Professional Documents
Culture Documents
MJ Hayes
D Cockrell
DR Smith
A systematic review of
musculoskeletal disorders
among dental professionals
Authors affiliations:
Melanie J. Hayes, Deborah Cockrell, Discipline
of Oral Health, School of Health Sciences,
Faculty of Health, University of Newcastle,
Ourimbah, Australia
Derek R. Smith, WorkCover New South
Wales Research Centre of Excellence,
School of Health Sciences, Faculty of
Health, University of Newcastle, Ourimbah,
Australia
Correspondence to:
Deborah Cockrell
School of Health Sciences
Faculty of Health
University of Newcastle
PO Box 127
Ourimbah
2258 NSW
Australia
Tel.: (02) 4349 4514
Fax: (02) 4349 4567
E-mail: deborah.cockrell@newcastle.edu.au
Dates:
Accepted 29 September 2008
Introduction
professionals.
159
OVID:
(2). MSD can cause pain in the neck, shoulder, arm, wrist, hands,
1 Musculoskeletal diseases
upper and lower back, hips, knees and feet (2). Musculoskeletal
2 Dental hygienists
3 Dentists
for CINAHL used the same search strategy for Scopus and the
significant issue for the profession (6, 7). Research has recog-
papers.
Study selection
For all of the papers identified by the search strategy, the title
associated with the prevalence of MSD (5, 9). Little research has
text copy was obtained, and these papers were subject to criti-
Search results
Methods
Criteria for inclusion of manuscripts
From these papers, 21 were considered irrelevant for this literature review. Papers were chiefly excluded on the basis that
the study did not measure the prevalence of MSD or possible
risk factors, that the manuscript was not a research study or lit-
to be dentists, dental hygienists or dental students; no restrictions were placed on age, gender, race or socioeconomic status.
Papers that researched the prevalence of MSD and risk factors
for MSD were considered.
Search methods
Results
Prevalence of musculoskeletal disorders
160
Table 1. Musculoskeletal disorder (MSD) prevalence rates by body site, country and year of publication
Body site
Participants
Country
Year
Author
Reference
Any
64
78
78
Dentists
Dentists
Female dental
personnel
Dental hygienists
Dental hygienists
Female dental
health workers
Dental hygienists
Dentists
Dentists
Dentists
Dental hygienists
Dentists
Dentists
Dental hygienists
Dental hygienists
Dentists
Dentists
Dentists
Dentists
Dental hygienists
Dentists
Dental hygienists
Dental hygiene
students
Dentists
Dental hygienists
Dentists
Dentists
Dentists
Dentists
Dentists and
dental hygienists
Dental hygienists
Dentists
Dental hygienists
Dental hygienists
Dentists
Dental hygienists
Dentists
Dentists
Dental hygienists
Dental hygienists
Dentists
Dentists
Dentists
Dental hygienists
Female dental
personnel
Dental hygienists
Dentists
Dental hygienists
Dentists
Dental hygienists
Dentists
Australia
Thailand
Sweden
1997
2000
1999
Marshall et al.
Chowanadisai et al.
Akesson et al.
10
11
12
United States
United States
Sweden
2002
2003
2006
Anton et al.
Anton et al.
Lindfors et al.
13
13
5
United States
Denmark
Australia
Poland
United States
Netherlands
Saudi Arabia
Sweden
Saudi Arabia
Poland
Australia
Netherlands
Netherlands
Sweden
Sweden
United States
United States
2004
1998
2006
2002
2001
2005
2001
1993
2002
2003
2007
2006
2007
1999
2000
2003
2003
Anton et al.
Finsen et al.
Leggat and Smith
Szymanska
Lalumandier et al.
Droeze and Jonsson
AlWazzan et al.
Oberg and Oberg
AlWazzan et al.
Szymanska
Leggat and Smith
Droeze and Jonsson
Droeze and Jonsson
Akesson et al.
Akesson et al.
Anton et al.
Morse et al.
13
3
18
17
19
20
21
22
21
17
18
20
20
12
12
13
15
Denmark
Sweden
Sweden
Australia
Poland
Netherlands
United States
1998
1999
1999
2006
2002
2005
2001
Finsen et al.
Ylipaa et al.
