretical and practical ergonomic training; and the control group, who received the same training only at the end of the study. For data analysis, Software IBM SPSS 27 and RStudio was used. Descriptive statistics were performed to verify the effectiveness of the intervention, and generalized linear models (specifically, generalized estimated equation models) were used. Poisson distribution was carried out with log link function and network analyses. Sixty female dental surgeons participated in the study. Twenty-two were distributed in the intervention group and thirty-eight in the control group. It was found that ergonomic training enabled a 63% reduction in the prevalence of awkward postures and that there was a statistically significant difference (p < 0.001) only in the intervention group. The analyses showed that the estimated marginal means of postures not recommended in the groups’ initial control, final control, initial intervention, and final intervention were 8.6, 8.2, 9.0, and 3.4, respectively. The relationship of networks analyses of the variables is shown with different profiles in the control and intervention groups, but the same pattern between the groups only vary in the strength and direction of the correlations. It was concluded that the ergonomic training based on the parameters of ISO 11226 and DIN EN 1005-4, and its adaptations to the dental practice provided by the European Society of Dental Ergonomics, as well as recent studies, contributed significantly to reducing the prevalence of awkward postures adopted by female dentists during the simulation of the basic periodontal procedures; however, it was not effective enough to improve the posture of the head and neck.

Ergonomic Risk Assessment of Dental Students-RULA Applied to Objective Kinematic Data

Musculoskeletal disorder (MSD) is already prevalent in dental students despite their young age and the short duration of dental practice. The current findings state that the causes of MSD are related to posture during dental work. This study aims to investigate the ergonomic risk of dental students. In order to analyze the ergonomic risk of dental students, 3D motion analyses were performed with inertial sensors during the performance of standardized dental activities. For this purpose, 15 dental students and 15 dental assistant trainees (all right-handed) were measured in a team. Data were analyzed using the Rapid Upper Limb Assessment (RULA), which was modified to evaluate objective data. Ergonomic risk was found for the following body parts in descending order: left wrist, right wrist, neck, trunk, left lower arm, right lower arm, right upper arm, left upper arm. All relevant body parts, taken together, exhibited a posture with the highest RULA score that could be achieved (median Final Overall = 7), with body parts in the very highest RULA score of 7 for almost 80% of the treatment time. Dental students work with poor posture over a long period of time, exposing them to high ergonomic risk. Therefore, it seems necessary that more attention should be paid to theoretical and practical ergonomics in dental school.

Analysis and prevention of ergonomic risk factors among dental students

INTRODUCTION

Dentistry is a high-risk profession for the development of work-related disorders. Dental students are also exposed to several risk factors. The goal of the study was to determine and localise musculoskeletal pain during dental work, afterwards to measure electromyography signals from the muscles groups mostly affected by the musculoskeletal pain. Study was done in order to provide possible suggestions for the most effective preventive measures of MS pain among dental students.

MATERIALS AND METHODS

In order to solve the objectives, the research was realised in two segments. In the first part of the study, specially designed questionnaires were used to determine the frequency of musculoskeletal pain, risk factors and preventive measures among students. The second part of the study included electromyography analyses of muscular activity of students during dental work. Inclinometers also were set up in the purpose of monitoring inclination of the spine.

RESULTS

Results of the questionnaire study indicated that pain during work was frequent, 81.8% of all the subjects reported pain during work. The recorded muscle activity of the neck muscles indicated a high ergonomic risk, while the muscle activity of the shoulders and back muscles indicated a medium risk. Work with a back flexion of 20 degrees and more indicates that students are at risk.

CONCLUSION

Dental students used to work in unnatural working position. High ergonomic risk occurred in neck muscles. Students should be aware of the potential risks during work and to learn how to prevent it. Regular physical activity is strongly suggested to the students in order to avoid ergonomic problems.

Teaching methodologies for improving dental students' implementation of ergonomic operator and patient positioning

OBJECTIVES

Musculoskeletal disorders (MSDs) related to operator and patient positioning are prevalent among dentists. Knowledge of correct operator and patient positioning promotes safe working postures that can prevent the development of MSDs. The aim of this study was to assess the impact of inter-professional teaching on the application of those skills associated with correct operator and patient positioning in dental settings.

METHODS

A randomized case-control study was conducted with 83 first-year dental students at the UNC-Chapel Hill Adams School of Dentistry in 2019. Forty-one (n = 41) of the students solicited for the project participated. All 83 students in the cohort participated in a didactic lecture on ergonomics and correct operator and patient positioning, along with a pre-clinical practice session with peer patients. During the clinical practice session, students in the case group received an additional 10 minutes of 1-on-1 instruction by a trained physical therapy student or dental faculty member. Two weeks later, the final cohort (n = 41) was assessed by 2 faculty members using a scored rubric on operator and patient positioning for restorative work on an anterior tooth, posterior mandibular tooth, and posterior maxillary tooth.

