|Year : 2013 | Volume
| Issue : 2 | Page : 115-121
Self-reported occupational health problems among dentists in Himachal Pradesh, India: A descriptive survey
Vinay Kumar Bhardwaj1, Rajeshwar Prasad Luthra2, Deepak Sharma3, Anil Chug4, Manish Sahore4, Aditya Sharma5
1 Department of Public Health Dentistry, H.P. Government Dental College and Hospital, Shimla, Himachal Pradesh, India
2 Department of Prosthodontics, H.P. Government Dental College and Hospital, Shimla, Himachal Pradesh, India
3 Department of Periodontology, H.P. Government Dental College and Hospital, Shimla, Himachal Pradesh, India
4 Department of Oral and Maxillofacial Surgery, H.P. Government Dental College and Hospital, Shimla, Himachal Pradesh, India
5 Department of Oral and Maxillofacial Surgery, Shri Ram Neuro-Sciences Centre, Kirti Nagar, New Delhi, India
|Date of Web Publication||26-Jul-2013|
Vinay Kumar Bhardwaj
Department of Public Health Dentistry, H.P. Government Dental College and Hospital, Shimla - 171 001, Himachal Pradesh
Source of Support: None, Conflict of Interest: None
Background: Occupation-related health problems are associated with risk or danger as a consequence of the nature of working conditions. Unique working conditions in dentistry can affect the health of dentists. Aim: The aim of this study is to collect information from dentists in Himachal Pradesh concerning common occupation-related health problems, their knowledge and the precautions they commonly took to avoid such problems. Settings and Design: Questionnaire survey conducted on a systematic random sample of 465 dentists among 1395 dentists registered in the state dental council. Materials and Methods: Questionnaires were sent by mail in September 2011 to systematic random sample of 465 dentists. The dentists were asked to complete the questionnaire and return it by mail using the stamped addressed envelope provided. Statistically Analysis Used: The data were analyzed using the software Statistical Package for the Social Sciences version 15 (SPSS Inc., Chicago). Z test was used for statistical comparison. Results: The response rate from the dentists was 81.7%. The most common problem experienced was musculoskeletal pain (46.1%) followed by allergic dermatitis of the hands (7.6%). Nearly, all of the respondent dentists wore gloves (100%) and face masks (97.4%) during work. 1/10 th respondents reported that they had received instructions or training through interactive workshops in occupational health and safety. Conclusions: There seems to be a substantial demand for continuing education on occupational health and safety among dentists in Himachal Pradesh. Hence, more emphasis on occupational health and safety is put into dental training with more continuing education activities on occupational health and safety to practicing dentists.
Keywords: Allergic dermatitis, dentist, musculoskeletal disorders, self-reported occupational health problems, Shimla
|How to cite this article:|
Bhardwaj VK, Luthra RP, Sharma D, Chug A, Sahore M, Sharma A. Self-reported occupational health problems among dentists in Himachal Pradesh, India: A descriptive survey. Int J Health Allied Sci 2013;2:115-21
|How to cite this URL:|
Bhardwaj VK, Luthra RP, Sharma D, Chug A, Sahore M, Sharma A. Self-reported occupational health problems among dentists in Himachal Pradesh, India: A descriptive survey. Int J Health Allied Sci [serial online] 2013 [cited 2020 Jun 1];2:115-21. Available from: http://www.ijhas.in/text.asp?2013/2/2/115/115688
| Introduction|| |
Occupational health should aim at the promotion and maintenance of the highest degree of physical, mental, and social well-being of workers in all occupations; the prevention of deviation from health among workers caused by their working conditions; their protection from risks resulting from factors adverse to health.  Healthy practitioners are particularly important for a successful dental practice and well-being of the patient.  Occupation-related health problems refer to health problems associated with risk or danger as a consequence of the nature or working conditions of a particular professional job. Evidence shows that unique working conditions in dentistry can significantly affect the health of dentists.  Dentists such as other health-care providers have occupation-related health problems mainly including neck and low back pain, allergies to latex, injuries from needles, and sharp instruments.  These health risks and problems are not unique to dentists in Himachal Pradesh. Risk of low back pain increases with a greater physical workload.  Gloved health-care workers are at risk of becoming sensitized to latex. Those with positive latex skin tests, long glove exposure time, and frequent glove changes are at risk of clinical latex allergy.  In the state of Himachal Pradesh dentists are working both in the government institutions as well as in the private sector. Studies have shown that dentist report more frequent and worse health problems than other high-risk medical professionals.  It is important to determine, whether the dentists in Himachal Pradesh have adequate knowledge of the occupation-related health problems and hazards they face, and their management. The collected information will be useful for planning continuing educational and awareness courses for this group of professionals in Himachal Pradesh and to reduce their occupation-related health problems. So far, no study regarding occupation-related health problems among dentists in the state of Himachal Pradesh has been reported. Hence, this questionnaire study was taken up to collect information from the dentists in the state regarding common occupation-related health problems, their knowledge about these problems, the precautions they commonly adopt during their practice schedule and to suggest corrective and preventive measures.
