Musculoskeletal disorders: back and neck problems among a sample of Iraqi dentists in Baghdad city

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1 Musculoskeletal disorders: back and neck problems among a sample of Iraqi dentists in Baghdad city Zaheda J. Mohammad B.D.S., M.Sc., Ph.D. (1) ABSTRACT Background: musculoskeletal disorders (MSD) represent an important occupational health issue in dentistry. Musculoskeletal pain, particularly back pain, has been found to be a major health problem for dental practitioners Aims: The aim of the present study was to determine the prevalence of back and neck problems among a sample of Iraqi dentists in Baghdad city. Subjects and Methods: The self-administered questionnaire was prepared comprising of 16 questions including personal details such as age, sex, occupation, specialty, weight. The study was conducted on sample of 100 dentists, were randomly selected form College of Dentistry, University of Baghdad, and private clinics in Baghdad city. Statistical analysis used: The study was analyzed using chi-square test with help of SPSS software. Results: the results of present study showed that back and neck problem among the dentist with 77% had complaints of back and neck problem. 67% of subject excessively bending and twisting in order to gain better access to oral cavity. There is significant relationship of back and neck problem with age, weight but no significant relationship of back and neck problem with weekly working hours. About 60% of dentists contributed stress increased their back and neck problems. Conclusion: The prevalence of musculoskeletal complains among dentist is high and well documented. Stress and wrong postural practices are the main contributing factors to back and neck problems among dentists. Keywords: Back Pain, Neck Pain, Dentistry Posture, Dental therapy. (J Bagh Coll Dentistry 2011;23(4):90-95). INTRODUCTION Dentistry is a demanding profession regarding concentration and precision (1). Dentists always know that dentistry is a challenge. A healthy dentist is one of the most important component in a successful dental practice 2. The dentist is a subject to a wide variety of physical and psychological ailments that are induced or aggravated by the work environment and they greatly affect the health of dental professionals (2). Musculoskeletal pain, particularly back pain, has been found to be one of the most common and major health problem among dental practitioners (3-6). Some investigations have shown that the prevalence and location of pain and other symptoms such as headache may be influenced by posture and work habits as well as other demographic factors such as age and sex of the dentist (5-7). The posture adopted during the practice of operative dentistry throughout the world has changed over the past 30 years. (1) Lecturer, Department of Oral Diagnosis, College of Dentistry, University of Baghdad. Originally, dentists commonly stood to practice. Sitting, as the preferred position for the dentist to adopt, was introduced in the 1960s in an attempt to reduce the fatigue and musculoskeletal problems associated with dental practice. The term four-handed dentistry was first presented at a conference in 1960 having been developed and implemented by faculty personnel at the university of Alabama school of Dentistry (8). This dental assistant utilization programme attempted to minimize stress and fatigue in dentists while achieving maximum efficiency in the practice of operative dentistry. The dentists position is standardized in relation to the patient while the dental assistant keeps the dentists field of operation clear, handing instruments to the dentist as appropriate and thereby eliminating the need for the dentist to look a way and then reaccommodate his/her view. Because of these changes which have evolved overtime, it might be expected that the problems experienced by newly-trained dentists and ones who have been practising for many years would be different. However, there seems to be little evidence to support the hypothesis that the prevalence of back and neck pain is decreasing (5,6,9,10). Thus, the aim of the present study was to determine the prevalence of neck and back problems among a sample of Iraqi dentists in Baghdad city. Oral Diagnosis 90

