Assessment of Knowledge and Practice of Ergonomics among Dental Practitioners in Riyadh City in Saudi Arabia.

Aim: The present study was undertaken to assess the knowledge and practice of ergonomics among dental practitioners in Riyadh, Saudi Arabia. Methodology: A self-administered questionnaire was distributed among dental practitioners through Google Forms. Link of the questionnaire was sent through social media and e-mail. The questionnaire was focused on the awareness of ergonomics and practice of ergonomics during dental practice.
Results: About 97.9% of participants are aware of different operating positions. About 71.7% of participants rate their operating procedure chair positions as good. 52.5% admit they feel numb fingers while working. Many questions were statistically significant according to educational qualification and type of practice (P < 0.050.
Conclusion: Majority of the study population were aware of proper chair positions, correct operating procedures and were practicing four-handed dentistry, maintained proper back support while working, and even performed stretching exercises during clinical working hours. Copyright:

INTRODUCTION

Dentistry is a branch of medicine that specializes with the diagnosis, prevention, intervention, and follows up of diseases and disorders of the oral cavity and associated maxillofacial structures. The clinical procedural work of a dentist does not only limit to teeth but also involves craniofacial complex such as the temporomandibular joint and other supporting anatomical structures.[1] Musculoskeletal disorder (MSD) prevalence among dental staff is high.[1] Center for Disease Control and National Institute of Occupational Safety and Health defines MSD as soft-tissue injuries that are caused by sustained or sudden to repetitive movements, vibration, force, and awkward positions, which can affect the nerves, tendons, muscles, joints, and cartilage in the limbs, neck, and lower back.[2]

As MSD comprises broad spectrum of degenerative diseases affecting muscles and tendons and nerves, invariably causes pain and difficulty in functioning, specifically in the neck, lower back, shoulders, elbows, hands, and associated structures.[3]

MSDs induced by professional procedures have become more prevalent. They predominantly faced in practices requiring repetitive, forceful, or prolonged exertions of the extremities and prolonged awkward postures. The level of risk greatly depends on the intensity, frequency, and duration of the exposure to the aforementioned scenarios.[4]

According to the WHO, there are more than 59 million health-care workers who are exposed to a wide range of occupational hazards which increase the incidence of work-related diseases and injuries that affect the physical, emotional, and economic aspects of health-care workers and their families.[5]

Work-related MSDs (WMSDs) are basically associated with many different professions. Prevalence can be reduced by concentrating on ergonomics.[4] Dental practitioner, while performing the procedure requires long-standing, asymmetric positions such as rotating the head laterally with the arms extended out of the body leading to exhaustion and strain of supporting joints and muscles (back), which trigger a symptoms of back and neck pain.[6] As dental practice requires to perform repetitive motions with uncomfortable, unsupported static positions, this study aims to assess work-associated MSDs among dentists.

Objectives

The objective of this study was to assess knowledge and practice of ergonomics among dental practitioners in the Riyadh region kingdom of Saudi Arabia.

MATERIALS AND METHODS

A cross-sectional study was performed to analyze professional practice-related ergonomics among dentists working in the Riyadh region, Saudi Arabia.

The need of the study was explained and received consent for the same. Official permission was taken from College of Dentistry, Prince Sattam Bin Abdulaziz University. Based on the detailed analysis of literature, structured questionnaire was framed with the assistance and guidance of panel of academic experts to achieve validated and relevant questionnaire.

A total of 380 dental professionals were involved for the survey. Dentists who previously had history of any chronic systemic inflammatory diseases, who underwent any surgery involving administration of spinal anesthesia or any history of major trauma in <1 year were excluded. Informed consent was availed from all participants. Questionnaire was structured to have 12 total questions emphasizing on assessment general awareness, level of understanding, application, and need for further training. Link containing the questionnaire was sent through social media and e-mail, and participants were requested to fill the questionnaire and send it back. The consent form was included in the questionnaire. A total of 500 questionnaires were distributed, of which 380 were included in the study for the analysis.

Statistical analysis

Statistical analysis was performed using SPSS version 23, IBM SPSS Statistics for Windows, (IBM Corp., Armonk, N.Y., USA). Chi-square test was used for comparing awareness and practice of ergonomics according to age, gender, and education according to the year of the study. Results were expressed as numbers and percentages. A P value of P < 0.05 was considered to be statistically significant.

RESULTS

Among 380 dentists, 247 were male and 138 were female, with 159 of them were <30 years of age and 146 between 30 and 50 years and 80 of them were elderly who have crossed 50 years, 189 among the participants held bachelor degrees, where 110 of them had procured masters in different specialties of dentistry, and 86 were Ph.D. holders. Two hundred and fourteen of them were having <5 years of experience and 171 of them had experience more than 5 years, further 221 among participants were general dental practitioners, and 164 of them were specialists specifically practicing their respective specialties [Table 1].

