DOI Number: 10.5958/j.2320-5962.2.1.

016
Indian Journal of Contemporary Dentistry, January-June 2014, Vol. 2, No. 1 81

Musculoskeletal Disorders among Dentists - A Review

Pallavi Yaduka1, S P Saravana Dinesh2, Aarthy Viswanath3

1
Student, 2Senior Lecturer, Department of Orthodontics, 3Senior Lecturer, Department of Prosthodontics, Saveetha
Dental College and Hospitals, 162, Poonamallee high road, Chennai

ABSTRACT

Musculoskeletal disorders are one of the major problems affecting health care professionals and IT
professionals. 20-30% of the world population is affected by work related musculoskeletal disorder
at any given time. This review gives a detailed discussion regarding musculoskeletal disorders among
healthcare professionals especially dentists. Research studies and literature reviews that report
musculoskeletal disorders in dental professionals have been reviewed. Most developed countries
report a prevalence of musculoskeletal disorders of more than 50% which is still lesser compared to
that in developing countries probably due to better ergonomic factor and less number of working
hours in developed countries. Dentists usually report with neck, shoulder, back pain. Endodontists
and Orthodontists are most commonly affected whereas Oral pathologists and Oral medicine
specialists are least commonly affected. Musculoskeletal disorders can be prevented by adopting
preventive measures and by knowing the ill effects of incorrect positioning and ergonomics. At present
scenario, there is a need for more research work and awareness among dentists regarding
musculoskeletal disorders and better ergonomics. Emphasis must be given on its prevention rather
than its cure.

Keywords: Musculoskeletal Disorders, Dentists, Ergonomics and Specialist Dentists

INTRODUCTION Saudi Arabia (59.2%) 2 , United States (53%) 3 and

Work Related Musculoskeletal disorders are
injuries or disorders of the muscles, nerves, tendons,
joints, cartilage, and spinal discs due to micro traumatic
events that accumulate in the body as a result of
workplace and work characteristics1. It can affect the
performance of work and can become worse if not paid
attention to. Tissue healing is never complete because
tissue injury repeatedly occurs 1. These are most
common in IT professionals and healthcare
professionals especially dentists. In dentistry
musculoskeletal problems often arise due to incorrect
standing or sitting posture or due to standing in the
same posture for long time. Prevalence rate of work
related musculoskeletal disorders among dentists is
almost 100% in India1 as compared to a much lesser
rate in developed countries such as Australia (87.2%)2,
Corresponding author:
Pallavi Yaduka
Student
Saveetha Dental College and Hospitals
162, Poonamallee high road, Chennai- 600077
Email: pallavi.yaduka@gmail.com
Denmark (50%)3. Back and neck are commonly affected
in dentists4 followed by shoulder, wrist and hand pain.
Therefore, measures for educating the dentists about
the adverse effects of incorrect posture and ergonomic
are necessary to prevent decline in work performance
and the incidence of work related musculoskeletal
disorders among dentists1.
MATERIALS AND METHOD
Extensive search was done in PubMed and Google
scholar using the keywords musculoskeletal disorders,
dentists, ergonomics and specialist dentists. Articles
that were published in English language from 1991 to
2013 were searched. Of all the articles listed only 25
most relevant articles were chosen and the prevalence
of musculoskeletal disorders among dental
professionals around the world is discussed in detail.
Prevalence and Incidence of Work Related
Musculoskeletal Disorders among Dentists
Various studies have been conducted across the
world in different populations and the incidence of

