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 Table of Contents  
Year : 2020  |  Volume : 7  |  Issue : 2  |  Page : 100-102

Work-related musculoskeletal disorders and ergonomic practices among dentists in Ludhiana

Department of Periodontics, Christian Dental College, Ludhiana, Punjab, India

Date of Submission11-Apr-2019
Date of Decision09-Jan-2020
Date of Acceptance18-Feb-2020
Date of Web Publication8-Oct-2020

Correspondence Address:
R Nissi Evelyn
Department of Periodontics, Christian Dental College, Ludhiana, Punjab
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/cjhr.cjhr_42_19

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Purpose: Prolonged static postures and forceful repetitive movements predispose the dentists for musculoskeletal disorders (MSDs). The purpose of the present study was to determine the prevalence of work-related MSDs (WMSDs) among the dentists in Ludhiana, Punjab, and to assess their knowledge, attitude, and practices regarding dental ergonomics. Methodology: A questionnaire-based survey was carried out among 146 dentists in the city of Ludhiana. Results:Majority of the surveyed dental practitioners (91%) were found to be suffering from WMSDs. The most common areas affected by WMSDs in the order of magnitude were the neck (70.5%), shoulder (48.7%), lower back (47.3%), and upper back (41.8%). It was found that senior consultants had better knowledge about dental ergonomics and had a better attitude toward applying ergonomic principles in their practice. Conclusion: The high prevalence of WMSDs exists among dentists. The knowledge about dental ergonomics does not necessarily lead to a positive attitude and practice of dental ergonomics. Incorporating the teaching, monitoring, and evaluation of ergonomic principles systematically into the undergraduate and postgraduate curriculum will improve the adoption and application of these principles in the routine clinical practices.

Keywords: Dentists, ergonomic practices, work-related musculoskeletal disorders

How to cite this article:
Evelyn R N, Jain R. Work-related musculoskeletal disorders and ergonomic practices among dentists in Ludhiana. CHRISMED J Health Res 2020;7:100-2

How to cite this URL:
Evelyn R N, Jain R. Work-related musculoskeletal disorders and ergonomic practices among dentists in Ludhiana. CHRISMED J Health Res [serial online] 2020 [cited 2021 Jun 18];7:100-2. Available from: https://www.cjhr.org/text.asp?2020/7/2/100/297580

  Introduction Top

Dental procedures demand a great deal of precision which requires prolonged static postures and repetitive forceful movements of the hands and wrists.[1] Repeatedly assuming such postures often predispose dental practitioners for injuries of the neck, back, shoulders, arms, wrists, etc., leading to the development of musculoskeletal disorders (MSDs).

MSDs not only affect the work quality, efficiency, and output of the practitioners but are also linked to the psychological disturbances and in some cases even early retirement among dentists.[1],[2] In addition, age, lack of physical exercise, poor working environment, and female gender may act as predisposing factors.[3],[4]

Ergonomics is an applied science concerned with designing products and procedures for maximum efficiency and safety of the operator. Following ergonomic principles routinely and effectively can prevent the occurrence of work-related MSDs (WMSDs) among dentists and thereby increase the efficiency and productivity of the clinician. The published literature indicates that the knowledge of WMSDs and ergonomic principles brings about a positive change in the attitude of the clinicians but may not always result in satisfactory behavior change.[5] Very sparse data are available in India on knowledge, attitude, and practices regarding ergonomic principles. This provided an impetus to carry out a study to determine the prevalence of WMSDs among dentists in an Indian city and to assess their knowledge, attitude, and practices regarding dental ergonomics.

  Methodology Top

A cross-sectional questionnaire-based survey was carried out among dentists in Ludhiana, Punjab. A convenience sample of 160 participants was taken which included private practitioners and dentists employed at various hospitals and dental colleges in the city. Dentists with <1 year of working experience, left-handed dentists, or with a history of trauma or musculoskeletal problems leading to musculoskeletal impairment were excluded from the study.

