Musculoskeletal Disorders among Dentists in the Private Sector

Objective: To assess the prevalence of musculoskeletal disorders among dentists practicing in the private sector in the city of Agadir, Morocco. Materials and Methods: We conducted a cross-sectional study among dentists in the city of Agadir after informed consent. An anonymous questionnaire containing 19 closed questions was distributed. Data entry and statistical analysis were performed using SPSS software at the Community Health, Epidemiology and Biostatistics Laboratory of the Faculty of Dentistry of Casablanca. Results: 100% of doctors reported at least one musculoskeletal complaint. 19.42% of these musculoskeletal disorders were diagnosed and under treat-ment, 80.58% were undiagnosed, mainly affecting the neck, shoulders and lumbar region. 40% of dentists were diagnosed between 5 and 10 years of practice, 50% had been practicing for less than 10 years, 46.6% were overweight and 40.3% of the participants did not practice sports. Discussion: The rate of dentists reporting musculoskeletal complaints is alarmingly high compared to rates recorded in the literature. Several factors linked to lifestyle and professional activity may explain the results found. Musculoskeletal suffering can also be amplified if the dentist does not respect ergonomics in his dental practice. Conclusion: The rate of musculoskeletal disorders found in our population is alarming. Further studies are needed to evaluate ergonomic compliance to understand better the results of our study.


Introduction
Musculoskeletal disorders (MSDs) are a group of diseases localized at or around the joints.These pathologies affect the muscles, tendons and tendon sheaths, nerves, bursae, blood vessels, joints and ligaments around the joints of the upper limbs, spine and lower limbs.MSDs occur progressively and can lead to the loss of function in a musculoskeletal system.Pain and discomfort in movement may appear and without preventive measures, MSDs can eventually lead to incapacity at work and in daily life [1].
The literature confirms that the dental profession is widely affected by MSDs, which cause pain in a variety of locations [2].Altaş et al. found that 54% to 93% of dentists suffer from MSDs as a result of their practice [3].A meta-analysis carried out in 2022 by Chenna's team on the prevalence of MSDs among dental care providers showed that around seven out of ten suffered from MSDs [4].
Several factors can cause or contribute to the onset of MSDs, such as psychological stress, lack of physical activity, pathological changes in the musculoskeletal system or failure to comply with ergonomic rules in dental practice [5].The onset of these disorders is today recognized as a major factor in the decline in quality of life and the slowdown in the professional activity of dentists, jeopardizing the longevity of their professional careers [3], [5].Doctors complain that musculoskeletal pain is a major nuisance in their day-to-day activities, affecting the quality of patient care and their comfort as dentists, sometimes forcing them to delay or even cut short treatment, and sometimes to stop treatment altogether.MSDs can be a cause of disability and early retirement.Some studies have even shown that these disorders are the main reason why dentists stop prematurely their careers [5]- [8].

Benfaida et al.
Our aim in this study is to assess the prevalence of musculoskeletal disorders among dentists practicing in the private sector in the city of Agadir.

Materials and Methods
We conducted a descriptive cross-sectional survey in the city of Agadir, using an anonymous questionnaire distributed directly to dentists.Our target population consisted of all dentists practicing in the private sector in the city of Agadir.We obtained the list of dentists by contacting the National Dental Council by email.The list included the names, addresses and telephone numbers of the 234 dentists in the city.
To gather the information required for our survey, we developed a questionnaire covering 2 sections: 1. Generalities: This part includes questions to identify the population, their general state of health, a description of their lifestyle and their professional activity.2. Musculoskeletal disorders: This section includes questions devoted to the identification of musculoskeletal disorders diagnosed by dentists, as well as the disorders perceived.
Questionnaires were distributed and collected by visiting dental practices.The results were entered and statistically analyzed using SPSS software at the Epidemiology and Research Laboratory of the Faculty of Dentistry in Casablanca.