| Materials and Methods|| |
The sample frame all the dentists registered in State Dental Council of Himachal Pradesh. In Himachal Pradesh dental health-care is provided to the public through government setup i.e., Government Dental College and Hospital as well as dental clinics in zonal hospitals, district hospitals, community health centers and primary health centers. Dental care in private set up is being provided through four private dental colleges and private clinics. A random sample of 465 dentists was selected through systematic sampling from the list of 1395 registered dentists in state dental council register. The sample was obtained by systematically selecting one in every three dentists whose names were listed alphabetically in the state dental council register. The structured questionnaire used in this study was pilot-tested on 25 dentists who were not included in the study sample. Use of words and clear understanding of the questions were checked. After pilot-testing, the questionnaire wording was amended where necessary. The final questionnaire was mailed [Appendix 1] [Additional file 1]. A stamped addressed envelope was provided to enable the dentist to return the completed questionnaire. The questionnaires were used to collect information about the dentist's knowledge and experience of occupation-related health problems and the safety precautions they took.
The collected information was coded and entered in the computer. The data were analyzed using the software Statistical Package for the Social Sciences version 15 (SPSS Inc., Chicago). Z test was used to assess the statistical significance of the differences in proportions between categories. P value ≤ 0.05, ≤ 0.01 was considered statistically significant and highly significant respectively. A forward stepwise logistic regression was used to estimate the level of effect of selected factors on the occurrence of musculoskeletal pain among the respondents. The dentist's demographic backgrounds, knowledge of musculoskeletal pain, time spent performing office exercise, bending of the back or neck while working, were used as independent variables in the analysis. The variable selection procedure was based on the P values for entry into and removal from the regression model.
| Results|| |
In this study, 465 questionnaires were mailed in the month of September 2011 and 380 completed questionnaires were received by 31 st December 2011. The response rate was 81.7%. Among the returned questionnaires, 126 respondents were dentist working in the government setup and 254 were from among the private practitioners. 2/3 rd of the respondents were men, around half of them (46.3%) were below 40 years of age. More than half (53.2%) had worked as a dentist for more than 10 years. Two-thirds of them worked for 41 h or more weekly [Table 1]. The most common problem, experienced by 46.1% of the respondents, was neck and/or low back pain, categorized as musculoskeletal pain. This was followed by allergic dermatitis of the hands (7.6%) and injuries from sharp instruments (3.7%) [Table 2]. Study revealed that nearly all of the respondent dentists wore gloves (100%) and face masks (97.4%) during work, but only 41.3% of them wore protective glasses or face-shields. Gloves were worn by 92.1% of the dentists when they handled patient-related materials, e.g., impressions, mercury, periodontal dressings, and mixing of restorative materials. Only 47.9% of the dentists performed simple office exercises in their clinics. A mere 12.4% of the respondents reported efforts to avoid bending the neck and back when treating patients [Table 3]. 1/10 th of the respondents reported that they had received instructions or training through interactive workshops in occupational health and safety. 31.3% of the respondents had a system of reporting occupational accidents or health problems in the dental clinic, in which they worked [Table 4]. When the respondents were asked to list the occupation-related health problems that they were aware of 68.8% mentioned musculoskeletal pain and fatigue and 60.3% mentioned cross-infection [Table 5]. Results of the logistic regression analysis of musculoskeletal pain experienced by the respondent dentists during the 3 months prior to the survey revealed that dentists who mentioned that they bend their back and neck during work, and those who worked in government clinics had a higher chance of having musculoskeletal pain [Table 6].
|Table 2: Occupation‑related health problems experienced by respondents during 3 months preceding the survey|
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|Table 5: Occupational‑related health problems nominated by the respondents|
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|Table 6: Logistic regression analyses of risk factors for musculoskeletal pain in the 3 months prior to the survey|
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| Discussion|| |
The social interaction of a dentist is influenced by the unique work setting and by personnel characteristics. There is increasing evidence that unique working condition in dentistry can significantly affect the health of a dentist. A systematic sampling procedure was used to select the sample. Private practitioners dominated both the survey group being 2/3 rd of the survey respondents. A response rate of 81.7% was excellent; which is higher than the studies, , and less than the result of the study conducted on Indian Army dental professionals.  More than half (53.2%) of the respondents had practiced dentistry for 10 years of more. Government dentists served a higher percentage of the working hours than private dentists. Despite this response it is probable that dentists who had experienced an occupation-related health problem and those who would like to receive more training in this aspect were more likely to respond to a survey of this type. Hence, the true prevalence of occupation-related health problems and the demand for further training in occupational safety among the general dentist population are likely to be lower than that reported in this survey. Since, the information was self-reported; there may be some recall bias even though the respondents were asked about their experience within a relatively short time i.e., previous 3 months.