A questionnaire was designed for the survey which consisted of three sections. The first section included demographic details and general work-related questions.

The second section had both open-ended and close-ended questions which assessed the participant's knowledge, attitude, and practices regarding dental ergonomics. The third section included Cornell's musculoskeletal discomfort questionnaire to assess the prevalence and severity of MSDs.

The study protocol was reviewed and approved by the Institutional Ethics and Research Committee. Face and content validation of the questionnaire was done. A pilot survey was carried out among 27 dentists, and required modifications were made. The dentists were visited in person and the questionnaires distributed by the hand. Among them, 146 dentists responded to the questionnaire with a response rate of 91.25%.

Data were collected and coded. The Chi-square test was used for the statistical analysis.

  Results Top

The study population consist predominantly of females (60.3%). For the purpose of comparison, we categorized the respondents into junior consultants, postgraduate students, and senior consultants. Junior consultants being 36.3%, 16.4% were PG students, and 47.3% were senior consultants. Majority (89%) of the participants were working approximately 5–10 h/day. Most of the practitioners were attending to more than five patients per day (53.4%).


Majority of the surveyed dentists (91%) were found to be suffering from WMSDs.

The neck appeared to be the most common affected area followed by the shoulder, lower back, and upper back [Table 1]. Eighty-seven percent of the participants reporting that the pain led to discomfort and 84% of the participants reported that the pain interfered with their work.
Table 1: Prevalence of work-related musculoskeletal disorders among dentists

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With 50% of the participants being aware of ergonomics, 57.5% were familiar with the preventive techniques to decrease the possible risks of having MSDs. According to the dentists, stretching exercises (23.3%) and correct working posture (35.6%) are the preventive techniques. The lack of practice of ergonomic working principles was reported by 45.2% of the participants, whereas 40.4% blamed habits and 34.9% felt that lack of knowledge of ergonomic working principles to be the reason for improper working postures leading to WMSDs. WMSDs are one of the main occupational health hazards affecting dentists was agreed by 89.7%.


Among the dentists, 93.8% reported that they have not attended any workshop on dental ergonomics. This shows a negative attitude toward ergonomics. Early and constant ergonomic monitoring of dental students is essential and should be used as a tool for the prevention of occupational hazards was agreed by 95% of the respondents, whereas 96% agreed that ergonomics as a discipline should be inducted into the dental curriculum.


Nearly 80.5% of respondents reported that they adopt awkward posture while working. Four-handed dentistry is practiced by 48.6% of the respondents and 52.7% of the dentists takes break in between the patient treatment [Table 1] and [Table 2].
Table 2: Knowledge, attitude, and practices regarding dental ergonomics

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  Discussion Top

The occurrence and severity of WMSDs among dental practitioners can be a major impediment to their work. Our results revealed a high prevalence of WMSDs (91%) among dental practitioners in the city which is similar to that seen in another study carried in India.[2] However, it is found to be higher when compared to some of the international studies.[1],[3],[6],[7],[8],[9],[10] Eighty-nine percent of the dentists had the average working time of 5–10 h. Twenty-six percent of the respondents agreed to excessively bending their neck, whereas 17% stated working in standing posture or getting up from their stools to retrieve instruments, and another 15% reported excessive bending of back. Lack of practice of correct working postures and poor working habits were found to be the major reasons for adopting these awkward postures while working. About half of the respondents reported practicing four- handed dentistry which is similar to a study conducted by Bârlean L et al among dentists in Romania.[11] Breaks between patients were taken by about 50% of the dentists. However, a very small percentage of the respondents actually reported changing their posture (26%) or doing stretching exercises (19.2%) to destress themselves between patients. Maintaining a good work posture and stretching exercises between the patients can go a long way to prevent the WMSDs as they lead to improved blood supply to the muscles and decreases muscle fatigue. In our study, the neck was found to be most commonly affected area followed by the shoulder, lower back, and the upper back. These results are similar to the study conducted by Ísper Garbin et al. among the Brazilian dentists[1] and Phedy and Gatam among the dentists of Indonesia.[6] Senior consultants had a better knowledge of ergonomic principles as compared to junior consultants and postgraduate students and were found most commonly to adopt correct working postures (72.5%), use four handed dentistry (82.6%), and were less likely to adopt awkward working postures [Table 2].

