Do dental students have a neutral working posture?

Development of a Novel Pictorial Questionnaire to Assess Knowledge and Behaviour on Ergonomics and Posture as Well as Musculoskeletal Pain in University Students: Validity and Reliability

BACKGROUND

Good posture is characterised by neutral spinal alignment with high physiological and biomechanical efficiency together with low stress and strain. The purpose of this study was to assess the validity and reproducibility of the adult version of the Aristegui questionnaire in university students.

MATERIALS AND METHODS

The study was conducted in two parts. The first part assessed content validity of the questionnaire where five experts provided their feedback on the content of the questionnaire. The second part evaluated the reliability of the questionnaire among a convenience sample of 10 university students in a test-retest study.

RESULTS

The content validity of the questionnaire was found to be excellent. Twenty-five out of twenty-seven items had an item content validity index higher than 0.79 (appropriate) and the scale content validity index was 0.93 (high). For the reliability, almost perfect agreements were found for nine items, substantial agreement for three questions, moderate agreement for one item and fair agreement for one item. The kappa coefficients ranged from 0.00 (slight) to 1.00 (perfect) for the items on behaviour.

CONCLUSIONS

The questionnaire was found to be a valid and reliable tool to measure the university students' knowledge regarding ergonomics and posture and postural behaviour as well as prevalence of musculoskeletal pain.

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.

Neck Disability Index Detects Higher Neck-Related Disability Levels among Physiotherapists and Family Medicine Specialists than among Dentists

BACKGROUND

Healthcare workers who are in physical contact with patients are prone to work-related musculoskeletal disorders (WMSDs). Much is known about the prevalence of neck pain, but the extent of disability associated with neck pain among physical therapists (PTs), dentists, and family medicine specialists (FMs) is unknown.

METHODS

The prevalence of neck pain and Neck Disability Index (NDI) data were collected from 239 PTs, 103 FMs, 113 dentists, and 112 controls from June to August 2022.

RESULTS

The highest prevalence of neck pain was found in FMs (58.3%), followed by dentists (50.4%), PTs (48.5%) and controls (34.8%). The NDI% in PTs and FMs had higher values than controls: 14.6 ± 12.4, p = 0.02 for PTs, 14.9 ± 12.4, p = 0.01 for FMs vs. 10.1 ± 10.1 controls. The dentist group did not differ from controls (11.9 ± 10.2, p = 0.13). Mild, moderate, or severe forms of disability were more common in medical professionals than in controls (44.2%, 9.5%, and 1.5% vs. 37.5%, 7%, and 0%). Dentists were the youngest group with high functionality and the lowest degree of disability, comparable to the control population. Gender or age had no effect on NDI scores in this population. FMs, who represented the oldest group, showed age dependency (eleven years older in higher disability groups). Gender had no effect on NDI. In PTs, females predominated in all disability categories and PTs became five years older with increasing disability level.

CONCLUSION

By using NDI in assessing neck-related WMSDs, we can detect medical professionals prone to more serious disability and potentially plan preventive actions.

Pinch force generation during scaling by dental professionals: A systematic review

OBJECTIVE

The objective of this review was to examine the impact of instrument designs on pinch force generation during scaling by dental professionals.

METHODS

Three databases were utilized from September 2019 to November 2021 in addition to hand-searching specific journals and reference lists. Research articles that examined pinch force generation in dental professionals during scaling with manual instruments only were included. Bias was assessed in the individual articles.

RESULTS

Six research articles were included with sample populations that varied from 12 to 24 participants. Four articles evaluated instrument designs in relation to pinch force generation during scaling by dental professionals. Two articles evaluated the clinicians' experience levels and the impact on pinch force generation. Results of three articles revealed instruments with large diameters and low weights produced the least amount of pinch force (p < 0.05). Additionally, two articles found instruments with a round, tapered shape produced less pinch force and instrument handles made of silicone produced higher pinch strength post-scaling (p < 0.05). One study indicated instrument designs associated with modified scaling techniques may reduce thumb and index finger pinch force (p < 0.05).

CONCLUSION

The findings from this review indicate weak evidence for instrument choices to reduce pinch force during scaling. Dental professionals should consider lightweight and large diameter instruments for manual scaling. Clinicians may also want to consider round, tapered handles and instrument designs with modified scaling techniques. This systematic review further identified the need for clinical research studies with rigorous research designs that examine the ergonomic impacts of instrument designs.

