Susan Parker RDH, B.S., MEd, MBA
Musculoskeletal disorders (MSD) are highly prevalent and represent a significant burden for the dental profession.
This well conducted systematic review, with a large number of studies but overall low sample sizes, suggests that dental health care workers may be at risk for MSD.
Among dental professionals, what is the prevalence of MSD and what are the possible etiological factors?
The authors searched five electronic databases between February and April of 2008. They considered studies, case studies and literature reviews that researched the prevalence of MSD. Only English-language articles were identified.
The authors ultimately included 23 articles in this review. in this review. There is a high prevalence of musculoskeletal pain among dentists and dental hygienists. Pain associated with MSD ranges between 64 percent and 93 percent of the surveyed populations. The most prevalent regions for pain in dentists were the back (36.3 percent-60.1 percent) and the neck (19.8 percent-85 percent) while the hands and wrists were the most prevalent regions for dental hygienists (60 percent-69.5 percent).
There was extensive evidence that musculoskeletal pain is a significant burden (occupational health concern) for dentists and dental hygienists. The reviewed studies demonstrated a high prevalence of musculoskeletal pain in the upper extremities, back and neck.
Source of Funding:
Faculty of Health at the University of Newcastle in Ourimbah, Australia. No outside funding was mentioned.
Importance and Context:
Studies have identified many risk factors associated with MSD in dentistry, including static and awkward postures, repetitive motion and work practices. Available studies assess various regions for musculoskeletal symptoms using different measurement tools. The standardized Nordic Questionnaire appears to be an accepted method of measuring prevalence of musculoskeletal complaints. Studies also use pilot surveys and questionnaires, mostly through self- report methods; however, these can introduce some recall bias.
Strengths and Weaknesses of the Systematic Review:
This review used accepted methods to identify and select studies. Several limitations were identified. The authors did not mention the number of reviewers involved nor did they identify the population size. They only included articles written in English, and made no mention of the specific word combinations and truncations used in their literature search. A meta-analysis could have been attempted, but the authors fail to explain why it was not done.
Strengths and Weaknesses of the Evidence:
This review shows MSD prevalence rates by body site, country and year of publication. Included studies in the review were Australia, Thailand, Sweden, Denmark, Poland, Netherlands, United States and Saudi Arabia, which are not globally representative. The type of studies included, although with significant methodological quality limitations, could be considered of the highest level possible to answer the question. The study dates ranged from 1993 through 2007. The studies could have introduced some bias, as some dentists experiencing pain might have left the profession. If the studies used registries, they may not have identified the real prevalence because of privacy issues.
Implications for Dental Practice:
MSD is a significant issue for the profession of dentistry and dental hygiene. More research and larger representative studies are urgently required to help clearly elucidate the development of musculoskeletal disorders. This will help identify proper measures to prevent MSD. Dental and dental hygiene programs should make it a priority to teach ergonomics to diminish the prevalence of MSD among dental professionals. Dentists and dental hygienists should implement ergonomic practices. Loupes, ergonomic chairs, and lights may aid the dental practitioner to some extent. Exercises that help to strengthen core muscles should be part of a physical fitness regimen.