Saira Afridi 1 , Brekhna Jamil 2 , Syed Imran Gilani 3
How to CITE:
Arfidi S, Jamil B, Gilani SI. Frequency of musculoskeletal pain in dentists working in public and private sector dental hospitals of Peshawar, Pakistan. J Pak Dent Assoc. 2012;21(4):197-201.
The objective of the present study was to determine the frequency of Musculoskeletal disorders that is backache, neckache and pain in fingers in Dentists working in Peshawar, Pakistan and to explore their association with gender of the dentist, number of working hours per day, number of patients treated per day, working posture and break between patients as well as duration of practice in years.
This questionnaire based survey was conducted on 104 dentists working in the private and public sector dental hospitals of Peshawar through a self administered. The questionnaire consisted questions about pain in the back neck & fingers and the working habits of the dentists. Chi-square test was used to explore the relationship between musculoskeletal pains with other study variables.
Our sample consisted 66.1% general dentists and 43.9% specialists. There were 60 males (68.2%) and 28 females (31.8%). Almost 56% of the dentists experienced backache, 41% had pain in the neck while 32% hand pain in fingers. Backache was found to be significantly associated with working position, years in practice; number of patients treated per day and breaks taken between patients, neck pain was related to years in practice while finger pain was not fund to be associated with any of the variable studies.
Dentists working in teaching dental institutions of Peshawar, Pakistan experience pain in the back and neck musculature. This pain is related to working conditions of the dental practitioners.
Dentist, Musculoskeletal pain, Pakistan
Health is a state of physical, mental, and social well-being1. Given a continuous social interaction between health care providers and their patients, healthy practitioners are particularly important for a successful dental practice and the well-being of their patients. There is increasing evidence that unique working conditions in dentistry can significantly affect the health of dentists. Studies suggest an increased vulnerability among dental professionals to certain disorders and afflictions that can only be categorized as profession- related 2-8. The practice of dentistry is a challenging job and a wide variety of deleterious work environmental factors are proved to affect the physical health of dentists or aggravate their preexisting disorders4, 5, 9-12.13, 14. The reason is that dentists spend their work days in awkward, static positions performing extremely precise procedures in a very small workspace – the patient’s mouth. Because there is no room for error, a steady hand and an awkward posture must be assumed and maintained. However, this comes at a cost to the back, neck and shoulder area of the dentist. The pain suffered by dentists may lead to reduced productivity in terms of missed time from work or reduced work hours and may also lead to inefficient movements while working, causing an increase in time spent per patient, thus limiting the number of patients seen per day15. The aim of this study, therefore, was to assess the prevalence of musculoskeletal disorders among dentists working at teaching Dental Hospitals in Peshawar, Pakistan and to correlate these with working posture as well as other variables such as the age, sex, work load and related factors.
SUBJECTS & METHODS
This cross-sectional questionnaire based study was conducted at two teaching dental hospitals of Peshawar namely Khyber College of Dentistry (KCD) and Sardar Begum Dental College (SBDC). Study population comprised of all the male and female dentists working as faculty members at KCD and SBDC. The faculty members included medical officers, senior registrars, assistant professors, associate professors and professors. There are total of 104 faculty members in both the institutions and all of them were included in the study.
The ethical approval was obtained by the ethical committees of both the dental institutions and formal approval for study was obtained from the heads of both the hospitals. Written informed consent was also obtained from every study participant. The study was conducted through a self administered questionnaire validated among a group of 10 dentists before using it for final survey. The questionnaire was designed to take approximately 8 minutes to complete. The instrument consisted of number of questions about age, gender, number of years in profession, pain in the back neck & fingers, working hours per day, number of patients treated per day, any break taken between patients or not, working positions used, type of vision used to treat the patients, leave taken due to musculoskeletal pain, Data was coded entered Statistical Package for Social Sciences (SPSS) version 16. The numerical variables like gender, number of years in the profession, number of patients treated, were presented as means and standard deviations. Nominal variables like gender, musculoskeletal pain, years in practice, type of vision, leave due to pain and break between patients were presented as frequencies and percentages. Chi-square test was used to explore the relationship between musculoskeletal pains with other study variables. For all analysis p value of less than 0.05 was considered significant with a confidence level of 95%.