Application of the rapid upper limb assessment tool to assess the level of ergonomic risk among health care professionals: A systematic review

BACKGROUND: Work-related musculoskeletal disorders (WMSDs) and ergonomic risk factors are widespread problems in the healthcare sector. OBJECTIVE: The primary objective of this review is to evaluate the application of the Rapid Upper Limb Assessment (RULA) tool in various healthcare professionals and to assess the level of ergonomic risk among them. METHODS: The databases MEDLINE, EMBASE, CINAHL, LILACS, SCIELO, DOAJ, PubMed, and PEDro were searched with terms associated with ergonomics, assessment, health care providers, risk factors, workplace, and RULA. We reviewed the literature from 2000 to 2020, including studies assessing RULA’s effectiveness for evaluating the WMSD’s and ergonomic risk in health care practitioners. We excluded the studies which were not open access and freely available. RESULTS: Overall, 757 records were screened; of these 40 potential studies, 13 different healthcare professionals were identified as eligible for inclusion. In most studies, the RULA tool was established as an effective tool in application and evaluating the level of the ergonomic risk among them. CONCLUSIONS: The RULA tool assessed the high ergonomic risk levels in dental professionals and low ergonomic risk levels in professionals working in the pharmacy department, clearly suggesting potential changes in work postures were necessary to prevent or reduce these risk factors.

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.

Comparative analysis of preclinical dental students' working postures using dental loupes and dental operating microscope

BACKGROUND

Dentists are susceptible to musculoskeletal disorders due to prolonged static postures during dental treatments. Using a magnification tool like dental operating microscope (DOM) or the dental loupes may correct the operator's posture. Up until now, few studies have focused on preclinical dental students' posture when working with the DOM, while most of them have focused on the loupes. The aim of this study was to comparatively analyse the working posture of preclinical students during a dental restoration procedure, working with two different magnification methods.

MATERIALS AND METHODS

This study used a randomised cross-over design in which seventeen third year students were randomly divided into three groups. The exclusion criteria were previous contact with magnification systems and previous clinical working experience. Each student prepared 3 Black class 1 cavities on artificial lower molars: first with no magnification, following dental loupes and DOM. They were video-recorded throughout the preparation. Trunk, neck and upper-arm position were evaluated using the Posture Assessment Instrument. Students completed a questionnaire on their subjective perception of the two magnification systems.

RESULTS

The statistical analysis showed significant improvement of the working posture using magnification systems compared to direct vision. The biggest improvement was obtained through the use of DOM, followed by the dental loupes. Students perceived dental loupes as being the most comfortable and easy to adapt to. They reported being more focused when using DOM.

CONCLUSIONS

Both magnification systems had a positive impact on the working posture, DOM having the best results. Loupes showed better adaptability while DOM showed better concentration.

Risk factors for work-related musculoskeletal disorders of dentists in Kuwait and the impact on health and economic status

BACKGROUND

Work-related musculoskeletal disorders have become a great health issue among dentists. However, it is never been examined among dentists in the State of Kuwait.

OBJECTIVES

The purposes of this study were to define the prevalence of work-related musculoskeletal disorders (WMSD) among dentists in the State of Kuwait, to identify risk factors for WMSD, and to explore relationships between WMSD and absenteeism/productivity.

METHODS

A descriptive cross-sectional design was used in this study. A self-administered questionnaire was distributed to dentists at government, private, and academic dental clinics.

RESULTS

A total of 186 questionnaires were returned (80% response rate). The results showed that 88 (47%) of responding dentists experienced WMSDs. Dentists self-reporting WMSD were older (36.4 (10.3) years vs. 32.6 (9.33); P = 0.01), in practice longer (11.7 (10.4) years vs. 8.2 (8.4); P = 0.013), and worked longer hours (34.9 (10.6) hours vs. 30.4 (11.5); P = 0.08) than dentists not reporting WMSD. A significant association was found between rating of pain and lost days from work (x2 (10, n = 85) = 20.96, ρ = 0.021).

CONCLUSIONS

Dentists' occupational procedures expose their bodies to prolonged and awkward postures, thereby subjecting the dentists to unnatural forces and stresses on crucial movement and functioning joints. Cumulative exposures to such postures lead to WMSDs. Generally, WMSD has a considerable impact on the health and economic status of the individual, family, and workplace. WMSD increases absenteeism and reduces productivity.

Common errors in selecting and implementing pen-paper observational methods by Iranian practitioners for assessing work-related musculoskeletal disorders risk: a systematic review

Objectives. This study aimed to determine the types and frequency of pen-paper observational methods (OMs) used by Iranian practitioners and to identify their errors in selecting and implementing these methods. Methods. This was a systematic review and analytical study of papers in which the OMs had been used. Scientific databases were analyzed from September 1970 to September 2018. Errors were determined based on a list of wrong practices both in the selection and implementation of methods. Three ergonomists carried out the process of identifying errors independently. Results. The most frequently used methods were rapid upper limb assessment (RULA), quick exposure check (QEC) and rapid entire body assessment (REBA), respectively. Errors in selecting and implementing pen-paper OMs were 53.3 and 36.4%, respectively. Conclusions. Despite the abundant number of pen-paper OMs, Iranian practitioners use few of them. The high rate of errors can indicate a lack of knowledge and skills among practitioners for selecting and implementing OMs. The development of decision-making tools may help practitioners to select appropriate pen-paper OMs for assessing different types of tasks.

