Development of a method to assess compliance with ergonomic posture in dental students

The Relationship of Death Anxiety With Quality of Life and Social Support in Hemodialysis Patients

This study aimed to determine the relationship of death anxiety with quality of life and social support in hemodialysis patients. This cross-sectional research was conducted on 226 patients with chronic renal failure. The results indicated that the means and standard deviations of MSPSS, QoL, and death anxiety of patients were 57.4 ± 10.1, 28.8 ± 5.9, and 42.5 ± 4.1, respectively. A significant negative correlation was found between QoL scores and death anxiety in hemodialysis patients (p = 0.007, r = -0.179). However, there was no statistically significant relationship between MSPSS scores and patients' death anxiety. The total score of patients' death anxiety decreased with increasing the total QoL score (p < 0.001, b = -0.18). Different variables that can affect death anxiety and QoL should be identified in the patient examination process. Also, the health care system should consider necessary planning to increase the QoL and reduce death anxiety.

Measuring ergonomic interventions and prevention programs for reducing musculoskeletal injury risk in the dental workforce: A systematic review

PURPOSE

Pain from musculoskeletal disorders (MSD) is experienced by all types of dental clinicians, leading to forced reduction of work capacity and premature retirement. Prolonged static posture is a major contributor to MSD in dentistry. Currently, there is no uniform ergonomic training in dentistry to prevent MSD. This systematic review explored and summarized methods and technologies for baseline and ongoing measurements of ergonomic intervention and prevention programs for reducing postural risk and for prevention of MSDs.

METHODS

The review was conducted in accordance with PRISMA guidelines. The literature search included PUBMED, Embase, CINAHL and the Cochrane Library, and identified relevant observational, experimental, quasi-experimental, research, and intervention studies. Quality was rated using a validated standardized instrument.

RESULTS

A total of 20 studies were included, of which 4 were rated as being of the high quality. Methods ranged from observers to motion sensors. Ten studies focused used established measuring tools (PAI, RULA, REBA), while nine studies focused on effectiveness of alternative methods of measurement. One study identified ISO standard 11226 for baseline comparisons. Evolving technologies were found to be suitable for baseline measurements of posture, and for feedback for developing sustainable postural behaviors. No studies measured ongoing postural performance improvement.

CONCLUSIONS

This systematic review adds to current evidence for the expanded and improved use of early training and testing of postural competence to reduce MSD risk among dental professionals. Further studies using technologies to assess the impacts of ergonomic training and testing among dental professionals are warranted.

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.

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.

Preclinical dental training: Association between fine motor skills and compliance with ergonomic posture techniques

OBJECTIVE

The aim of this study was to evaluate the dental students' fine motor skills and their compliance with ergonomic posture techniques over the course of a preclinical training year. The correlation between fine motor skills and compliance was also assessed.

METHODS

The ergonomic posture of students enrolled in the second year of a five-year undergraduate dental degree programme (n = 62) was assessed using the Compliance Assessment of Dental Ergonomic Posture Requirements (CADEP). This assessment relied on photographs of the students performing preclinical laboratory procedures during the school year. The photographs of each procedure received a score, and the final score obtained (0 to 10) corresponded to the extent of the student's compliance with ergonomic posture techniques. Initial compliance was calculated during the first two months of the training programme, whilst final compliance was calculated during the last two months. Fine motor skills were evaluated using the modified Dental Manual Dexterity Assessment (DMDA), which was also applied at the beginning and the end of the school year. Data were assessed statistically by Student's paired t test, and the correlation between fine motor skills and compliance with ergonomic posture techniques was estimated by Pearson's correlation coefficient (r) and Student's t test (α = 0.05).

RESULTS

The compliance scores were higher at the end of the academic year than at the beginning of year (p < 0.001; t = -5.300). Fine motor skills improved significantly with time (p < 0.001; t = -10.975). Non-significant correlations were found between students' fine motor skills and their economic posture compliance both at the beginning (r = -0.197; p = 0.126) and at the end of the training year (r = 0.226; p = 0.078).

CONCLUSION

The students' manual dexterity and compliance with ergonomic posture techniques increased over the course of the preclinical training year, and the correlation between students' fine motor skills and their ergonomic posture compliance was not significant.