Table 1

Demographic characteristics of study population

	Frequency (%)
Gender
Male	247 (64.2)
Female	138 (35.8)
Age group (years)
<30	159 (41.3)
30-50	146 (37.9)
>50	80 (20.8)
Education
Bachelors	189 (49.1)
Masters	110 (28.6)
PhD	86 (22.3)
Year of practice
<5	214 (55.6)
>5	171 (44.4)
Type of practice
General practitioners	221 (57.4)
Specialist	164 (42.6)

When 380 participants were assessed for knowledge and practice of ergonomics, 97.9% of participants were aware of different operating positions for surgical and nonsurgical procedures, whereas 2.1% of participants were not knowing. Eighty percent of the participants think they follow correct operating procedures and positions while working, where 2.3% among participants responded as no. 71.7% of participants rate their operating procedure chair positions as good, whereas 21% of them agreed it to be average and 2.3% of them accepted it as poor. Ninety-three percent of participants work with assistants performing four-handed dentistry, where rest worked without any assistants. 57.7% of participants experienced back and shoulder pain always, whereas 39.8% experienced it sometimes, and only 2.9% of participants did not have any such experiences. Ninety percent of the agreed that they do regular neck exercises, and 71.9% of the participants rest their feet on the ground while working with only 66.8% of dentists were sure of resting the back while working. Nearly half of the participants comprising 52.5% admit they feel numb fingers while working. In this study 77.4% of participants were aware of how to practice stretching exercises also they have adapted it during clinical hours. 91% of participants exhibited their willingness to adapt ergonomic principles in prospectively inheriting it to tools and equipment used in routine dental practice and 95.1% of the participants expressed positivity to obtain information and training about ergonomics [Tables 2 4].

Table 2

Response of study participants on knowledge and practice of ergonomics

Question	Age	Number	Percentage
Are you aware of different operating procedures for surgical and nonsurgical procedures	Yes	377	97.9
	No	8	2.1
Do you follow correct operating procedures while working	Yes	308	80.0
	No	9	2.3
	Don’t know	68	17.7
how well do you rate your operating procedures chair positions	Good	276	71.7
	Average	100	21.0
	Poor	9	2.3
Do you work with an assistant	Yes	361	93.8
	No	24	6.2
How often do you experience back, neck, and shoulder pain postprocedure	Always	222	57.7
	Sometime	152	39.5
	Never	11	2.9
Do you perform neck/shoulder exercises	Yes	347	90.1
	No	38	9.1
Do you feel numbness in your fingers while working	Yes	202	52.5
	No	137	35.6
	Sometime	46	11.9
Do you make it a point to rest your feet on ground while working	Yes	277	71.9
	Sometime	94	24.4
	Never	14	3.6
Do you make it a point to rest your back while working?	Yes	257	66.8
	Sometime	106	27.5
	Never	22	5.7
Are you aware of stretching exercises which can be done in clinical hours?	Yes	298	77.4
	No	87	22.6
How often do you ergonomic principles before purchasing work materials, tools or equipment	Always	188	48.8
	Sometimes	164	42.6
	Never	33	8.6
Do you think information and training about ergonomics will be useful	Yes	366	95.1
	No	19	4.9

Table 4

Comparison of demographic factors with response related to ergonomic practice by the dentists

Question	χ2, P
	Year of practice	Type of practice
Are you aware of different operating procedures for surgical and nonsurgical procedures	1.08, 0.47 (NS)	1.32, 0.29 (NS)
Do you follow correct operating procedures while working	5.56, 0.06 (NS)	10.47, 0.05 (S)
how well do you rate your operating procedures chair positions	4.61, 0.099 (NS)	24.47, <0.001 (HS)
Do you work with an assistant	7.98, 0.005 (S)	1.88, 0.20 (NS)
How often do you experience back, neck, and shoulder pain postprocedure	3.99, 0.13 (NS)	1.09, 0.57 (NS)
Do you perform neck/shoulder exercises	5.59, 0.024 (S)	0.168, 682 (NS)
Do you feel numbness in your fingers while working	1.85, 0.39 (NS)	11.24, 0.004 (S)
Do you make it a point to rest your feet on ground while working	9.39, 0.009 (S)	0.510, 0.775 (NS)
Do you make it a point to rest your back while working?	4.79, 0.09 (NS)	6.93, 0.031 (S)
Are you aware of stretching exercises which can be done in clinical hours?	1.91, 0.17 (NS)	2.230, 0.141 (NS)
How often do you ergonomic principles before purchasing work materials, tools, or equipment	7.65, 0.022 (S)	9.79, 0.007 (S)
Do you think information and training about ergonomics will be useful	2.65, 0.154 (NS)	0.002, 1.000 (NS)

