|Year : 2022 | Volume
| Issue : 1 | Page : 53-60
Prevalence of musculoskeletal pain in dentists; A systematic review and meta-analysis
Nikhil Chandrakant Thorat1, S Sahana1, Neeraj Chauhan2, Tarun Pratap Singh1, Anshika Khare1
1 Department of Public Health Dentistry, Peoples College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India
2 Department of Public Health Dentistry, Bhabha College of Dental Sciences, Bhopal, Madhya Pradesh, India
|Date of Submission||02-Feb-2022|
|Date of Acceptance||27-Feb-2022|
|Date of Web Publication||23-Jun-2022|
Nikhil Chandrakant Thorat
64/A Mini Niwas, Yashwant Nagar, Jalgaon - 425 001, Maharashtra
Source of Support: None, Conflict of Interest: None
Musculoskeletal disorders (MSDs) are the most common occupational illnesses in the world. Dental professionals are more prone to injuries and pain in their muscles, tendons, nerves, and joints, which are known as MSDs. Prolonged static postures, repeated actions, workplace designs, poor alignment, genetic predisposition, mental stress, physical conditioning, age, and nonwork activities are all factors that might contribute to musculoskeletal pain (MSP). This systematic review and meta-analysis was based on Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, and the articles were retrieved from the search engines such as PubMed, Google Scholar, and Web of Science after fulfilling the eligibility criteria. After screening, a final of ten articles were included in the final analysis. This systematic and meta-analysis follows the PRISMA checklist. Medcalc software was used in order to find the significance of the prevalence of lower back pain, followed by neck pain, upper back pain, shoulder pain, and hand and wrist pain in dental practitioners. Significant differences were considered at P < 0.05. A total of ten studies were included, of which six studies met the criteria for the meta-analysis. The prevalence rates of musculoskeletal diseases were high. The lower back was the region most affected (47.753%, 95% confidence interval [CI]: 45.007–50.509), followed by the upper back body region (44.167%, 95% CI: 41.300–47.063%), neck pain (41.633%, 95% CI: 39.066%–44.234%), shoulder pain (33.608%, 95% CI: 31.222%–36.058% and 18.656%), and hand/wrist pain (95% CI: 16.359%–21.128%). Work-related MSP is the major health problem among dental professionals. Working posture of dental professionals is important and has been identified as a major risk factor for the development of work-related MSDs. A proper ergonomic design and posture can reduce the MSP. Therefore, further research is needed on possible ergonomics needed for preventing MSDs.
Keywords: Back pain, dental practitioners, musculoskeletal disorders, musculoskeletal pain, neck pain, shoulder pain, wrist pain
|How to cite this article:|
Thorat NC, Sahana S, Chauhan N, Singh TP, Khare A. Prevalence of musculoskeletal pain in dentists; A systematic review and meta-analysis. J Head Neck Physicians Surg 2022;10:53-60
|How to cite this URL:|
Thorat NC, Sahana S, Chauhan N, Singh TP, Khare A. Prevalence of musculoskeletal pain in dentists; A systematic review and meta-analysis. J Head Neck Physicians Surg [serial online] 2022 [cited 2022 Jun 28];10:53-60. Available from: https://www.jhnps.org/text.asp?2022/10/1/53/347998
| Introduction|| |
Dentistry is a difficult profession that necessitates the capacity to maintain static postures for lengthy periods of time, among other things. Dentists have been found to have more frequent and severe health problems, notably musculoskeletal discomfort. Musculoskeletal disorders (MSDs) are the most frequent occupational ailments worldwide, impacting around one million people each year in nations such as the United Kingdom. Low back discomfort, joint ailments, and various types of repetitive strain injuries are among them. Around 83.8% of dentists in China suffer from neck pain. Various researchers in different study contexts have indicated considerably greater prevalence of musculoskeletal pain (MSP) throughout the Indian subcontinent. Dental practice does not result in contact injuries (like in sports), but it can cause muscular imbalance, neuromuscular inhibition, pain and dysfunction, owing to accumulated micro trauma, and the utilization of awkward positions on a regular basis. However, rather than a single risk factor, a mixture of many risk variables appears to function in the majority of cases. Prolonged static postures, repeated actions, workplace designs, poor alignment, genetic predisposition, mental stress, physical conditioning, age, and nonwork activities are all factors that might contribute to back pain. Maintaining a neutral and basic working posture that allows relaxed muscles and well-balanced is crucial since postures outside the neutral posture might cause musculoskeletal system (MSS) difficulties. This systemic review and meta analysis answers the question “What is the prevalence and risk factors of MSP in dental practitioners?”