Musculoskeletal pain was the most common problem reported by the respondents (46.1%) being lower than the results of the studies, ,, where it was ranging from 50% to 82% and higher than the results of the study conducted among armed force personnel.  Musculoskeletal pain in dentists usually presents as low back pain.  The problem was higher among dentist working in the government sector than in the private sector (65.8% vs. 36.2%) and statistically this difference was highly significant (P < 0.01). Prevalence of musculoskeletal disorder in the respondents may result from the lack of understanding of ergonomic principles, uncomfortable working environment, and residual effects of treating seated patients. A study in Netherlands,  has shown that recommendations to reduce musculoskeletal disorders are often only partially implemented even in a highly motivated group. Changing old routines was the main barrier in modifying the existing working practices. The dental surgeon assumes a strained posture during treatment, which causes stress on the spine and limbs. Back pain syndromes diagnosed in dentists originate from spine degeneration in different phases.  The posture of the dentist at work, with the bent and twisted neck, abducted arm and repetitive movements of the hands, cause the neck syndrome and pain within the shoulder, and upper extremities. Bending on patient will cause lower back ache.  Preventive action includes maintaining correct body posture when treating patients, taking adequate rest and doing some exercises. In this survey, 47.9% of the respondents replied that they performed some simple exercises in their office. Working in the government dental service is a risk factor, may be because government dentists have little control over their patient appointment schedules that are usually busy. Thus, they may have to work continuously during their office hours without getting adequate breaks between patient's treatments. Being injured at work was less frequent among Himachal dentists. 4.74% of the respondent dentists reported such injuries within the 3 months prior to this survey. Similar findings were reported in surveys of dentists in Canada and the United States. ,,
Nearly, 7.6% of the respondents had experienced allergic dermatitis of the hands being significantly higher among government dentists than private practitioners. It is mainly to latex glove component and most of these can be classified as glove dermatitis. These reactions may range from dry, itchy skin to a life-threatening, anaphylactic response. Studies in Thailand,  and United States, , found that 14% to 25% of dental health workers have allergic dermatitis. Nearly, all the respondents in this study were aware of using protective barriers like use of gloves, facemasks, and aprons during patient treatment similar to the results of other studies. , All the dentists in the government setup were vaccinated with Hepatitis-B vaccine, whereas 89.5% of the private practitioners were vaccinated. The reason could be that for government employees vaccination is compulsory and free of cost.  Government dentists were using gloves while handling patient's material than private dentists (98.4% vs. 89%), which was statistically significant. Irradiation detection device was used more frequently by private practitioners than government dentists (92.9% vs. 80.2%). Statistically, this difference between two employment statuses was significant. This could be due to the fact that private practitioners themselves take the radiographs, whereas in the government sector it is being taken by the radiographers. There seem to be a substantial demand for continuing education on occupational health and safety among Himachal dentists. Results of the study had revealed that only 1/10 th of the dentists have agreed that they had attended a workshop on occupational safety. They had also received necessary instructions about the handling of occupational accidents in dental clinics. One fifth of the dentists surveyed, thought that they had adequate training. When the respondents were asked to nominate the occupation related health problems that they were aware of, 68.8% mentioned musculoskeletal pain and fatigue and 60.3% mentioned cross infection. Government dentists nominated musculoskeletal problems more than private dentists (92.9% vs. 56.7%) and statistically this difference was highly significant (P < 0.01). Less than half of the respondents mentioned injury through needles, instruments, and burns, which was significantly more among government dentist than private dentist (65.8% vs. 28.3%) (P < 0.05). Logistic regression analysis of musculoskeletal pain experienced by the respondent dentists during 3 months prior to the survey, found that dentists who mentioned that musculoskeletal pain was an occupation-related health problem, those who bent their backs and necks during work and those who worked in government clinics had a higher chance of having musculoskeletal pain. Similar results were observed in the study conducted among dentists in Hong Kong. 
| Summary and Conclusion|| |
There seems to be a substantial demand for continuing education on occupational health and safety among dentist in Himachal Pradesh. One tenth of the dentist surveyed thought that they had adequate training and 90% of them desired a need for further training. It is recommended that more emphasis on occupational health and safety be put into dental training. The dental and medical professional bodies and educational institutions should offer more continuing education activities on the issue of occupational health and safety. Talks on this aspect should be held regularly, so that dentists can update their knowledge. This study revealed that the experience of occupation-related health problems was rather common among dentists in Himachal Pradesh, and that their knowledge of occupational health and safety was inadequate. There is a substantial need for further training on different aspects of occupational health and safety among dentists.
| Limitation and Suggestions|| |
In the present study, occupational health problems included are mainly concerned with the physical health of the dentists. Since, female dentists are mostly working housewives too so the incidence of all these musculoskeletal problems are higher. Factors such as mental, psycho-social, and behavioral health issues such as anxiety, stress dependence on drugs, alcohol were not taken into consideration. In future, a study should be carried out taking into consideration above mentioned factors. Further, research is needed to elucidate the causes of these problems among dental practitioners and to determine the impact of occupational Health Problems on the productivity of the dentist workforce. The causes of occupational health problems affecting government dentists need to be determined with greater accuracy, along with occupational safety measures to help reduce their prevalence and impact, which will be a major step toward finding the solutions of these health problems.
| Acknowledgments|| |
I thank all the dentists in Government and Private sector in Himachal Pradesh who have participated in this study. I also thank Dental College and Hospital Shimla administration for permitting me to conduct this study and statistician.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]