Prevalence of self-reported musculoskeletal disorders of the hand and associated conducted therapy approaches among dentists and dental assistants in Germany

A quantitative study on the impact of educational modules on the awareness of postural ergonomics among the dental clinical trainees of Jouf University: A North Saudi Arabian Cohort

This research aimed to evaluate the difference between self-reported and actual work postures among dental clinical trainees and the effect of health education on their ergonomic postures. Bad postures induce fatigue, musculoskeletal pain, errors, a negative attitude, and job dissatisfaction. It is necessary to evaluate the awareness of posture ergonomics among clinical trainees as the bad postures captured during their learning years transform into habits that could affect future productivity. Hence, a three-level quantitative study was conducted among the dental trainees at Jouf University, Saudi Arabia. The first level comprised a self-reported survey and an observational study to record the working postures of the participants. At the second level, appropriate health education is customized based on the findings observed at the first level. An unannounced observational study was conducted at the third level to assess the impact of ergonomic education on the working postures of the participants. Gender and the academic year level of the participants were the variables considered in the study. The study found that the participants overrated their correct postures (P = 0.005). Fortunately, the final post-ergonomic education observations found a significant improvement in work posture (8.6 vs 12.4), regardless of the variables considered in the study (P = 0.001). The three best correct postures were placing the feet resting on the floor (52.6 vs 92.8 %), using the seat of a dental chair (57.9 vs 89.5 %), and using an upright position of the legs at the thigh-to-leg angle (53.9 % vs 86.2 %). Therefore, the study emphasizes the importance of training in ergonomics and regular, periodic observation to eradicate bad postures before they become a habit among young dentists.

Āsana for Back, Hips and Legs to Prevent Musculoskeletal Disorders among Dental Professionals: In-Office Yóga Protocol

Dental professionals are exposed to significant unavoidable physical stress, and theoretical ergonomic recommendations for a sitting workplace are inapplicable in many dental activities. Work-related musculoskeletal disorders (WMSDs) represent a serious health problem among dental professionals (prevalence: 64-93%), showing involvement of 34-60% for the low back and 15-25% for the hips. Muscle stress; prolonged sitting; forward bending and twisting of the torso and head; unbalanced working postures with asymmetrical weight on the hips and uneven shoulders; and others are inevitable for dental professionals. Therefore, the approach for the prevention and treatment of WMSDs must be therapeutic and compensatory. This project was conceived to provide a Yoga protocol for dental professionals to prevent or treat WMSDs from a preventive medicine perspective, and it would represent a Yoga-based guideline for the self-cure and prevention of musculoskeletal problems.

METHODS

Specific Yoga positions (āsana, such as Virāsana, Virabhadrāsana, Garudāsana, Utkatāsana, Trikonāsana, Anuvittāsana, Chakrāsana, Uttanāsana, Pashimottanāsana) have been selected, elaborated on and adapted to be practiced in a dental office using a dental stool or the dental office walls or a dental unit chair. The protocol is specifically devised for dental professionals (dentists, dental hygienists and dental assistants) and targeted for the low back, hips and legs (including knees and ankles). The protocol includes Visranta Karaka Sthiti (supported positions) in sitting (Upavistha Sthiti) and standing (Utthistha Sthiti) positions, twisting/torsions (Parivrtta), flexions/forward bend positions (Pashima) and extensions/arching (Purva) for musculo-articular system decompression and mobilization.

RESULTS

Over 60 Yogāsana-specifically ideated for back detensioning and mobilization, lumbar lordosis restoration, trunk side elongation, hip release and leg stretches and decontraction-are shown and described. The paper provides a meticulous description for each position, including the detailed movement, recommendations and mistakes to avoid, and the breathing pattern (breath control) in all the breath-driven movements (āsana in vinyāsa). An exhaustive analysis of posture-related disorders affecting the lower body among dental professionals is reported, including low-back pain, hip pain and disorders, piriformis syndrome and quadratus femoris dysfunction (gluteal pain), iliopsoas syndrome, multifidus disorders, femoroacetabular and ischiofemoral impingement, spinopelvic mobility, lumbopelvic rhythm, impairment syndromes, lower crossed syndrome, leg pain, knee pain and ankle disorders.