S: Significant, NS: Nonsignificant, HS: Highly significant

DISCUSSION

Ergonomics is a science which deals with working environment and human capabilities. Basic strategy of ergonomics is to enhance the professional works to perform task competently causing less discomfort. The uncomfortable and nonstatic position can lead to complex professional related MSDS that can lead to loss of productivity.[78] Among dentists, it is true that with repetitive actions in unsupported positions for extended periods of time can lead to the development of chronic WMSDs, which can make practicing difficult for a professional.[1] It is also noted that four-handed dentistry is best-implemented way to execute the dental procedures with minimizing discomfort and also it is known that posture has a significant role in developing MSDS in dentists where orthostatic posture should be encouraged to minimize the risk.[910] Consistent fact has been noted that MSDS is more commonly associated with females when compared to males, probably related to lesser muscular tone, strength, and hormonal factors.[111213] Moreover, working time is also vital aspect, where dentists who continuously worked for long hours develop WMSDs when compared.[14]

In the present study, it is found high prevalence with the fact that 57.7% of working dentists always experienced back, neck, and shoulder pain whereas 39.5% sometimes had pain episodes provides evidence of the association of MSDS with dental procedures. The finding is consistent with various studies conducted around the globe.[14151617] Majority of the participants were aware of operating positions for surgical and nonsurgical procedures and followed accurately. About 93.8% of the participants worked with assistants to achieve four-handed dentistry to minimize the risk of development of MSDs. Further, in the present study, high prevalence of chronic pain in the neck, shoulder, and back was noted even though they were aware of resting the back while working to maintain the lower back curve which can prevent lower back pain and in addition 77%, which comprises the major study population knew stretching exercises, the practice of that was imparted during working hours.

On the further assessment of the present study, it is noted that the majority of the study population were ware of proper chair positions, correct operating procedures and plasticized four-handed dentistry, maintained proper back support while working, and even performed stretching exercises during clinical working hours. Despite all above-mentioned facts, it is evident that high prevalence of MSDS exists among the dental fraternity probably associated with long-standing working hours, nonstatic working positions, unsupported stature, repetitive uncomfortable movements, and actions demanded by various specialty procedures makes dentists more prone for the development of MSDS. Dentist's needs to follow the basic health and safety principles along with imparting positive lifestyle changes involving regular physical exercises during working and nonworking hours, and fraternity should impart ergonomics and its basic principles in academics or through educational programs to make skilled dental professionals more aware to promote practical implementation.

Financial support and sponsorship

Self-sponsored.

Conflicts of interest

There are no conflicts of interest.

Table 3

Comparison of demographic factors with response related to ergonomic practice by the dentists

Question	χ2,P
	Age	Gender	Education
Are you aware of different operating procedures for surgical and nonsurgical procedures	2.58, 0.27 (NS)	1.93, 0.26 (NS)	0.58, 0.74 (NS)
Do you follow correct operating procedures while working	10.14, 0.03 (S)	1.02, 0.59 (NS)	23.14, <0.001 (HS)
how well do you rate your operating procedures chair positions	33.93, <0.001 (HS)	5.22, 0.07 (NS)	28.41, <0.001 (HS)
Do you work with an assistant	3.76, 0.15 (NS)	3.73, 0.053 (NS)	7.01, 0.03 (S)
How often do you experience back , neck and shoulder pain postprocedure	1.45, 0.83 (NS)	8.16, 0.017 (S)	10.35, 0.035 (S)
Do you perform neck/shoulder exercises	4.70, 0.09 (NS)	0.018, 1.00 (NS)	5.63, 0.06 (NS)
Do you feel numbness in your fingers while working	7.31, 0.12 (NS)	1.70, 0.42 (NS)	9.66, 0.04 (S)
Do you make it a point to rest your feet on ground while working	8.99, 0.06 (NS)	4.27, 0.118 (NS)	6.16, 0.18 (NS)
Do you make it a point to rest your back while working?	4.41, 0.35 (NS)	6.65, 0.036 (S)	1.67, 0.796 (NS)
Are you aware of stretching exercises which can be done in clinical hours?	1.07, 0.58 (NS)	0.043, 0.899 (NS)	11.02, 0.004 (S)
How often do you ergonomic principles before purchasing work materials, tools, or equipment	4.43, 0.35 (NS)	10.72, 0.005 (S)	17.04, 0.002 (S)
Do you think information and training about ergonomics will be useful	3.57, 0.16 (NS)	0.158, 0.809 (NS)	1.17, 0.55 (NS)

S: Significant, NS: Nonsignificant, HS: Highly significant