The questionnaire was distributed among 104 dentists. Out of those 92 agreed to participate in the study giving a response rate of 88.5%, 88 questionnaires were included in final analysis as four of the questionnaires received were incompletely filled. Principal reasons for non-participation were: sickness leave, lack of time, and refusals.
Our sample consisted 66.1% general dentists and 43.9% specialists. The mean age of the study subjects was 37.05 + 10.2 with an age range of 24 years to 62 years. There were 60 males (68.2%) and 28 females (31.8%). Mean age of male dentists was 38.9 + 8.8 years while that of the female dentists was 33 + 11.8 years. When t-test was applied to compute the differences between the mean ages of two groups, female dentists in the present study were significantly younger in age than their male colleagues (p=0.02).
The study variables are presented in Table 1, which highlight that almost half of the dentists experienced backache while almost 41% of the dentists experienced pain in the neck Table 2 highlights the factors that were found to be significantly associated with musculoskeletal pain in the present study population. Backache was related to most of the factors studied while none of the factors were significantly related to pain in fingers and/or hands.
The present study also used a self-administered questionnaire to determine the prevalence of musculoskeletal disorders among dentists; and to identify the relationship between back pain, working time, number of patients and posture. The questionnaire was a very effective method of receiving information. By having questions where the respondent selected answers or brief statements, the questionnaires become simple to analyze.
This is the first survey of occupational musculoskeletal pain among dental professionals in Pakistan.
The response rate was 88% while those of previous similar questionnaire surveys among dentists in Hong Kong have been between 57% and 63%16. Thus, the survey response rate was considered satisfactory compared with previous studies.
Careful analyses of the results show that 86% of dentists sampled have experienced neck/back pain. This figure is very high and a worry for current and future dentists. Self-reported pain was used as a proxy measure for musculoskeletal disorders. Pain is the cardinal symptom of musculoskeletal disorders, but it is also a normal transient reaction to muscular strain17. Although not well documented, an acute reaction is generally considered to indicate a risk for later development of musculoskeletal disorders18
Occupational back pain among dentists had been reported between 37% and more than 55% 9,19-21. The prevalence of upper back and shoulder pain has varied from 10% to 73% in previous studies22-24. For other body sites, data on prevalence of musculoskeletal complaints are sparse. A greater prevalence of back pain among women has been reported by some authors23. Lower back pain has been cited as the most prevalent symptom among Australian dentists (experienced by 64% of those who suffered pain) 25. Given the wide range in results of previous studies, comparison with the current findings is difficult.
Our study found that most professionals referred some kind of musculoskeletal pain in the last 6 months, in coincidence with the information found in the literature26. It is important to underscore that the great majority of the respondents had mild symptoms, and that only a small percentage suffered moderate or severe pain.
The role of age on musculoskeletal problems in dentistry is even more controversial. While there are studies that claim that the frequency of pain remains stable with age21, others believe that musculoskeletal discomfort is worst around the sixth decade of life20. This could be due to incorrect working positions, since older dentists use more indirect vision and usually avoid neck overload. A third group of authors believe that discomfort is greater in oung professionals22. In our study, we found no correlation between age and the incidence of back, wrist and neck pain. Most authors find that females are more susceptible to this type of pain, though the reason is unclear; we however, did not find any such correlation with the gender of the dentist.
Although the results of our study found no direct correlation between age and the incidence of musculoskeletal pain; however, number of years in the profession was strongly correlated with musculoskeletal pain. Our results also indicate that the complaints of back pain were strongly related to the number of patients treated daily. In concurrence with our findings the occurrence of musculoskeletal complaints among dentists has been previously associated with work-relatedphysical load2.
The results of our study show the complaints of backache were strongly and inversely related to the number of breaks between patients. It can therefore be concluded that dentists that take more breaks suffer less back pain. The facts are staggering, and it could be suggested to all dentists to try and take as many breaks as possible during a working day.
From this study, it can be concluded that back pain and neck pain is highly prevalent among dental practitioners of Peshawar, Pakistan. It can also be said that there is a higher incidence of back pain in those dentists who take only one break per day; treated a large number of patients a day; and the longer they are in the profession the more likely they are to develop back ache. Numbers of years in the profession is also related to neck pain.
The authors would like to thank all the administrators in all teaching hospitals who helped to get the written informed consent about the conduct of this survey and to distribute the questionnaires to the subjects.
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