| Methods|| |
Protocol and registration
This review follows the Preferred Reporting Items for Systematic Reviews and Meta-analysis checklist for reporting systematic reviews and meta-analysis [Figure 1].
|Figure 1: A flow diagram following the preferred reporting items for systematic reviews and meta-analysis template|
Click here to view
Articles were retrieved using the search engines Pubmed, Embase, Elsevier, and Journal on web databases. In order to remove duplicates for the same type of article in more than one database the ENDNOTE 20. software was used.
The research question was focused using the “SPIDER” framework. The research question was used to determine the inclusion and exclusion criteria.
- Sample – Dental practitioner of both gender irrespective of age
- Phenomenon of interest – Assessment of prevalence
- Design – A cross-sectional study
- Evaluation – Prevalence and associated risk factors
- Research type – Observational study.
All studies including Dental practitioner affected with musculoskeletal pain. Cross sectional studies assessing prevalence of musculoskeletal pain among dentists. In the framework of 2015 onwards till 2021.
Non-English-language studies, case reports/series, reviews, and studies.
Eight key terms were used for the search: (1) Musculoskeletal pain, (2) Dental practitioners, (3) back pain, (4) Musculoskeletal disorders, (5) Neck pain, (6) Shoulder pain, and (7) Wrist pain with the help of Boolean operator “AND” and “OR.”
EndNote software was used to remove duplicates in the study.
All the title and the extracts were independently screened by two reviewers. The full-text articles were carefully reviewed, and the data collected and recorded in data extraction table showed the various data items evaluated for the review.
The data extraction table included study, location, demographic characteristics, medication, prevalence, outcome, and risk factors associated with prevalence.
The quantitative data were synthesized by using MedCalc Statistical Software version 19.2.6 (MedCalc Software bv, Ostend, Belgium; https://www.medcalc.org; 2020).
| Results|| |
In this systematic review, 624 articles were retrieved from various databases (Pubmed, Scopus, Elsevier, and Journal of web). A total of 298 studies were excluded on the basis of abstracts and titles and then, 268 studies were excluded because they were unrelated to this purpose and duplicated, and 48 articles were excluded as parameters other than prevalence of MSP were assessed. After assessing for the eligibility, 10 articles were included for qualitative evaluation and 6 were analyzed quantitatively.
Characteristics of the reviewed studies are presented in [Table 1]. All papers studied the prevalence of MSDs including both males and females. The studies included employed nordic or self-designed questionnaire.
Across all musculoskeletal diseases, each article studies a part of MSD, including neck pain in five studies, lower back pain in five studies, upper back pain in three studies, shoulder pain in six studies, and wrist pain in four studies The study characteristics are summarized in [Table 1].
A total of six studies were included in the metaanalysis.
Prevalence of lower back pain among the study population
A total of five studies were evaluated which included a sample of 1295 dentists. The pooled prevalence was 47.7% (95% confidence interval [CI]: 45.007% to 50.509%) in the fixed-effect model and 60.8% (95% CI: 39.072% to 80.488%) in the random model, as per the random-effect model which was significantly higher. The heterogeneity was 97.91% for the lower back pain studies, suggesting a wider variability in this study which could be attributed to the wide age range of the dentists included for the analysis. Publication bias was negligible as per the Eggers and Begs test [Figure 2].
Prevalence of upper back pain among the study population
A total of three studies were evaluated which included a sample of 1170 dentists. The pooled prevalence was 44.167% (95% CI: 41.300%–47.063%) in the fixed-effect model and 41.994% (95% CI: 35.468% to 48.664%) in the random model, as per the random-effect model which was significantly higher. The heterogeneity was 74.55% for the upper back pain studies, suggesting a wider variability in this study which could be attributed to the wide age range of the dentists included for the analysis. Publication bias was negligible as per the Eggers and Begs test [Figure 3].