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 82 Indian Journal of Contemporary Dentistry, January-June 2014, Vol. 2, No. 1
musculoskeletal disorders in dentists was found to be
nearly 100%1 after the age of 45 years2.
A systematic review of musculoskeletal disorders
among dental professionals by Hayes M et al says that
most commonly pain occurs in the back (36.3-60.1%)
and neck (19.8-85%)4.
In a study conducted in China, female students are
shown to present higher risk of musculoskeletal
disorders than male, especially those who specialize
in alveolar surgery. Shoulders (50.8%-65.1%), neck
(47.5%-69.8%), upper back (25.6%-46.5%) and lower
back (27.1%-51.2%) were the regions most commonly
reported with musculoskeletal disorders.
Prosthodontists suffer more of wrist disorders than
other specialities and surgeons suffer more of knee
disorders due to standing for long hours. Periodontists
reported more severe symptoms in neck, upper back
and lower back compared to others. Neck, shoulders
and upper back are more commonly affected in
Endodontists. Risk of developing musculoskeletal
disorders is higher in Endodontists and Orthodontists
at an earlier age5.
According to another study conducted in Alberta,
Canada, among Orthodontists, 59% of them had lower
back pain, 56% had neck pain, 47% had problems in
the shoulder. 52.4% were affected at the time of study.
No correlation was found between age, sex, years of
work or number of hours of work6.
In another study conducted in Andhra Pradesh,
India, results showed that 52% neck disorders, 26%
wrist disorders, 29% shoulders and 41% of lower back
problems occurred.68% males were affected. 90% of
them were less than 45 years. 100% incidence of
musculoskeletal disorders was found in Orthodontists
and Oral physicians. 28% Prosthodontists were
affected and 60% of general dental practitioners were
affected2.
Study by Vijaya K Kumar et al showed an overall
one year period prevalence rate of 100% for work
related musculoskeletal disorders among Indian
dentists. The symptoms present were pain (99.06%),
stiffness, fatigue. The regions affected were neck
(75.74%), wrist/hand (73.13%), lower back (72.01%),
shoulder (69.4%), hips (29.84%), upper back (18.65%),
ankle (12.31%) and elbow (7. 46%). Recurrent
symptoms were present in 76.11 %1.
Studies in Iran showed that the operative dentists
have the highest incidence of musculoskeletal
17. Pallavi --81--.pmd 82
disorders followed by Endodontists, Prosthodontists,
Oral surgeons and then Periodontists. Doctors
specialized in oral pathology and oral medicine are
least affected. Prevalence of neck pain was 43%,
followed by back pain 38%, shoulder and wrist pain
25%. Work related musculoskeletal pain was more
common in dentists after 35-50 years of practice.7.
A study of all liscensed dentists of Lithuania
concluded that fatigue and musculoskeletal problems
had a negative impact on their work performance.
84.9% of the affected population were females and
15.1% were males. Prevalence of musculoskeletal
disorders was 86.5% among general dentists. Their
mean work experience was 21.41 years. 91% dentists
suffered from back pain. Chronic headache manifested
in 88.7% of the dentists8.
Melanie J Hayes et al did a study on
musculoskeletal disorders and symptom severity
among Australian dental hygienists. The study showed
that the victims to musculoskeletal disorders were
predominantly females (96.1%). The dental hygienists
in Australia reported neck pain (85%) more frequently,
followed by shoulder pain (70%) and lower back pain
(68%)9.
Prevalence and correlates of musculoskeletal
disorders among Australian dental hygiene students
by Hayes MJ et al showed that the neck ( 64.29%) was
most commonly affected followed by back (57.94%)
and shoulder regions (48.41%). Working 6-10 hours
long was a risk factor10.
Another study done by Omid Aminian et al on the
musculoskeletal disorders in female dentists and
pharmacists showed that the female dentists were at
higher risk of developing musculoskeletal disorders
particularly in the neck, upper back and upper
extremities. The incidence is higher in young dentists11.
Study by Anna Kierklo et al in Poland, showed that
majority of the dentists who suffered from
musculoskeletal disorders didn’t have an assistant.
33% worked without any break, 36.4% of the dentists
had one break and only 8% had a short rest break. Over
92% of the dentists suffered from musculoskeletal
disorders especially in the neck (47%), lower back
(35.1%), discomfort in hands and fingers (29%), hip
joint disorders (23.3%), shoulders (20.1%), wrists
(18.3%), pain in knees, feet and elbows (15-16%). More
females experienced pain in the fingers and more males
experiences pain the lower back region. Most disorders
were reported after 9-10 years of practice12.
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 Indian Journal of Contemporary Dentistry, January-June 2014, Vol. 2, No. 1 83
Study by Kwai Yee Chew et al in a dental school in
Malaysia, showed that 93% of the clinical year students
reported with work related musculoskeletal disorders.
Among the 93%, higher number of females reported
with pain. The neck and lower back pain were more
frequently reported with prevalence rate of 82% and
64% respectively. Majority of them (92%) did not
participate in workshops related to ergonomics in
dentistry and around 77% of them did not know about
the treatment for work related musculoskeletal
disorders13.
Dajpratham et al conducted a study on the
prevalence and associated factors of musculoskeletal
pain among the dental personnel in a dental school in
Bangkok and concluded that cervicobrachial type of
musculoskeletal pain was most common among dental
personnel in Bangkok with the mean age of 33+/- 9
years old. The results were as follows: shoulder pain
72.2%, neck pain 70.3%, lower back pain 50.6%14.
A study by Abiodun solanke et al in Nigeria
showed that in males the prevalence of neck pain was
83.2% and back pain was 86.9%. In females the
prevalence of neck Pain was 80.6% and back pain was
89.3%. Working hours of females were more affected
than that of males due to musculoskeletal disorders15.
A study conducted on the prevalence of
musculoskeletal disorders in dentists in Greece
showed that lower back pain was most frequently
reported (46%). Complaints of neck and shoulder pain
were less prevalent than back pain. The dentists had