A dismal percentage (6.2%) of attendance of preventive workshops and poor knowledge of preventive techniques (57.5%) reflects a general lack of interest and a casual attitude toward promoting healthy work habits among the dental community. Although educating the dentists about the ergonomic principles may be one of the most important factors in preventing WMSDs and improving the quality of their professional life, we found that in many cases, the awareness of WMSDs and the knowledge of ergonomic principles did not translate into improved work-related practices.

We feel that if the knowledge of ergonomic work principles, WMSDs, and ways to prevent them is incorporated systematically into the dental curriculum by teaching, observing, evaluating, and assessing the principles, it will develop good working habits among dentists. Regular awareness programs through workshops and seminars should be conducted for dental practitioners.

  Conclusion Top

This study has identified a high prevalence of WMSDs among dentists. Adopting proper ergonomic principles can prevent WMSDs. The lack of practice and poor working habits were found to be the reasons for the high prevalence of WMSDs. Knowledge did not transfer into practice in our study. Hence, the incorporation of teaching, monitoring, and evaluation of the ergonomics in the undergraduate and postgraduate curriculum can motivate the dentists to incorporate in their clinical practices. Conducting regular workshops can update the practicing dentists about the principles and will encourage and motivate them to adopt these principles in their practices.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Ísper Garbin AJ, Soares GB, Arcieri RM, Saliba Garbin CA, Siqueira CE. Musculoskeletal disorders and perception of working conditions: A survey of Brazilian dentists in São Paulo. Int J Occup Med Environ Health 2017;30:367-77.   Back to cited text no. 1
Nagarajappa R, Thakur P. Prevalence of work related musculoskeletal disorders among dental practitioners in Kanpur, India. Natl J Integr Res Med 2015;1:6.   Back to cited text no. 2
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.   Back to cited text no. 3
Rundcrantz BL, Johnsson B, Moritz U. Pain and discomfort in the musculoskeletal system among dentists. A prospective study. Swed Dent J 1991;15:219 28.   Back to cited text no. 4
Karibasappa GN, Sujatha A, Rajeshwari K. Dentists' knowledge, attitude and behavior towards the dental ergonomics. IOSR J Dent Med Sci 2014;13:86 9.  Back to cited text no. 5
Phedy P, Gatam L. Prevalence and associated factors of musculoskeletal disorders among young dentists in Indonesia. Malays Orthop J 2016;10:1-5.   Back to cited text no. 6
Rafie F, Zamani Jam A, Shahravan A, Raoof M, Eskandarizadeh A. Prevalence of upper extremity musculoskeletal disorders in dentists: Symptoms and risk factors. J Environ Public Health 2015;2015:517346.   Back to cited text no. 7
Marshall ED, Duncombe LM, Robinson RQ, Kilbreath SL. Musculoskeletal symptoms in New South Wales dentists. Aust Dent J 1997;42:240-6.   Back to cited text no. 8
Alexopoulos EC, Stathi IC, Charizani F. Prevalence of musculoskeletal disorders in dentists. BMC Musculoskelet Disord 2004;5:16.   Back to cited text no. 9
Jaoude SB, Naaman N, Nehme E, Gebeily J, Daou M. Work related musculoskeletal pain among lebanese dentists: An epidemiological study. Niger J Clin Pract 2017;20:1002-9.  Back to cited text no. 10
[PUBMED]  [Full text]  
Bârlean L, Danila I, Sãveanu I. Dentists ergonomic knowledge and attitudes in North East Region, Romania. Roman J Oral Rehabil 2012;4:40-3.  Back to cited text no. 11


  [Table 1], [Table 2]


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