2 SUBJECTS AND METHODS A questionnaire study was conducted on a sample of 100 Iraqi dentists in Baghdad city with age group ranging from years participated actively in the study and was obtained from colleges of dentistry in Baghdad city and other hospitals and private clinics. The self-administered questionnaire was prepared comprising of 16 questions including the personal details i.e. age, sex occupations, department and weight of the candidate. Questions regarding weekly working hours, routine postural practice, type of operating chair and, previous complaints of back and neck pain, periods of missed work, medical assistance sought and financial loss due to back and neck pain were covered in the questionnaire, table (1). The questionnaire was designed to take approximately 10 minutes to complete. The data were analyzed using chi-square test with help of SPSS software. Statistical significance was based on probability values of less than RESULTS Among 100 dentists who participated in the present study, 49% were males and 51% were females (table 2). About 36% of all subjects their age was ranging from 22-30years, while 64% of the subjects participated in this study, their age range was years (table 3).Also the results showed that15% of the subjects their weights less than 55kg, 30% their weights ranging between 56-70kg, 38% of subjects their weights ranging between kg, and only 17% of subjects their weights more than 85kg. (table 4). According to weekly working hours, 63% of the subjects had less than or equal to 30 weekly working hours while 37% of subjects had more than 30 weekly working hours (table 5).About 67% of subjects had excessively bending and twisting in order to gain better access to oral cavity (table 6) and the prevalence of back and neck pain complaints was present among 77% of the subjects who had previous complaints of back and neck problems (table 7).Depending on the frequency of back and neck pain among dentists, 52% of subjects frequently get neck and back pain once in a week and 24% of subjects rarely get neck and back pain as shown in (table 8) Only 24% of the subjects had missed work due to back and neck pain (table 9). The percentage of subjects who has been in this study was 58% didn t seek any therapy and 42% of subjects had took medical therapy due to neck and back pain (table 10).The percentage 76% of subjects rarely do exercise as a part of daily routine. Only 24% of subject do exercise as a part of daily routine (table11). 60% of subject felt stress increases their back and neck problem (table 12). Only 14% of subjects had suffered from significant financial loss due to back and neck pain as shown in (table 13). Asignificant relationship of back and neck pain with weight has been found in this study (p<0.05) as shown in (table 14). significant relationship of back and neck pain with weekly working hours has been found in this study ( p>0.05) (table15) and the relationship between back and neck pain with age group was significant p<0.05 (table 16). Oral Diagnosis 91

3 Table 1: Questionnaire about back and neck problems among Dentists and Dental Auxiliaries Age: Occupation: Sex: Weight: Department: Q1: How many working hours you have in a day? i) 0-2 hours ii) 2-4 hours iii) more than 4 hours Q2: Do you have continous prolonged working hours sitting on dental chair? Q3: Do you work while sitting/standing on dental chair? Sitting Standing Both Q4: Which type of dental chair do you operate? Hydraulic Fully automatic Semi automatic Q5: Which type of operating chair do you use? Adjustable n-adjustable Q6: Do you excessively bend/twist for better access and visibility within oral cavity? Q7: Did you have any previous complaints of back and neck problem? If yes 7 a. Has the problem aggravated while working on dental chair? Q8: How often do you get neck and back pain? Once in a week Once in 15 days Once a mth Once in 3 mths Very rare Q9: How long does the pain remain? For minutes For hours For days t applicable Q10: Does the pain get relieved after adequate rest? t applicable If yes 10 a. How does it get relieved? i) Medication ii) Rest iii) Both i & ii iiii)n of these Q11: Do you take breaks in between while working on patients? Q12: Have you missed work due to neck and backache? Q13 Have you taken any therapy for neckache and backache? Q14: Do you practice any exercises as part of daily routine? Q15: Does stress aggravates your neck and back problem? Q16: Do you suffer any significant financial loss due to neck and back problem? Thank you very much for your cooperation Oral Diagnosis 92

4 Table 2: Subject classification by gender Sex Total Percentage Male 49 49% Female 51 51% Table 3: Frequency of age-range of the subject. Age-rang (years) Number Percentage % % Table 4: Subject classification by weight. Weight Number Percentage < % % % > % Table 5: Weekly working hours of the subject. Weekly working hours Number Percentage Less than or equal to % More than % Table 6: Subjects who excessively bend or twist to better access to oral cavity. Excessive bending and Number Percentage twisting by subject 67 67% 33 33% Table 7: Subjects with previous complaints of back and neckache. Back and Neckache Number Percentage 77 77% 23 23% Table 8: Frequency of back and neckache among the subjects. Frequency Number Percentage Once in a week 52 52% Once in 15 days 10 10% Once in a mth 13 13% Once in 3 mth 1 1% Very rare 24 24% Table 9: Subjects who missed work due to back and neck problem. Missed work Number Percentage 24 24% 76 76% Table 10: Subjects who took medical therapy for neck and back problem. Medical therapy Number Percentage 42 42% 58 58% Table 11: Subjects who do exercise as a part of daily routine. Exercise Number Percentage Regurarly 24 24% Rarely 76 76% Table 12: Subjects where stress aggravated the back and neck problem. Stress Number Percentage 60 60% 40 40% Table 13: Subjects who suffered significant financial loss due to neck and backache. Financial loss Number Percentage Significant 14 14% Insignificant 86 86% Table 14: Relation between prevalence of neck and backache with weight. Prevalence of back and neck pain Weight Present Absent Total < % % % % % % 38 > % % 17 Total % 100 X 2 =3.564 p=0.048 p<0.05 Sig Oral Diagnosis 93