CONCLUSIONS

A detailed guideline of āsana for low-back decompression, hip joint destress, piriformis and gluteal muscle release, lumbar lordosis recovery and a spinopelvic mobility increase has been elaborated on. The designed Yogāsana protocol represents a powerful tool for dental professionals to provide relief to retracted stiff muscles and unbalanced musculoskeletal structures in the lower body.

Ergonomic Risk Assessment of Oral and Maxillofacial Surgeons - RULA Applied to Objective Kinematic Data

BACKGROUND

The prevalence of musculoskeletal disorders is high in oral and maxillofacial surgeons (OS) due to their static and contorted working positions. Hence, the aim of this study was to conduct posture analyses in this specific group of dental professionals using the Rapid Upper Limb Assessment (RULA).

METHODS

In total, 15 (12 m/3 f) OS participated in this study. An inertial motion capture system (Xsens) was used to collect kinematic data during a simulated workflow. Computer-based routines calculated the RULA score for the extracted joint angles at each defined time point. Then, an analysis of the time-dependent RULA scores by body regions was conducted. Key variables were the relative occurrence of specific RULA scores during the complete workflow, individual subtasks, and for treatment of each of the four different dental quadrants. The subtasks and dental quadrants were compared using the Friedman test.

RESULTS

The total median RULA score represented a high risk for OS during their work (7), including the temporal component (OS spent 77.54% of their working time with a RULA score of 7). The wrists and hands, elbows, lower arms, and the neck were exposed to postures with the highest risk for musculoskeletal strain.

DISCUSSION

For OS, both the right and the left assisting hand were heavily strained while working on the first dental quadrant caused the most unfavorable postures for OS.

The Prevalence and Development of Neck and Lower Back Pain and Associated Factors in Dentistry Students—A Long-Term Prospective Study

Musculoskeletal disorders (MSDs) represent a significant occupational burden for dentists and dentistry students. This study aimed to assess the five-year development of most common musculoskeletal complaints among dentistry students during the whole length of their studies and to analyze the impact of some potentially associated risk factors. A longitudinal questionnaire survey regarding the occurrence of MSDs was conducted among a total of 73 dentistry students between 2014 and 2021. The same students enrolled in three consecutive years were monitored throughout their entire studies. Statistical analysis was performed using methods of descriptive statistics, Chi-square test, Fisher’s exact test, McNemar test, and univariate and multivariate logistic regression analyses. The most frequent areas of complaints were neck (61.6%) and lower back (49.3%). The increase in self-reported complaints between the first and the fifth year was statistically significant for neck pain (increase by 15%, p = 0.043) but not for lower back pain (by 6.8%, p = 0.44). According to our data, age, performing top-level sport, and participating in regular sporting activities had a statistically significant influence on neck and/or back pain. The results of this longitudinal prospective study showed that neck, as well as lower back pain, are significant problems for dentistry students.

A RULA-Based Comparison of the Ergonomic Risk of Typical Working Procedures for Dentists and Dental Assistants of General Dentistry, Endodontology, Oral and Maxillofacial Surgery, and Orthodontics

BACKGROUND

In general, the prevalence of work-related musculoskeletal disorders (WMSD) in dentistry is high, and dental assistants (DA) are even more affected than dentists (D). Furthermore, differentiations between the fields of dental specialization (e.g., general dentistry, endodontology, oral and maxillofacial surgery, or orthodontics) are rare. Therefore, this study aims to investigate the ergonomic risk of the aforementioned four fields of dental specialization for D and DA on the one hand, and to compare the ergonomic risk of D and DA within each individual field of dental specialization.

METHODS

In total, 60 dentists (33 male/27 female) and 60 dental assistants (11 male/49 female) volunteered in this study. The sample was composed of 15 dentists and 15 dental assistants from each of the dental field, in order to represent the fields of dental specialization. In a laboratory setting, all tasks were recorded using an inertial motion capture system. The kinematic data were applied to an automated version of the Rapid Upper Limb Assessment (RULA).

RESULTS

The results revealed significantly reduced ergonomic risks in endodontology and orthodontics compared to oral and maxillofacial surgery and general dentistry in DAs, while orthodontics showed a significantly reduced ergonomic risk compared to general dentistry in Ds. Further differences between the fields of dental specialization were found in the right wrist, right lower arm, and left lower arm in DAs and in the neck, right wrist, right lower arm, and left wrist in Ds. The differences between Ds and DAs within a specialist discipline were rather small.