Effect of magnification factor by Galilean loupes on working posture of dental students in simulated clinical procedures: associations between direct and observational measurements

Objectives

To determine the effect of different levels of Galilean loupe magnification on working posture as measured by compliance with ergonomic posture positions, angular deviation from the neutral position of the neck, and muscle activation in the neck and upper back region during simulated clinical conditions.

Methods

An experimental laboratory study was performed in which the dependent variables were compliance with ergonomic posture requirements while performing simulated restorative procedures in Restorative Dentistry, angular deviation from the neutral position of the neck, and muscle activation in the neck and upper back. The independent variable was the level of Galilean loupe magnification, which was tested at four levels (naked eye, 2.5× magnification, 3.0× magnification, and 3.5× magnification). The cavity preparations and Class I composite resin restorations were performed on artificial first molars on a mannequin in a dental chair. The Compliance Assessment of Dental Ergonomic Posture Requirements (CADEP) was used for the postural analysis; as was an analysis of the angular deviation from the neutral position of the neck and surface electromyography. Working posture was recorded on video over the course of the procedure. Participants were filmed from three different angles. The Compliance Assessment of Dental Ergonomic Posture Requirements (CADEP) assessed compliance with ergonomic posture requirements. A locally produced posture assessment software analyzed angular deviation. Surface electromyography bilaterally assessed activation of the sternocleidomastoid, descending trapezius and ascending trapezius muscles. Two-factor analysis of variance (ANOVA) and either Tukey's post-hoc test or the Games-Howell post-hoc test were performed (α = 0.05).

Results

During the cavity preparations and restorations, the use of Galilean loupes at all magnifications positively influenced working posture as measured by participants' compliance with ergonomic posture positions (p < 0.01) and neck angulation (p < 0.01); the use of these loupes did not affect muscle activation in the regions evaluated (p > 0.05).

Conclusion

The use of Galilean loupes had a positive effect on dental students' working posture during the restoration procedures performed.

Development and assessment of an indirect vision training programme for operatory dentistry: Effects on working posture

OBJECTIVES

Students experience difficulty working with indirect vision and often adopt inadequate working postures because of it. This study created and then assessed the effects of an indirect vision preclinical training programme on dental students' working posture.

METHODS

The study enrolled students in the third year of the 5-year undergraduate programme in dentistry in the School of Dentistry of São Paulo State University (UNESP), Araraquara (N = 54). The programme consisted of four training sessions in which students performed different types of activities in which only a mirror was used to see the procedure they were performing. To evaluate posture, students were asked to perform class III cavity preparations (distal-palatal and mesial-palatal preparations) on upper central and lateral incisors in a dental mannequin (tooth numbers 11, 12, 21 and 22) both before and after the indirect vision training programme. Photographs were taken of the students' working postures. The photographs were assessed by a duly trained researcher using the Compliance Assessment of Dental Ergonomic Posture Requirements. A descriptive statistical analysis was performed, and the assumptions of normality were verified. Student's paired t test was also performed. The significance level adopted was 5%.

RESULTS

A significant difference was found between the percentages of correct ergonomic postures adopted before and after the training programme (p = 0.039).

CONCLUSIONS

The preclinical training programme for indirect vision was found to have a positive effect on the working postures of the students evaluated herein.

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.

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.

Ergonomic working posture in simulated dental clinical conditions: effect of magnification on the operator's experience

Objectives

This study observed the effect of different magnification systems on working posture and neck angulation during cavity preparation procedures according to operator's experience.

Methods

This was a laboratory study. The response variables were the neck angulation and the working posture adopted during Class I cavity preparations (N = 640) that were performed under four conditions (unaided visualization, simple loupe, Galilean loupe and Keplerian loupe). Working postures were recorded and evaluated by the Compliance Assessment of Dental Ergonomic Posture Requirements (CADEP). The two-factor ANOVA and Games-Howell post-hoc test were performed (α = 0.05).

Results

For all treated teeth it was observed higher posture scores and lowest neck angulations while using the Galilean and Keplerian loupes (p < 0.01). No correlations were found between operator's experience and working posture (p = 0.71-0.88).

Conclusion

It can be concluded that Galilean and Keplerian loupes helped operators to maintain an ergonomic posture and lower neck angulations for all teeth and the operator's experience provided better ergonomic posture for the mandibular teeth.

Implementing magnification during pre-clinical training: Effects on procedure quality and working posture

OBJECTIVE

The objective of this study was to evaluate the effects of magnification on the quality of two pre-clinical procedures, class I cavity preparations and composite resin restorations, and to evaluate the working posture.

