Prevalence of Ocular Injuries, Conjunctivitis and Musculoskeletal Disorders-Related Issues as Occupational Hazards Among Dental Practitioners in the City of Salem: A Randomized Cross-Sectional Study.

BACKGROUND: Similar to several other occupations, dentists are also stricken by bounteous occupational health hazards (OHHs) such as musculoskeletal disorders (MSDs) and ocular health-related issues. AIMS: The aim of this study was to evaluate the diffusion of MSDs and ocular health-related issues among dental surgeons in Salem city, Tamil Nadu, India, according to age, sex, and number of practicing hours per week.
OBJECTIVES: A survey was conducted to examine the rate of prevalence of these OHHs amidst the dental surgeons in Salem city.
MATERIALS AND METHODS: The study was performed through a questionnaire amidst 150 dentists practicing in Salem City, Tamil Nadu, India. Dental surgeons were questioned about any occupational disorder that they had experienced related to a musculoskeletal pain and its location whether in the back, upper limbs, or lower limbs. In extension to this, dental surgeons were asked about any ocular injury that they had.
RESULTS: MSD showed higher rate of occurrence correlated to ocular health-related issues.
CONCLUSION: The practice of protective measures is crucial, in perspective of the high rate of these disorders in the community of dental surgeons.

INTRODUCTION

Endowing to the World Health Organization, health is a state of physical, mental, and social well-being. An occupational threat is something undesirable that you may go through or experience as a consequence of doing your task.

As in any other laboring atmosphere, dental practice can be linked with adverse effects to dental surgeons, attributed to as occupational health hazards (OHHs). Dental surgeons and their units are exposed to a number of occupational hazards. This leads to numerous ailments specific to the profession, which advance and aggravate with years.

These OHHs can be broadly classified into biological (close contact with patients, infectious bio-aerosols, and blood); physical (burns and scalds from autoclaves, vibrational injury, and eye and ear injury); chemical (toxicity, hypersensitivity, and allergy due to dental materials); contact dermatitis; and ergonomic risks such as musculoskeletal disorders (MSDs),varicose veins, hemorrhoids, and carpal tunnel syndrome.[1]

The common OHH seen in dentists is MSD caused by awkward position (both while standing and sitting close to a patient), which ultimately leads to overstress of the spine and limbs. This refers to the 37.7% of the work period. The overstress yields a negative reaction on the musculoskeletal system and the peripheral nervous system; above all, it affects the peripheral nerves of the upper limbs and the neck nerve roots.[23]

They are represented by the existence of pain, stiffness, and neurological features such as tingling, paresthesia, muscle weakness, discomfort, disability, or constant pain in the joints, muscles, tendons, and other soft areas.[4]

A constrained operational space with artificial lighting leads to eyestrain, conjunctivitis, blurred vision, or shortsightedness. Ocular injuries may have harmful and long-term effects. Manifestations of direct mechanical trauma commonly relate to the degree and type of trauma, and include pain, lacrimation, and blurring of vision. However, mild signs may camouflage a potentially blinding intraocular foreign body. Nonionizing radiation has grown into a serious affair with the usage of blue light and ultraviolet light to cure various dental materials. Exposure to the radiations given out by these can harm various structures of the eye, including the retina and the cornea.[56] Regular use of safety glasses and pertinent shields can minimize or eliminate the radiations in this regard.

As the additive effects of these OHHs are harmful, there is demand for realization against these problems in the overall interest of the dental surgeons’ health, which is important for his/her productivity.

Thus, this study was executed to evaluate the prevalence of MSDs and ocular health–related issues among dental practitioners in Salem, Tamil Nadu, India.

MATERIAL AND METHODS

This study comprised a population of dental surgeons who are sustaining clinical practice in various areas of Salem city. The details were collected with the aid of a self-administrated questionnaire that involved questions on personal data, information about occupational hazards and measures taken, and the experience of occupational hazard while in practice. The questionnaire included details on the areas of manifestation of MSD, whether it interfered with their usual work and compelled the dental surgeons for engrossing sedatives or consulted medical help. An identical questionnaire for checking work-related stress, fatigue, ocular injury, conjunctivitis, etc., was also integrated in the questionnaire. All data were entered into the computer and analyzed by means of SPSS software, version 16.0, for Windows. Statistical analysis was performed with results on continuous measurement presented as mean ± SD (Min-Max), and significance was evaluated at 5% level of significance. Chi-square/Fisher tests were used to find the significance of the study parameters.