Prevalence of neck pain among the study population
A total of five studies were evaluated which included a sample of 1429 dentists. The pooled prevalence was 41.633% (95% CI: 39.066% to 44.234%) in the fixed-effect model and 48.602% (95% CI: 29.610% to 67.806%) in the random model, as per the random-effect model which was significantly higher. The heterogeneity was 97.83% for the neck pain studies, suggesting a wider variability in this study which could be attributed to the wide age range of the dentists included for the analysis. Publication bias was negligible as per the Eggers and Begs test [Figure 4].
Prevalence of shoulder pain among the study population
A total of six studies were evaluated which included a sample of 1499 dentists. The pooled prevalence was 33.608% (95% CI: 31.222% to 36.058%) in the fixed-effect model and 36.758% (95% CI: 24.000% to 50.538%) in the random model, as per the random-effect model which was significantly higher. The heterogeneity was 95.86% for the shoulder pain studies, suggesting a wider variability in this study which could be attributed to the wide age range of the dentists included for the analysis. Publication bias was negligible as per the Eggers and Begs test [Figure 5].
Prevalence of hand/wrist pain among the study population
A total of four studies were evaluated which included a sample of 1061 dentists. The pooled prevalence was 18.656% (95% CI: 16.359% to 21.128%) in the fixed-effect model and 26.848% (95% CI: 15.805% to 39.591%) in the random model, as per the random-effect model which was significantly higher. The heterogeneity was 92.45% for the hand/wrist pain studies, suggesting a wider variability in this study which could be attributed to the wide age range of the dentists included for the analysis. Publication bias was negligible as per the Eggers and Begs test [Figure 6].
Quality of risk assessment
All included studies were cross-sectional studies, so the Axis tool was used to evaluate the quality. The quality rating is from low risk to high risk, and low risk indicates high-quality articles [Figure 7].
| Discussion|| |
MSDs are delicate tissue wounds brought about by abrupt to repetitive movement, force, vibration, and abnormal positions. Musculoskeletal issues (MSDs) have increased. During the prior, it became more and more widespread in the world. MSDs are common occupational disorder among dental practitioners because of abnormal work posture. In most studies, the prevalence rate was high. Therefore, the dental practitioners are particularly at high risk of MSP. This was also evident when looking at the prevalence rates of the individual body regions.
Lietz et al. conducted a meta-analysis of MSDs among the dental professionals in Western countries where the prevalence of MSDs was high. The prevalence rates of musculoskeletal diseases and pain ranged from 10.8% to 97.9%, with pooled annual prevalence rate of 78.0% (95% CI: 60.2–95.8). Ohlendorf et al. also observed the prevalence rates of the individual body region, and the neck was the most frequently affected body region (pooled annual prevalence: 58.5%, 95% CI: 46.0–71.0). The author observed that the static working posture possibly contributed to particular muscular strains in the neck. Ohlendorf et al. also stated that other studies also found high prevalence rates for neck pain (above 66%) among Asian dental professionals.
Awareness of interventions or prevention strategies is needed to effectively manage and prevent injuries. Applying ergonomics to the practice of dentistry provides safety benefits and also ameliorate performance objectives through greater productivity., A good posture provides the dentist more working energy, lower stress level, increased comfort, lack of pain and muscular tension, and a lower risk for therapeutic errors. Aerobic exercise must be performed 3–4 times a week for at least 20 min. Aerobic exercise increases blood flow to all tissues and improves their ability to use oxygen. Prevention of chronic pain requires dentists to gain more knowledge, change their habits, select appropriate ergonomic equipment, and have a break period after each operation with stretching exercise. Additionally, exercise plays an important role in their career to be healthy, to be safe, and have longer practice years.
| Conclusion|| |
This study shows evidence that work-related MSP are the major health problems in dental professionals. Our findings revealed that there are high prevalence rates of MSDs. Different regions of the body were affected by MSP, especially lower back followed by neck, upper back, shoulder, and hand and wrist. Working posture of dental professionals has an important role, and it has been found to be a main risk factor for the development of work-related MSDs and maintaining poor posture for clinical procedure for longer duration can lead to MSP which increases gradually with time. A proper ergonomic design and posture can reduce the MSP. Therefore, further research is needed on possible ergonomics and exercises that can reduce the musculoskeletal disease among dental professionals.