worked for 18.5 years approximately. Age was not a
factor and females were more affected as they
commonly took leave from work16.
Rundcrantz BL, in his study, pain and discomfort
in the musculoskeletal system among dentists showed
that female dentists were more commonly affected
than male dentists. Only 17% of dentists reported with
no pain or discomfort17.
A five year follow up study on musculoskeletal
disorders among female dental personnel showed that
dentists commonly reported with shoulder, wrist and
hip pain. People who left the profession showed
higher prevalence of combined symptoms from several
body regions. Those who remained in the profession
had increased risk of developing symptoms in
shoulders and hands18.
Review by S J Booyens et al on the musculoskeletal
disorders among practicing South African oral
17. Pallavi --81--.pmd 83
hygienists showed that 75.2% of general dental
practitioners and 40.5% of dental specialists suffered
from musculoskeletal disorders. 70.2% of dental
specialists were orthodontists. Their mean age was 30-
39yrs. Excessive hand scaling and removal of heavy
calculus was associated with hand and shoulder
symptoms19.
Karmen et al in his study showed that 79.8%
dentists in Barcelona (Spain) experienced
musculoskeletal disorders. Women were more severely
affected. Only 34% took preventive measures20.
Study in Colombia, South America showed that
63% of female dentists were affected and 37% males
were affected. 80% of them were in clinical practice.
89% of them varied the working posture, 67%
frequently changed positions, 13% did stretching
exercise. 15% reported with neck pain, 13% cervical
dorsal pain, 6% arm and forearm pain21.
Dayakar et al showed that 93.87% of the dentists
reported with atleast one symptom of musculoskeletal
disorders. Limitations to work were caused by 45.83%
of males. The prevalence of back pain was 67.34%, neck
(59.81%), hand (34.69%), shoulder (32.65%), wrist
(30.61%), hip/thigh (20.40%), ankle (18.36%) and knee
(16.32%) 3.
The prevalence of musculoskeletal disorders
among dentists in Denmark is (50%)3, United States is
(53%)3, Saudi Arabia is (59.2%)2, Australia (87.2%)2,
Lithuania (86.5%)2,8 and Turkey (94%)2 .
CONCLUSION
Musculoskeletal disorders are one of the major
problems affecting health care professionals. 20-30%
of the world population is affected by work related
musculoskeletal disorders 1 and the prevalence of
musculoskeletal pain ranges from 64% - 93% in
general4,22,23. Musculoskeletal disorders are the most
common reason for early retirement age (29.3%) of
dentists throughout the world24. The prevalence of
shoulder pain is 20.1%-72.2%, neck pain 15%-85%,
upper back pain 18.65%-46.5%, lower back pain 35.1%-
91%, wrist and arm pain 6%-73.13%, hip discomfort
20.40%- 29.84% and ankle and feet pain is 12-15%
approximately from the above reviewed articles.
Endodontists and Orthodontists are most
commonly affected whereas Oral pathologists and Oral
medicine specialists are least commonly affected7. It
can affect the performance of work. In dentistry
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 84 Indian Journal of Contemporary Dentistry, January-June 2014, Vol. 2, No. 1
musculoskeletal problems arise due to incorrect
standing or sitting posture or due to standing in the
same posture for long time. The victims to
musculoskeletal disorders were predominantly
females. Majority of the dentists who suffered from
musculoskeletal disorders didn’t have an assistant and
worked without any break12. Most disorders were
reported after 10 years of practice. The number of
hours spent on work is directly proportional to the
severity of musculoskeletal pain23. Diabetes mellitus,
rheumatoid arthritis, recent pregnancy, hormonal and
anti-inflammatory medications can contribute to early
development of musculoskeletal disorders19. The use
of hand piece and vibratory instruments with pinch
grip, force, number of patients treated per day, number
of years of experience, monotonous work, visual
fixation, posture, psychological stress, ergonomic
factors, presence or absence of assistants are
predisposing factors to musculoskeletal disorders19.
Necks flexed to 60 degrees or more, trunk flexed to 30
degrees or more and one shoulder abducted caused a
mechanical disadvantage of muscles with respect to
their joints as they required high muscle force to hold
these positions19.
Ergonomic factors such as supports for upper limb,
adjustable backrest, instruments with long handles,
mechanically adjustable chair, indirect vision and
proper illumination can help to prevent
musculoskeletal disorders20. The successful application
of ergonomics ensures high productivity, increased
satisfaction among workers and avoidance of illness
and injuries22. Unsuccessful application of ergonomics
can lead to work related musculoskeletal disorders22.
Good ergonomic design of tools, processes and
furniture improves personal comfort, health, morale,
productivity and readiness22.
Prevention and rehabilation is recommended by
regular physical exercise, stretching and aerobic
exercises20. Stretching of muscles is helpful in relieving
pain20. Improvements of functional parameters and
increase in work productivity were recorded in dentists
who followed physical therapy25. The prevalence and
severity of musculoskeletal disorders decrease by
performing regular exercises23. There is an increasing
trend of dentists being treated by physiotherapists for
musculoskeletal disorders23. The physical therapy
advice included posture correction, ergonomic advice,
stretching exercises23.
Awareness among dentists about these and
following the correct preventive measures is still
17. Pallavi --81--.pmd 84
lacking. Dentists must be educated about the
importance of ergonomics, correct posture, prevention
and treatment of musculoskeletal pain. “Prevention is
always better than cure”.
ACKNOWLEDGEMENTS
We would like to thank Dr. N.M. Veeraiyan,
Cancellor, Saveetha Dental College and Hospitals and
Dr. Deepak Nallaswamy, Director of Academics,
Saveetha Dental College and hospitals for their
encouragement and support in completion of this
article.
Conflict of Interest: There is no conflict of interest as
this is a review article.
Source of Funding: There is no source of funding as
this is a review article.
Ethical Clearance: Ethical clearance is not required as
this is a review article.
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