METHODS

This was an experimental laboratory study. The response variables were the quality of cavity preparations and Class I restorations as well as the working posture adopted during the execution of these procedures. The independent variables were the magnification system under four levels (unaided visualisation, the use of a simple loupe, the use of a Galilean loupe and the use of a Keplerian loupe) and the artificial teeth treated. Class I cavity preparations and restorations (N = 320) were performed using standardised procedures, and the quality achieved was evaluated using pre-established criteria. Working posture was recorded using digital video cameras and was evaluated using the Compliance Assessment of Dental Ergonomic Posture Requirements (CADEP). A two-factor analysis of variance (ANOVA) and multiple comparison test were performed (α = 0.05).

RESULTS

The quality of cavity preparation did not differ significantly amongst the different magnification systems (P = 0.082). Galilean and Keplerian systems had a positive impact on restoration quality only for the left mandibular first molar (P = 0.04). Higher posture scores were observed when Galilean and Keplerian loupes (P = 0.01) were used, regardless of the tooth being treated.

CONCLUSION

The use of Galilean and Keplerian magnification lenses did not affect the quality of the pre-clinical procedures performed whilst improved the scores of ergonomic posture.

Prevalence of musculoskeletal pain in dental students and associated factors

Aim: The objective of this research was to evaluate the prevalence of painful symptoms among dental academics, as well as their associated factors. Methods: A cross-sectional study was carried out at a public higher education institution, and the study population (n = 303) included undergraduate students who studied at least one subject that included clinical activities. For data collection, two self-administered questionnaires were delivered to the participants, the first of which consisted of sociodemographic variables, academic life, harmful habits, physical activity practice, and general health. The validated Nordic Musculoskeletal Questionnaire was used to identify musculoskeletal symptoms, the need to seek health resources, and to assess whether the disorders interfered with the work activities of academics. Results: The presence of pain in the past 12 months was observed in 199 participants (82.6%). Several variables, including gender, number of courses performed, physical activity, and general health status, had an association with painful symptoms in at least one area of the body (GA) over the past 12 months. In addition, variable general health was associated with pain symptoms in any area of the body (DG) over the past seven days. Conclusion: There was a high prevalence of musculoskeletal symptoms, especially in the upper limbs, and there were associations between muscular pain and the number of disciplines studied and between muscular pains and the general health of the students.

Preclinical dental training: Association between difficulty in performing restorative procedures and the adoption of ergonomic posture

OBJECTIVE

The aim of this study was to determine any correlations between difficulty in performing restorative procedures and the adoption of ergonomic posture by dental students in a preclinical course.

METHODS

The sample was composed of second-year undergraduate students enrolled in the School of Dentistry of São Paulo State University (UNESP), Araraquara (n = 56). The data were collected from weekly records in which students who had participated in training in a preclinical restorative dentistry laboratory registered the difficulty they experienced performing given proposed preclinical procedures and adopting ergonomic posture (positioning of students' legs, thighs, spine, arms, and forearms, as well as the positioning of both the dental light and the dental mannequin's head, the distance between the operating field and the operator's eyes, and the location of the instruments used in the procedures). Answers were provided on a scale of zero to ten points (zero = no difficulty; 10 = maximum difficulty). A descriptive statistical analysis was performed. The correlation between the level of difficulty in performing the restorative procedures and in the adoption of ergonomic posture was estimated using the Pearson correlation coefficient (r), and its significance was tested using Student's t test. To evaluate the effect of time on students' perceived difficulties in implementing ergonomic posture, the first 2 weeks of training was defined as the initial time, whilst the last 2 weeks was defined as final time (scores from these periods were averaged). After the normality assumptions were verified, Student's t test for paired samples was performed. The significance level adopted was <5%.

RESULTS

A correlation was found between the difficulty students experienced performing the preclinical procedures and their difficulties implementing ergonomic posture; the correlation was significant, though the correlation ranged from slight to moderate (P < 0.001; r = 0.38-0.63). In addition, the data also showed that the students' perceptions of how difficult it was to implement these posture items decreased significantly over time (P < 0.001).

CONCLUSION

The correlation between perceived difficulty in performing the preclinical restorative dentistry procedures and the application of ergonomic posture was slight to moderate, and the students' perceived difficulties in maintaining ergonomic posture decreased over the course of the school year.