DISCUSSION

Independent of whether one works as a D or DA, the percentage of time spent working in higher risk scores is reduced in endodontologists, and especially in orthodontics, compared to general dentists or oral and maxillofacial surgeons. In order to counteract the development of WMSD, early intervention should be made. Consequently, ergonomic training or strength training is recommended.

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.

Musculoskeletal Disorder Symptoms in Saudi Allied Dental Professionals: Is there an Underestimation of Related Occupational Risk Factors?

This study aims to examine the prevalence of musculoskeletal disorder (MSD) symptoms in allied dental professionals (ADPs) in Saudi Arabia and risk factors for MSDs. The study also explores ADPs' opinions and attitudes about the effect of MSD symptoms on the quality of life and potential mitigatory measures. This is a prospective cross-sectional study. Participants were 355 licensed dental staff (average age 33.6 ± 8.1 years, 69% women) working as assistants, lab technicians, radiology technicians, or sterilization technicians with at least six months' work experience. The self-administrated questionnaire comprised socio-demographics, work-related factors, and items from the Nordic Musculoskeletal Questionnaire. Multivariate and univariate logistic regressions were conducted to investigate risk factors for MSD symptoms. Overall, 93% of ADPs complained of MSD symptoms in at least one body site in the past 12 months. Factors related to work conditions (e.g., 'keeping an uncomfortable posture for long periods of time', 'lifting heavy objects') and years of experience were proven to be significant risk factor for developing MSDs. The cohort of ADPs showed a high MSD symptoms prevalence. Efforts are imperative in addressing the risk factors of ergonomics and the workplace environment, and more rigorous studies are needed to further investigate risk factors.

Prevalence of Musculoskeletal Diseases of the Upper Extremity Among Dental Professionals in Germany

Objective

Although many findings on occupational musculoskeletal complaints are available from American and European dentists, the corresponding data from Germany are still scarce. Therefore, the aim of this study was to provide additional information on the prevalence of and risk factors for musculoskeletal disorders of the upper extremity, particularly the shoulder in this specific population.

Methods

A written survey was carried out among 600 dentists in the state of North Rhine-Westphalia, Germany. Questionnaire items included physical and psychosocial workload, general health, and the occurrence of musculoskeletal symptoms during the previous 12 months that led to sick leave and medical care according to a modified version of the Nordic Musculoskeletal Questionnaire (NMQ). Regression analysis was used to evaluate relevant risk factors for severe musculoskeletal disorders.

Results

A total of 229 dentists were participated in the study (response rate 38%). Overall, 92.6% of the participants had already suffered from musculoskeletal symptoms in at least one body region. Symptoms were mostly reported in the neck (65.1%) and in the shoulder (58.1%). Limitations in daily activities were experienced by 15.9% due to neck pain and by 15.4% due to shoulder pain. Medical care was sought by 23.7% because of neck pain and by 21.1% due to shoulder pain. Risk factors for symptoms in the upper extremity regions were gender (female), increased physical load, and numerous comorbidities.

Conclusion

There is a high prevalence of musculoskeletal disorders among dentists. Suitable interventions are therefore needed to prevent musculoskeletal diseases and pain among dental professionals, with particular attention to female dentists.

The Development of Musculoskeletal Disorders during Undergraduate Dentistry Studies-A Long-Term Prospective Study

Musculoskeletal disorders (MSDs) frequently occur among dental practitioners and present a significant occupational burden with an early onset in the dentists' career. This study aimed to analyze the five-year development of self-reported overall MSDs among the dentistry students during the course of their studies and to assess the possible influence of the risk as well as protective factors. The questionnaire inquiry was performed among the first-year dentistry students, regarding the occurrence of MSDs and the presence of potential risk and protective factors. The same students were followed, and they filled in the same questionnaire in the middle and at the end of their studies. A total of 73 dentistry students and 28 general medicine students participated. The occurrence of the overall MSDs statistically significantly increased from 30.1% at the beginning of the first year to 45.2% at the end of the fifth year among the dentistry students. The top-level sport was statistically significantly associated with the higher occurrence of MSDs in the fifth year and with the development of new MSDs between the first and the fifth year. This longitudinal prospective evaluation showed a significant increase in the MSDs occurrence among the dentistry students during their studies.