Ergonomic intervention on a packing workstation with robotic aid -case study at a furniture manufacturing industry

BACKGROUND

Several risk factors among packing lines workers can lead to Work-related Musculoskeletal Disorders (WRMSD) occurrence. Foreseeing WRMSD prevention and productivity increase, some furniture manufacturing industries have been investing in the adoption of robotic solutions. In this field, ergonomics plays an important role to verify if automation implementation has been successful.

OBJECTIVE

This study aims to address the general impact and effectiveness from an ergonomics point of view of the implementation of a robotic aid in a packing workstation.

METHODS

The Nordic Musculoskeletal Questionnaire (NMQ) was applied to 14 workers of semi-automated packing lines. Some additional questions about occupational conditions were included. In order to assess the ergonomic impact of the robotic aid, Rapid Upper Limb Assessment (RULA) was also applied by trained ergonomists, by analyzing the considered packing workstations before and after the adoption of the robotic aid proposed solution.

RESULTS

The results showed that trunk torsion was the most highlighted WRMSD risk factor by all workers, associating it with the lumbar pain. The obtained RULA scores demonstrated that the adoption of a robotic aid eliminated this risk factor and, consequently, reduced the corresponding WRMSD risk.

CONCLUSIONS

The adoption of robotic aids can be instrumental in reducing WRMSD risk in furniture manufacturing industries. Ergonomic studies with workers' participatory approaches seem to be an appropriate strategy to enable the validation and development of industrial robotic solutions.

The effectiveness of ergonomics interventions in reducing upper limb work-related musculoskeletal pain and dysfunction in sonographers, surgeons and dentists: a systematic review

The aim of this systematic review was to summarise the effects of ergonomics interventions on work-related upper limb musculoskeletal pain and dysfunction, and on productivity in sonographers, surgeons and dentists. A total of 31 studies were included. All studies reported effects on upper limb pain. Nine studies reported effects on dysfunction and only two studies reported effects on productivity. Moderately strong evidence in reducing upper limb pain was found for instigation of microbreaks into long duration surgical procedures, and the use of wider, lighter handles in dental instruments. Moderate evidence was also found for use of prismatic glasses and favourable positioning in reducing upper limb pain. Weak, inconsistent or no evidence was found for all other ergonomics interventions in reducing upper limb pain and dysfunction and increasing productivity. The lack of high quality research, particularly in sonographers and in the outcome of productivity, should be addressed. Practitioner summary: This systematic review investigates the effectiveness of ergonomics interventions on upper limb pain, dysfunction and productivity in sonographers, dentists and surgeons. Instigation of microbreaks during long duration procedures and the use of wider, lighter instrument handles were most effective in reducing upper limb work-related pain. Abbreviations: ANOVA: analysis of variance; CLS: conventional laparoscopic surgery; DMAIC: define, measure, analyze, improve and control; GRADE: grading of recommendations, assessment, development and evaluations; HD: high definition; PRISMA: preferred reporting items for systematic reviews and meta-analyses; PROSPERO: The International Prospective Register of Systematic Reviews; RCT: randomised control trial; SILS: single incision laparoscopic surgery; VITOM: video telescopic operative microscope; WNSWLHD: Western New South Wales Local Health District; WMSD: work related musculoskeletal disorder.

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.

Musculoskeletal Risks: RULA Bibliometric Review

The objective of this study was to reveal RULA method applications in terms of the knowledge, country, year and journal categories. The search was performed using the "Web of Science Core Collection". The period from 1993 to April 2019 was selected. Eight hundred nine results were obtained, of which 226 were used. The largest number of publications was determined to be in the fields of industry and health and social assistance, which coincides with the OWAS and Standardized Nordic Questionnaire methods. By country, the USA stands out for its greater number of research studies and categories that are encompassed. By date, 2016 was the year when more studies were carried out, again coinciding with the Standardized Nordic Questionnaire. By journal, "Work-A Journal of Prevention Assessment and Rehabilitation" is highlighted, as it is for the REBA method as well. It was concluded that RULA can be applied to workers in different fields, usually in combination with other methods, while technological advancement provides benefits for its application.

Standardized photometric assessment method: A novel approach for the analysis of dental ergonomic posture

Background:

Identification and documentation of the proper and improper dental ergonomic postures have gained its importance in the recent years due to the increased prevalence of work-related musculoskeletal disorders (WMSDs) among dentists and dental students who do not practice proper ergonomic procedure.