This material has never been published and is not currently under evaluation in any other peer-reviewed publication.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Shekhawat KS, Chauhan A, Sakthidevi S, Nimbeni B, Golai S, Stephen L. Work-related musculoskeletal pain and its self-reported impact among practicing dentists in Puducherry, India. Indian J Dent Res 2020;31:354-7.
] [Full text]
Yamalik N. Musculoskeletal Disorders (MSDs) and dental practice Part 2. Risk factors for dentistry, magnitude of the problem, prevention, and dental ergonomics. Int Dent J 2007;57:45-54.
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Tzsche PC, Ioannidis JP, et al
. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: Explanation and elaboration. BMJ 2009;339:b2700.
Aljanakh M, Shaikh S, Siddiqui AA, Al-Mansour M, Hassan SS. Prevalence of musculoskeletal disorders among dentists in the Hail Region of Saudi Arabia. Ann Saudi Med 2015;35:456-61.
Al-Mohrej OA, AlShaalan NS, Al-Bani WM, Masuadi EM, Almodaimegh HS. Prevalence of musculoskeletal pain of the neck, upper extremities and lower back among dental practitioners working in Riyadh, Saudi Arabia: A cross-sectional study. BMJ Open 2016;6:e011100.
Kaur J, Malik M, Punia S, Yogesh.
Prevalence of back pain and neck pain among dentists in Hisar, India. Int J Health Sci Res 2018;8:146-50.
Meisha DE, Alsharqawi NS, Samarah AA, Al-Ghamdi MY. Prevalence of work-related musculoskeletal disorders and ergonomic practice among dentists in Jeddah, Saudi Arabia. Clin Cosmet Investig Dent 2019;11:171-9.
Alshouibi EN, Almansour LA, Alqurashi AM, Alaqil FE. The effect of number of patients treated, dental loupes usage, stress, and exercise on musculoskeletal pain among dentists in Jeddah. J Int Soc Prev Community Dent 2020;10:336-40.
Ajwa N, Khunaizi FA, Orayyidh AA, Qattan WA, Bujbarah F, Bukhames G, et al.
Neck and back pain as reported by dental practitioners in Riyadh city. J Dent Health Oral Disord Ther 2018;9:340-5. [doi: 10.15406/jdhodt. 2018.09.00405].
Babar RA, Sadiq A, Hussain SA, Farooq U. Work related neck pain among the dentists working in Islamabad & Eawalpindi; A cross-sectional survey. Northwest J Med Sci 2020;5:22-6.
Vodanović M, Sović S, Galić I. Occupational health problems among dentists in Croatia. Acta Stomatol Croat 2016;50:310-20.
Veeresh DJ, Yunus GY, Deepta R. Prevalence of musculoskeletal pain in dental practitioners in Davangere, Karnataka: A cross-sectional survey. J Indian Assoc Public Health Dent 2015;13:302-6. [Full text]
Downes MJ, Brennan ML, Williams HC, Dean RS. Development of a critical appraisal tool to assess the quality of cross-sectional studies (AXIS). BMJ Open 2016;6:e011458.
Rundcrantz BL, Johnsson B, Moritz U. Occupational cervico-brachial disorders among dentists. Analysis of ergonomics and locomotor functions. Swed Dent J 1991;15:105-15.
Lietz J, Kozak A, Nienhaus A. Prevalence and occupational risk factors of musculoskeletal diseases and pain among dental professionals in Western countries: A systematic literature review and meta-analysis. PLoS One 2018;13:e0208628.
Ohlendorf D, Naser A, Haas Y, Haenel J, Fraeulin L, Holzgreve F, et al.
Prevalence of musculoskeletal disorders among dentists and dental students in Germany. Int J Environ Res Public Health 2020;17:8740.
Abdolalizadeh M, Jahanimoghadam F. Musculoskeletal disorders in dental practitioners and ergonomic strategies. ASJ 2015;12:161-6.
Jodalli PS, Kurana S, Shameema, Ragher M, Khed J, Prabhu V. Posturedontics: How does dentistry fit you? J Pharm Bioallied Sci 2015;7:S393-7.
Varmazyar S, Amini M, Kiafar S. Ergonomic evaluation of work conditions in Qazvin dentists and its association with musculoskeletal disorders using REBA method. J Islam Dent Assoc Iran (JIDAI) 2012;24:3.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]