Each profession has its own specific working conditions, some of which are more or less risk factors for the health. Musculoskeletal disorders (MSDs), which are associated with risk factors in professional practice, are becoming increasingly common. These factors apply fully to the dentists.

WHO definition of MSDs:

The term musculoskeletal disorders denote health problems of the locomotor apparatus, i.e. of muscles, tendons, the skeleton, cartilage, ligaments and nerves. Musculoskeletal disorders include all forms of ill-health ranging from light, transitory disorders to irreversible, disabling injuries.

Distribution among dental professionals

In a 1946 study, Biller found that 65% of dentists complained of back pain. Even after the transition to a sitting posture and the development of modern ergonomic equipment, studies have shown frequent manifestations of neck, back, shoulder and arm pain that range between 60% and 81%. (2)

In her book "Practice Dentistry Pain-Free: Evidence-based Ergonomic Strategies to Prevent Pain and Extend Your Career ", Bethany Valachi provides sample data from USA that shows the economic importance of the problem. (7) Almost 30% of the dentists who retire early do so as a result of MSDs (3), with 14% acquiring disabilities before the age of 45. (4) More than 70% of dental students complain from the MSDs as early as the third year of their follow-up. (6)

In his book "Musculoskeletal Disorders in Dentists Related to Dental Practice and Their Prophylaxis" Dr. Peter Georgiev Bozhinov presents data for Bulgaria which shows that the incidence of pain due to MSDs among dental doctors is high (81.87%) and women suffer from MSDs (87.16%) significantly more than men (72.24%). (1)
Numerous studies in dental medicine make it clear that every member of the dental team is prone to pain or injury in different parts of the body, depending on the position they occupy.

Types of musculoskeletal disorders and their symptoms:

• Lower back pain, lumbar region - may be caused by stretching or unstable postures due to weak positioning muscles, intervertebral facet joints with reduced mobility, degeneration or herniation of the intervertebral discs.
• High back pain, chest area.
• Neck and shoulder pain.
• Tension neck syndrome - pain, stiffness and tenderness in the neck and m. trapezius and muscle spasms. The occurrence factor is the tilted head - a problem that is common in dentists due to long-term work in a non-physiological posture involving the bending and rotation of the head in an unbalanced forward position for better visibility into the operative field during treatment. If more than 75% of the time working with more than 15° of neck flexion may be a risk for developing MSDs, and dentists spend more than 82% of their time working with flexion greater than 30°. (5)
• Neck instability - A forward-facing posture causes instability in the cervical vertebrae and can lead to a flattening of the cervical curve. With contracted muscles and tendons, the new position of the head results in increased compression of the discs, which increases the risk of injury and herniation. The cervical muscles are in a state of spasm and can become inflamed as they work in a state of emergency to keep the head in a forward position. The forward position can lead to cervical spondylosis and degenerative conditions, spinal cord compression, stiffness and numbness of the hands.
• Impact of rotator cuff - gradual wear of the m. supraspinatus tendon, which passes between humerus and acromialis due to frequent arm raises and shoulder abduction. Frequent shoulder abduction causes micro-rupture of the rotator cuff from excessive use. Abduction of the shoulder more than 30 degrees causes ischemia, which dentists are prone to.
• Myalgia of m. trapezius includes pain, cramps and trigger points at the top of the m. trapezius on the side of the arm, retracting with the dental mirror. The pain is localized to one side of the neck and can be felt as pain behind the eye.

Written by

Bozhinov P., DMD, PhD

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Nikolova D. - Dental Student

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References:

1. Божинов, П. Мускулно – скелетни разстройства при лекарите по дентална медицина, свързани с денталната практика и тяхната профилактика
2. Biller FE, Occupational hazards in dental practice. Oral Hyg 1946; 36: 1994
3. Burke FJ, Main JR, Freeman R. The practice of dentistry: an assessment of reasons for premature retirement. BrDentJ 1997; 182(7):250- 4
4. Back and cervical disabilities sideline dentists most often. Chicago, 111.: ADA News- Dec 2005;8.
5. Hedge, A. http://www.ergostereonline.com/back-care.dentists.html
6. Rising DW, Bennett BC, Hursh K, Plesh O. Reports of body pain in a dental student population. JADA 2005;136:81-86.
7. Valachi B. Practice dentistry pain free, strategies to prevent pain and extend your career, 2008