Akesson et al.
Leggat and Smith
Szymanska
Droeze et al.
Lalumandier et al.
3
23
12
18
17
20
19
Saudi Arabia
Saudi Arabia
Sweden
United States
United States
United States
Netherlands
Australia
United States
Sweden
Poland
Netherlands
United States
United States
Sweden
2002
2003
1993
2002
2001
2002
2005
2006
2002
1993
2002
2005
2001
2002
1999
AlWazzan et al.
AlWazzan et al.
Oberg and Oberg
Anton et al.
Lalumandier et al.
Lalumandier et al.
Droeze and Jonsson
Leggat and Smith
Anton et al.
Oberg and Oberg
Szymanska
Droeze and Jonsson
Lalumandier et al.
Lalumandier et al.
Akesson et al.
21
21
22
13
19
19
20
18
13
22
17
20
19
19
12
United States
Australia
United States
Australia
United States
Australia
2003
2006
2004
2006
2005
2006
Anton et al.
Leggat and Smith
Anton et al.
Leggat and Smith
Anton et al.
Leggat and Smith
13
18
13
18
13
18
Back
Hand wrist
Neck shoulder
Neck only
Shoulder only
Lower extremities
93
67 (upper back)
81
(upper extremity)
57 (lower back)
60 (lower back)
54 (lower back)
60
24
45
36
39
21
44
34
21 (hand only)
14 (wrist only)
64
54
69
60
60
64
85
57
56
51
28
28
20
62
68
21
26
52
53
60
81
48
12
6 (leg)
8 (leg)
23 (hip)
19
13
14
19
16
12
(hips thighs)
(hip)
(knee)
(knee)
(ankles feet)
(ankles feet)
161
and hand region was also the most prevalent symptom (69.5%)
enced some pain in the hand and arm region (15). While this
study was small, the results indicate that the onset of musculo-
rately.
Back pain
60.1% (17). Similarly, less than 60% of Danish dentists (3) and
lia reported that neck pain was the most prevalent musculo-
162
pain (22).
Lower extremities
arms (3, 4), using repetitive motions (4, 5, 13, 15, 24, 25) with
fine tuned actions (5) and using vibrating instruments (4, 15).
neck position (4, 12, 26) and extended neck flexion (3, 13) and
poor posture (3, 4, 6, 21) that are also associated with musculo-
enced pain in the hips or thighs, 13.7% in the knee region and
15.8% in the feet (13). Pain in the lower extremities was expe-
the knees and 11.6% for the ankles and feet (18). A study of
and 53% and 50% of their work time respectively with a trunk
tors looked at Swedish dental hygienists (5, 23, 24), which may
make it difficult to generalize the results to the global profession. It appears to be very difficult to separate the various pos-
Discussion
study of Danish dentists who found that older dentists had the
found that those who did not report any symptoms had been
163
dental association membership registers (3, 10, 11, 18, 23, 24).
This again may introduce bias into the results, as those dental
personnel who experienced severe musculoskeletal pain may
have left the profession, which may dilute the results.
Conclusion
Overall, this review clearly demonstrates that MSD represent a
ence (3, 11, 18). It has been hypothesized that more experi-
finding.
A number of studies examined the prevalence of musculoskeletal problems in dental hygienists. Those that did reported
that dental hygienists are more likely to experience neck,
shoulder and hand wrist pain than other dental professionals
(12, 19). The manuscripts that included data on dental hygienists often had a small sample size, or a low percentage of the
total respondents fall into this profession. In a study of
Swedish female dental personnel, only one third (n = 30) of all
participants were dental hygienists (12). In this particular follow-up study, a large number of participants who left the study
during the 5-year period had a high prevalence of musculoskeletal pain, many of whom were dental hygienists (12). A separate Swedish study of female dental health workers only
acquired dental hygienists as 12% of all respondents (5). Small
sample size (n = 82) was identified as a limitation of the study
of dental hygiene students in Connecticut (15). The study of
dental hygienists in Iowa, USA also had small sample size
(n = 109), and selection bias was introduced to the study as
participants were recruited from a continuing education conference on ergonomics (13). The problem with small samples
means it is difficult to generalize the results to the broader
dental hygiene profession. Further studies are required into
164
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