5 Table 15: Relation between prevalence of neck and back pain with weekly working hours. Prevalence of back and neck pain Weekly working hours Present Absent Total Less than or equal 49 to % % 63 More than % % 37 Total % % 100 X 2 =1.838 p=0.175 p>0.05 NS DISCUSSION Back pain is one of the most common complaints its exact causes and an exact diagnosis is often difficult. So back and neck problems have been cited as the second most common reason for missing work in an industrial population in united states (3). A survey of 432 dentists in Denmark of which 90.4% were utilizing the sit-down operating technique showed that 60% suffered from pain in neck and back (3). In a study in New South Wales, Australia 59% of the dentists that participated in the study reported trunk pain during the previous month (5). A survey of 430 dentist in Thessaloniki, Greece reported that 62% of dentists had musculoskeletal complaint (11). A study in south eastern Nigeria on seventy-eight dentists reported neck and back pain were higher in males, also generalists had more symptom than specialists (12). Also there was another studies reported that neck and back pain were higher among dentists (13,14). The result of present survey showed that back and neck problem are common among the dentists with 77% had complaints of back and neck problem, it can attributed to their wrong postural practices which was confirmed from the finding of this survey with 67% wrong backward postures and excessively bending and twisting in order to gain better access to oral cavity. Also the present result shows the problem of backache and neckache has a significant relationship with age group with prevalence of 67.53% of back and neck problem common among the old dentists than their young dentist and this result is inagreement with other study (15), also present study shows significant relationship between back and neck problem with weight of dentists and this is inagreement with other study (15). significant difference was observed between weekly working hours and prevalence of back and neck problem. Table 16: Relation between prevalence of neck and back pain with age group. Prevalence of back and neck pain Age-range Present Absent Total % % % % 64 Total % 100 X 2 =2.166 p=0.049 p<0.05 Sig So high job demand requires longer working hours where neck and back problem becomes significant. Very few dentists (24%) missed their work due to back and neck problem. Stress also plays a very important role in aggravating back and neck problem with 60% of subjects contributed stress as their aggravation factors. Higher work load, increased work output all these contribute to increase mental stress level and hence increase incidence of back and problem. REFERENCES 1. Finisen L, Christensen H, Bakke M. Musculoskeletal disordes among dentists and variation in dental work. Appl Ergon 1998; 29: Puriene A, Janulyte V, Musteikyte M, Bendinskaite R. General health of dentists. Literature review. Stomatologija Dental and Maxillofacial J 2007; 9(1) Khalid A. Al wazzan, Khalid Almos, Salah E. Al shethri, Mohammed Q. Al Qahtani. Back and neck problems among Dentists and Dental Auxiliaries. Journal of contemporary Dental practice 2001; 2 (3): Scully C, Cawson RA, Griffiths M. ch.3 physical and chemical dangers in dentistry. In: Occupational Hazard to Dental Staff. London British Medical J 1990: Marshall ED, Duncombe LM, Robinson RQ, Kilbreath SL. Musculoskeletal Symptoms in New South Wales dentists. Aust Dent J 1997; 42(4): Milerad E, Ekenvall L. Symptoms of the neck and upper extremities in dentists. Scand J work Environ Health 1990; 16: Jacobsen N, Aasenden R, Hensten-Pettersen A. Occupational health complaints and adverse patient reactions as precevied by personnel in public dentistry. Community Dent Oral Epidemol 1991; 19: Robinson GE, Wuehrmann AH, Sinnett GM, McDevitt EJ. Four-handed: dentistry the whys and whereforse. J Am Dent Assoc 1968; 77: Christensen H, Finsen L. Musculoskeletal disorders among Dentists and lack of variation in the dental work. Proc 12 th Triennial Cong Int Ergonomics Assoc 1994; 2: Oral Diagnosis 94

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