RESULTS

This study involved a population of 150 dental surgeons. The dental practitioners with age groups between 36 and 46 years exhibited highest rate of OHHs, that is, 28.6%, compared to other age groups of 24–30, 41–50, and 51–60 years. The study sample showed higher frequency for males 54.37% than females (45.65%). The 75 dentists who had been practicing for last 510 years showed prevalence rate of OHH as 42.6%. Dentists who had been practicing for 10–20 years showed this rate as 20.36% and those practicing for more than 20 years showed as 4.58%.

Longer working hours were exhibited by highest number of dental surgeons (54.35%), that is, those who worked for 6–8 h/day, whereas 22.46% worked for 1–5 h/day, 23.06% for 9–12 h/day and only 1.05% worked for longer than 12 h/day. In this study, 94.68% of the dental practitioners liked to practice in sitting position, whereas 24.56% preferred standing while working.

In our study, 52.35% of the dentists were having pain in the lower back region [Table 1]. The percentages of the dental surgeons who had pain in the neck, shoulder, upper back, wrist/hand, arms/forearms, and hips/thighs were 53.84%, 26.35%, 13.74%, 8.36%, 5.06%, and 1.74%, respectively. However, 16.08% of the dentists did not report any pain recently. The results are described according to each group in which eye protection is required and the complications that resulted from inadequate protection.

Table 1

Prevalence of different musculoskeletal pain among dentists

Work experience	Neck	Shoulder	Lower back	Upper back	Wrist	Arms/forearms
5 years, n = 41	16 (41.4%)	6 (17%)	21 (53.6%)	7 (17%)	5 (14.5%)	4 (7.3%)
6–10 years, n = 75	38 (51.7%)	22 (26.3%)	36 (46.5%)	11 (16.7%)	3 (5%)	2 (1.4%)
11–15 years, n = 29	12 (5.09%)	14 (44.7%)	14 (55.3%)	3 (7.5%)	3 (14.7%)	6 (18.6%)
16–20 years, n = 25	3 (40%)	3 (40%)	4 (80%)	0	0	0
P value	0.711	+0.073	0.494	0.583	0.226	0.015**

Significant P (P < 0.001); ** highly significant (P < 0.001); + Very highly significant (P < 0.001)

Ocular injury–related issue was shown by 52.6% of the dental surgeons in our study followed by conjunctivitis (27%), corneal abrasion (5%), retinal lesion due to chemical injury (4.3%), and cataract (1.3%). However, 33.57% dentists did not experience any of the ocular injury–related issues [Table 2]. Our study showed overall occurrence of MSD and ocular injury as 81% and 54.3%, respectively.

Table 2

Prevalence of ocular injury among dentists with age

Work experience	Conjunctivitis	Corneal burn	Retinal lesion	Cataract
5 years, n = 41	20.07 (31%)	11.14 (14.6%)	4.24 (9%)	4.11 (4.8%)
6–10 years, n = 75	40.32 (43.0%)	30.11 (27.9%)	0	3.21 (3.9%)
11–15 years, n = 29	22.14 (44.4%)	13.06 (35.4%)	0	1.17 (3.7%)
16–20 years, n 25	4.06 (50%)	3.04 (30%)	0	0
P value	0.156	0.054**	+ 0.006	0.570

Significant P (P < 0.001); ** highly significant (P < 0.001); + very highly significant (P < 0.001)

DISCUSSION

The occupational hazards that are seen among dentists consisted of ample amount of danger. Awareness and realization about these risks is necessary. Dentistry is commonly observed as higher threat than any other occupation. This is exhibited from other studies performed.[4] Operator’s eyes are at danger from both acute and cumulative effects of back-reflection of blue light, which can lead to phototoxic and photoallergic reactions. Even though many polymerization units are factory equipped with filters that reduce harmful light, simple precautionary measures such as radiation filtering protective goggles, glasses, or shields are highly desirable.[7] Burnout is observed to be higher amidst general dental practitioners and oral surgeons as compared to other specialties.[8] The higher count of burnout may be liable with some facets of their working pattern. According to our findings, musculoskeletal problems occur in initial years of dental career. The increased occurrence of MSD may be due to lack of awareness of ergonomic principles and restlessness atmosphere.[9]

Among muscular disorders, 52.3% had several types of aches such as in lower limb, wrist, and back.

This is in agreement with a study conducted in Greece where 66% of dentists were affected by these problems.[10]

Therefore, worldwide musculoskeletal problems exhibited highest frequency amidst dentists, with a recorded prevalence of 48%51%.[11] The musculoskeletal disorders are commonly been associated with dental treatment since there is constant single movement of the arm which exerts pressure on the wrist and elbow.[12]

CONCLUSION

Occupational hazard in the dental field displayed a serious threat that should be considered. Dental practitioners should be conscious of their operating posture including thorough protection of themselves while working.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.