RESULTS

There was a statistically significant difference between the 2 groups with respect to the composite ergonomic positioning score (P = 0.006), operator shoulder abduction position (P = 0.03), and lateral flexion of the spinal column (P = 0.02).

CONCLUSIONS

Hands on instruction with physical therapists and trained dental faculty positively affects ergonomic compliance and provides students with tailored feedback that can be applied to clinical practice.

Nordic Assessment of Occupational Disorders among Dental Students and Dentists in Saudi Arabia

Objectives

Ergonomics and the avoidance of occupational or work-related musculoskeletal disorders (WRMSDs) are crucial for a future dentist's career, as studies have linked WRMSDs to some serious complications, including early retirement. This study aimed to investigate the level of knowledge and awareness about ergonomics and the prevalence of WRMSDs among dental students and dentists in Makkah province, Saudi Arabia.

Materials and Methods

A cross-sectional study was conducted of 322 dental students and dentists from two universities in Makkah province, Saudi Arabia, using a self-report questionnaire to measure ergonomic awareness and the Nordic Musculoskeletal Questionnaire to measure WRMSDs.

Results

Among the respondents, only 4.82% could correctly explain ergonomics, 14.16% had attended a course or workshop on ergonomics, 55.12% were familiar with preventive techniques for WRMSDs, and 37.95% were familiar with remedies/treatment for WRMSDs. Females were significantly more aware of WRMSDs than males. There was 81.33% who had trouble (pain, aches, or discomfort) in one or more parts of their body during the previous 12 months. The most common sites for WRMSDs were the upper back (48.19%), wrists/hands (44.27%), lower back (43.98%), neck (36.45%), and shoulder (33.43%). In most body parts, WRMSDs were more common among males and participants from a governmental university than among females or those from a private university.

Conclusion

Both dental students and dentists in Saudi Arabia lacked awareness of ergonomics and experienced high levels of WRMSDs. More educational efforts and attempts are needed to boost dental professionals' knowledge about musculoskeletal disorders related to dental profession and built the skills to cope with them.

Dental and physical therapy faculty collaborate in assessing and educating dental students on musculoskeletal disorders

INTRODUCTION

Research shows 54% to 93% of practicing dentists suffer from musculoskeletal disorders (MSDs), with many developing afflictions early in their careers. Studies also show that dental students are developing MSDs early in their professional education.

OBJECTIVE

The research goal was to quantify the prevalence, anatomical location and initial onset of MSDs among first-year dental students. The study also assessed the students' self-reported opinion as to whether there were enough educational touchpoints to improve their ergonomics in daily activities.

METHODS

At the conclusion of a 9-month preclinical restorative course, that included 2 lectures on MSDs, ergonomics, and postural cueing sessions, a dental and physical therapy faculty member administered a survey to 143 first-year dental students. This survey included questions about the history and presentation of the students' MSD symptoms and their opinion on the relative value of the educational interventions.

RESULTS

There was a 96.5% response rate to the survey with 87.8% of students reporting mild to moderate pain. The cervical spine (41.7%) and hands (42.4%) were the most common areas afflicted. 55.4% reported pain commencing 1 month after starting in the simulation clinic. Over 60.9% of students "agreed" or "somewhat agreed" that the 2 sessions of hands-on ergonomic educational interventions resulted in improved biomechanics and students requested additional educational resources.

CONCLUSION

Dental students are developing MSDs as soon as 1 month after commencing dental school. Dental education should include ongoing ergonomic training throughout the curriculum to help students prevent MSDs.

Improving the Awareness of Musculoskeletal Disorder Risks Among Dental Educators

Prolonged and static postures among dental workforce personnel may lead to work-related musculoskeletal disorders (WMSDs). The aim of this study was to determine whether feedback involving photography and self-assessment would improve dental educators' postures and accuracy of ergonomic self-assessment. This study used a randomized control design. The Modified-Dental Operator Posture Assessment Instrument (M-DOPAI) was used for all ergonomic evaluations over a four-week period at one U.S. dental school. At week 1, all 30 participating dental educators were photographed and completed an M-DOPAI without viewing the photographs. In weeks 2 and 3, the educators in the control group (N=15) completed an M-DOPAI without any additional photographs. The educators in the training group (N=15) had additional photographs taken and used the photographs to complete an ergonomic self-assessment with the principal investigator. From week 1 to week 4, the ergonomics training utilizing photography resulted in improvements in the dental educators' ergonomic scores but not the accuracy of their ergonomic self-assessments. All participants strongly agreed it was important for both dental students and dentists to understand proper ergonomics, properly apply proper ergonomics, and have accurate ergonomic self-assessment skills in clinical practice. Although these dental educators valued ergonomic principles, they lacked training in applying these principles with dental students. Without additional training in ergonomics and self-assessment, the development of these skills in dental students will be affected.