Aim:

The aim of the present study is to analysis ergonomic posture among dental students while performing supragingival scaling (SGS) procedure, using the standardized photometric assessment method (SPAM).

Materials and Methods:

A total number of 90 students from the third year (III year) to final year (IV year) and internship (Intern) (30 each) were included in the study. All the 90 students were asked to perform SGS procedure and were photographed and analyzed using the current technique. Eight dental ergonomic postures were analyzed in this study and grouped according to the classification system developed for scoring dental ergonomic postures by Garbin et al., in 2011. Analysis of variance test with Bonferroni correction was used to statistically analyze the collected data.

Results:

The mean index value for III year, IV year and Intern were 2.00, 2.03, and 2.13, respectively, which was not statistically significant (P = 0.709).

Conclusions:

Analysis of the dental students using the current method showed that most of them come under inadequate and regular category which puts them in a high risk for developing WMSDs. The SPAM to analyze the dental ergonomic posture was simple and effective and should be further explored in the future studies for its pros and cons.

What are the effects of photographic self-assessment on students' risk for musculoskeletal disorders using Rapid Upper Limb Assessment

PURPOSES/OBJECTIVES

Musculoskeletal disorders (MSD) affect the careers of dental professionals. Research suggests symptoms of MSD begin during educational careers. This sequential explanatory study aimed to determine if dental hygiene students' self-assessment using the Rapid Upper Limb Assessment (RULA) tool reduced the risk of MSD development and explore students' experiences using a risk tool.

METHODS

Dental hygiene students (n = 21) in the last 2 of 4 sequential clinical semesters completed self-assessment using the RULA, employing photographs taken during patient care. Initial photographs were taken before students participated in a workshop about ergonomics and application of the RULA tool. Using a within-subjects repeated measures design, student risk scores were calculated for pre- and post-workshop photographs over 4 consecutive weeks. Students (n = 10) participated in a focus group to share their experiences with the risk tool.

RESULTS

Repeated measures one-way analysis of variance compared differences in student RULA scores between weeks. There was a statistically significant effect of time on student self-reported RULA scores, F(3, 60) = 7.04, P < .001. Emergent themes from the focus group were practice using RULA, video versus photographs, adjust tool for dental hygiene practice, increased self-awareness, and connect theory to practice.

CONCLUSIONS

Results suggested using self-assessment utilizing a risk tool increased self-awareness for ergonomics, thus reducing the risk of developing MSDs for dental hygiene students.

Assessment of the ergonomic risk from saddle and conventional seats in dentistry: A systematic review and meta-analysis

Objective

This study aimed to verify whether the saddle seat provides lower ergonomic risk than conventional seats in dentistry.

Methods

This review followed the PRISMA statement and a protocol was created and registered in PROSPERO (CRD42017074918). Six electronic databases were searched as primary study sources. The "grey literature" was included to prevent selection and publication biases. The risk of bias among the studies included was assessed with the Joanna Briggs Institute Critical Appraisal Tool for Systematic Reviews. Meta-analysis was performed to estimate the effect of seat type on the ergonomic risk score in dentistry. The heterogeneity among studies was assessed using I² statistics.

Results

The search resulted in 3147 records, from which two were considered eligible for this review. Both studies were conducted with a total of 150 second-year dental students who were starting their laboratory activities using phantom heads. Saddle seats were associated with a significantly lower ergonomic risk than conventional seats [right side (mean difference = -3.18; 95% CI = -4.96, -1.40; p < 0.001) and left side (mean difference = -3.12; 95% CI = -4.56, -1.68; p < 0.001)], indicating posture improvement.

Conclusion

The two eligible studies for this review provide moderate evidence that saddle seats provided lower ergonomic risk than conventional seats in the examined population of dental students.

Validity and reliability of the Disabilities of Arm, Shoulder, and Hand scale in dental students: A transnational study

This study aimed to evaluate the validity and reliability of the Disabilities of Arm, Shoulder, and Hand (DASH) scale in Brazilian and American dental students and assess the influence of demographic variables on disability in them. A cross-sectional observational study was conducted with a nonprobabilistic sample. The sample was composed of students of both genders from the School of Dentistry of Araraquara, State University of São Paulo (UNESP) (n = 288), and students from Stony Brook University, New York, NY, USA (n = 149). The disabilities of the upper limbs were estimated using the DASH scale. The samples were characterized by collecting information on gender, academic year, and sports and work activities. The refined bifactorial model presented goodness-of-fit indices for both countries. There was a significant effect of the variables gender and academic year for the Brazilian sample and the variable sports practices for the American sample. The refined bifactorial model was valid and reliable for the Brazilian and American populations. In this model, the removal of item 17 for the Brazilian sample and items 3, 13, and 23 for the American sample was necessary. Demographic variables such as gender, academic year, and sports practice contributed significantly to the level of disability in the study populations.