Results and Discussion
A participation rate of 88.04% was recorded.Women represented 57.3% of the sample.The results of the study are shown in Tables I-V.
Our study revealed that 100% of dentists in the city of Agadir report at least one musculoskeletal complaint.This alarming rate is higher than those reported in similar studies: 95.8% in Germany [7] 48% in Kuwait [8], 83% in Dubai, Abu Dhabi, Sharjah and Ajman [9], and 87% in Pakistan [10].19.4% of our population were diagnosed with MSDs, the main ones being tendonitis affecting 30%, scoliosis affecting 22.5% followed by neuralgia, 34 sciatica, herniated disc and osteoarthritis affecting 17.5% and carpal tunnel syndrome affecting only 12.5%.Ohlendorf and al found that 32.2% of dentists reported musculoskeletal diagnoses, the main pathologies being carpal tunnel syndrome affecting 12.7%, hyperlordosis affecting 9.8%, herniated disc affecting 7.8% and tendonitis affecting 7.6% [7].
The concentration of musculoskeletal pain in these areas can be explained by their heavy use over long periods.Practitioners are usually in a dorsal curvature position, with a twisted neck that also weighs down the shoulder region.
In our study, the main consequence of MSDs reported by dentists was a change in work frequency (57.5%).37.5% did not see their activity affected by MSDs.81.5% of dentists in Pakistan found MSDs to be a real obstacle affecting their daily activity, but could not afford a change in work frequency due to economic pressure [10].Alnaser et al. showed that 30% of dentists in Kuwait adapt to their musculoskeletal suffering and cannot change the frequency of their activity for fear of being perceived as incompetent [8].Brown et al. showed that 55% of prematurely retired dentists in the UK reported MSDs as the main reason for leaving the profession (excluding life-threatening conditions) [2].
The presence of musculoskeletal pain in our population can be explained by several factors, in particular the lifestyle of dentists.Recently, new risk factors such as obesity and physical inactivity have been directly linked to the development of MSDs [11], [12].
In our population, 46.6% of dentists are overweight.In India, a study by Shivlingesh et al. found that 35.24% of dentists were obese [13].In Iran, Tirgar and al showed that the average body mass index of dentists was 22.34, which corresponds to an ideal weight [14].Altaş's team conducted a similar study among Turkish dental students and found that 73.3% of participants were of normal weight [3].The overweight found in our population can be explained by dietary habits, lack of physical activity, etc.
Physical activity was also incriminated as a factor, 40.3% of participants didn't practice sports.Kierklo et al. showed that only 10% of the 220 practitioners surveyed regularly practice physical activity.68% of doctors resumed sport only after the reappearance of musculoskeletal symptoms [15].In Turkey, Altaş and al found that only 38.3% of dental students engaged in regular physical activity at least once a week) [3].Peros et al. conducted a study on dental students and showed that those who regularly exercised had significantly less back pain [16].
The most practiced sports in our population were running and strengthening (Gym/Crossfit).Dentists must opt more for muscle-relaxing physical activities such as swimming, yoga and Pilates.Muscle-relaxation exercises should be part of the dentist's lifestyle to increase blood flow to all body tissues, optimize oxygen use by muscles and promote their relaxation.Valachi [17], [18].
The type of professional activity and its relationship with the appearance and development of MSDs was also studied by Nowak and al.Their work showed that compared with general practitioners, the orthodontists place their head and thorax in more unfavorable postures and are therefore more predisposed to developing MSDs [11].88.35% of the dentists in our study were general practitioners.Further studies are needed to explain better the impact of the type of professional activity on the onset of MSDs.Frequency of activity and taking breaks between patients also influence the development of MSDs [19].
The relationship between the number of years of dental practice and the development of musculoskeletal disorders was studied.In our study, 40% of dentists interviewed were diagnosed between 5 and 10 years of practice, 35% were diagnosed beyond 10 years, and 12.5% of these doctors developed these disorders during clinical internships within university hospital services.Two studies in Poland and Serbia confirmed our findings, demonstrating that the proportion of dentists developing MSDs increases proportionally with the number of years in practice [20], [21].Conversely, two other studies carried out in Australia and Thailand found that the rate of dentists reporting musculoskeletal pain was inversely proportional to the number of years in practice [22], [23].Two explanations were proposed by the Thai researchers: 1.More experienced dentists with more years of practice have learned to adapt their working posture to avoid exacerbating musculoskeletal suffering.2. Dentists who developed severe MSDs after long years of work had already ceased their activity and were therefore not included in the sample [23].
Dental students are also susceptible to developing MSDs during their clinical learning years, due to their postural imbalance.A study conducted in Maranhão, Brazil, among dental students who had already started their clinical placements showed that 75% reported musculoskeletal complaints [24].

Conclusion
Our study showed that the rate of musculoskeletal disorders reported by our study is alarming.A strong correlation between musculoskeletal disorders observed in our population and several factors such as weight, physical activity, type of professional activity and number of years of practice was noted.The adoption of a healthy lifestyle should be encouraged during university studies and at the start of a professional career.A further ergonomic study is needed to better understand the results found.An additional study on ergonomics to better understand the results found is necessary.

TABLE I :
General Description of the Population

TABLE II :
Description of the Population's Professional Activity (N = 206)

TABLE III :
Data Concerning the Physical Activity of Dentists

TABLE IV :
Musculoskeletal Disorders Diagnosed

TABLE V :
Musculoskeletal Disorders Perceived et al. offer advice for dentists wishing to start a sports program: