Work-Related Musculoskeletal Pain Among Dental Students at Dow University of Health Sciences, Karachi


Khurram Parvez Sardar1                   BDS, MPH

Rida Fatima Khan2                               BDS

Kunal Kumar3                                         BDS

Abeeha Batool Zaidi4                          BDS              

INTRODUCTION: The objective of this study was to evaluate incidence of work-related musculoskeletal pain among dental students of Dow University of Health and Sciences, Karachi.

METHODOLOGY: The study design was Cross-sectional. 290 students of 3rd year, 4th year and house officers were included in the study by convenient sampling method. The response rate was 90.6%. Data was gathered through self-compiled questionnaire and it consisted of demographic variables, pain related variables, sites of pain, interference with clinical work and awareness of appropriate working positions and postures. SPSS version 16 was used for statistical analysis. Chi-square test was applied between the presence of musculoskeletal pain, pain-related variables and the locations of pain. P-value less than 0.05 was considered significant.

RESULTS: Majority (76.2%) of students reported to have musculoskeletal pain, out of which back pain was experienced by 32.1% and neck pain by 32.4%. .Although 82.9% dental students knew the correct working posture, only 43.8% dental students’ worked corresponding to the guided working positions. Our results suggest a significant association between presences of musculoskeletal pain, pain-related variables and the locations of pain (p<0.05). We also found an insignificant association between operating postures and position of practitioner and the presences of musculoskeletal pain. (p=0.10).

CONCLUSIONS: Most of the dental students were suffering from musculoskeletal pain in spite of being knowledgeable about correct work related posture.

KEY WORDS: Musculoskeletal pain, dental students, working postures, Dental ergonomics.

HOW TO CITE: Sardar KP, Khan RF, Kumar K, Zaidi AB. Work-related Musculoskeletal Pain Among Dental Students at Dow University of Health Sciences, Karachi. J Pak Dent Assoc 2014; 23(3):117-121


Work related musculoskeletal pain is a common reason for chronic pain and disability throughout the world.  The incidence of work related musculoskeletal pain is quiet high in dental professionals1.

As dentists have a restricted narrow space to deal with therefore to attain proper visibility they carelessly bend in wrong working positions. Primarily the pain may not be as severe but if the dentists practice the same routine, this can convert it into a problematic musculoskeletal problem, working in inadequate postures often affects muscular, skeletal, peripheral and nervous system2,3. Discomfort, disability and continuous pain in different body parts are the major symptoms that lead to ill health1,2. The incidence of work related musculoskeletal pain is quiet high in dental professionals1,4-10. However if appropriate working guidelines are provided to these dentists at a younger age, severe disability can be avoided.11-13.

The risk factors associated with these conditions include prolonged stiff postures, monotonous inaccurate actions, inadequate light, inherent tendency, anxiety, tension, body conditions, and old age1. Various researchers have reported on the causes of musculoskeletal issues among dental professionals. Madaan and Diaz-Caballero reported that the major cause of musculoskeletal pain was incorrect working postures and uncomfortable positions1,14. We therefore conducted a study to assess the frequency of Musculoskeletal Pain among dental students (third year, fourth year and house officers) of Dow University of Oral Health And Sciences, Karachi.


A cross sectional study investigating the incidence of musculoskeletal pain was conducted at Dow University of Health Sciences. The duration of study was two weeks. A convenience sampling method was used for this study. Two hundred and ninety (290) dental students filled the questionnaire out of 320 dental students and house officers posted in clinical OPD’s.

Modification of Standard Nordic questionnaire was used. It consisted of 14 simple questions divided in to 4 parts. The first part consisted of demographic details while the second part was comprised of sites of pain. The third part consisted of questions regarding the presence characteristics of pain (Duration, Onset, Intensity, Aggravating and relieving factors) in the last part there were questions assessing the knowledge regarding proper positions and postures and its interference with their clinical performance. SPSS version 16 was used to analyze the data collected. Descriptive statistics was used to report frequency and percentages Chi-square test, was used to compared the presences of musculoskeletal pain and the categorical data, with level of significance less than/ equal to 0.05 considered as significant. To generate charts and figures Microsoft Office Excel 2010 was used.


A total of 290 (90.6%) participants out of 320 initially contacted completed the questionnaire. Majority of the respondents were females (80%). (Table no.1) Majority of the respondents (n=221, 76.2%). reported experiencing some sort of musculoskeletal discomfort. Because of more operating hours and lengthy dental practice, house officers tend to have greater percentage of musculoskeletal pain (n=76, 83.51%). (Table no.2) Question concerning the appearance of musculoskeletal

Table no.1: Details of number of Participant.

Table no.2: Incidence of Musculoskeletal pain.

Table no.3: Details of clinical practice.

Table no.4: Statistical analysis: Chi-square test applied between presences of musculoskeletal pain and the following Variables.

pain in the last 1 year was included in the study and it was reported that the maximum number of dental students (n=76, 26.3%) experience it within 1-3 months and (73, 25.2%) experience it within 0-1week. (Figure no.1). The respondents reported back (32.1%) and neck (32.4%) region to be most commonly involved site. (Figure no.2). Two thirty-nine (82.4%) participants had knowledge about correct postures while performing the dental procedure while only thirty-seven (12.8%) participants reported operating according to the standard criteria of working postures and positions. Majority of respondents reported working with both direct and indirect vision (56.9%). (Table no.3)

Chi square test revealed a significant association between presences of musculoskeletal pain, pain-related variables and the locations of pain (p<0.05). We also found an insignificant association between operating postures and position of practitioner and the presences of musculoskeletal pain. (p=0.10).(Table no.4)


A high percentage of musculoskeletal pain among dental professionals has been reported in published literature4-11. Greater use of heavy forces, working for long hours in the same uncomfortable position and constant posture are the prime factors responsible for musculoskeletal pain7,9,15. It has been reported that the musculoskeletal pain is also responsible for keeping the dentist away from his duty and possible early retirement2,3. Unfortunately the occurrence of musculoskeletal disorders especially among dental students has  been under reported. Hence the Incidence of work-related musculoskeletal pain among dental students was the prime purpose of our study. Madaan reported 81% musculoskeletal pain among dental students1. Another study by Diaz-Caballero reported 80% of dental students attending clinical practice had muscular pain14. Our results are in agreement with these

Figure no.1: Duration of musculoskeletal pain.

Figure no.2: Sites of musculoskeletal pain involved.

*Does not total 100%, because of multiple responses. two studies.

Duration of pain is a significant part of this study and question regarding the duration of pain in the last 12 months was also included .A study was conducted in which it was found that the pain not necessarily develops after long clinical exposure, it can also develop in a short training period ,this study was conducted by Mellis M. (2004)15. Similarly in our study, musculoskeletal pain developed within one week of time in (n=73,26.3%) dental students and within 1-3 months is(n=76,76.2%).

It is normally seen that the percentage of musculoskeletal pain in published literature is high among female dentist as compare to male dentist, for example in a study conducted by Lindfors (2013)5 showed high chances of musculoskeletal pain among female dental  practitioners, these results are similar to ours. However, our results should be interpreted with caution since majority of our study participants were females which can introduce a systematic bias.

We found back (32.1%) and neck (32.4%) region as most frequently reported affected region. Similar observations were made by Kierklo A16, Shrestha BP17 and Dayakar MM8.

Kanteshwari K18 reported that less than 50% were aware of the correct working posture in their study while 70% had musculoskeletal pain. Our results are in partial agreement with this study since the awareness of our participants was better, however the occurrence of reported pain was similar in both studies. However, a conclusion of better awareness of our study participants cannot be made from this questionnaire based study. The majority of dental students in this study (n=253, 87.2%) reported using a posture of their convenience. Whereas 71(24.5%) participants reported that they bend themselves for an easy vision, hence the use of mouth mirror was also reported only by 54 (18.6%) out 29 participants. However, it was also seen that 165 (56.9%) participants work by both direct and indirect vision method hence bend themselves sometimes. It has been reported in a previous study that dentists who use a mouth mirror suffered less pain then those who were working on patient without much use of mouth mirror19-20.

A study conducted by Dayakar MM (2013)8 reported that dental professionals from the beginning of their practice can lower the load of muscular pain by functioning in a proper manner .There is no doubt that dental schools should concentrate more on students correct working posture from the starting of their clinical rotations. Dental students tend to have a less clinical working time but still they have reported high level of musculoskeletal pain even after a shorter engaging period clinically. In order to reduce this problem, the dental students should be taught and trained about correct working posture so that chronic painful conditions and possible early retirements can be avoided. The results of our study must be interpreted with caution due to limitations of our study.


Under of the limitations of the study conducted, a high incidence of work-related musculoskeletal pain was reported among dental students of Dow University of Health sciences. It was also found that majority of respondents in this study have a good knowledge regarding correct posture and positions of working.


  1. Madaan V, ChaudhariA:Prevalence and risk factors associated with musculoskeletal pain among students of MSM Dental College: A cross sectional survey. J ContemDent 2012; 2:22-27.
  2. A, KedjaruneU. and. Smith D.R:Occupational health problems in modern dentistry: a review J Ind Health 2007;45:611-621.
  3. C.,Stathi I.C. and CharizaniF :Prevalence of musculoskeletal disorders in dentists.BMC Musculoskeletal Disorders2004;5:1-8.
  4. DhanyaMuralidharan, NusrathFareed, Shanthi M. Musculoskeletal Disorders among Dental Practitioners:Does It Affect Practice?.Epid Research Int  2013;Article (716897):1-6
  5. Lindfors P, Von thiele U and LundbergU:Work characteristics and upper extremity disorders in female dental health workers .J Occup Health 2006;48:192-197.
  6. Hayes M. J, SmithD. R. and Cockrell D.: Prevalence and correlates of musculoskeletal disorders among Australian dental hygiene students .Int J Dent Hyg 2009;7:176-181.
  7. Morse T, Bruneau H, and DussetschlegerJ: Musculoskeletal disorders of the neck and shoulder in the dental professions.Work 2010;35:419-429.
  8. Dayakar MM, Sachin Gupta, George Philip, Prakash Pai : Prevalence of musculoskeletal disorder among dental practitioners .ASL Muscuskel Dis 2013;1:22-25.
  9. Pandis N, Pandis BD, Pandis V, EliadesT :Occupational hazards in orthodontics: A review of risks and associated pathology. Am J Orthod Dentofacial Orthop 2007;132:280-292.
  10. SabahatUllah Khan Tareen, YasirKhattak, Shakeelur-Rehman : Ergonomics Related Disorder among Dentists in Peshwawer-A Questionnaire survey . J Khyber Coll Dent 2013;3:24-29.
  11. Maj John D. Childs ;Knowledge in Managing Musculoskeletal Conditions and EducationalPreparation  of Physical Therapists in the Uniformed Services .Military Medicine 2007;172:440-445.
  12. Patel Harshid L, MarwadiMehul R, RupaniMihir, Patel Piyanka :PrevelanceAnd Associated Factors of Back Pain Among Dentists In South Gujarat .Nat J Med Research 2012;2:229-231
  13. MontakarnChaikumarn :Differences In Dentists Working postures :(JOSE) 2005;11:441-449.
  14. Diaz-Caballero AJ, Gómez-Palencia IP, DíazCárdenas S: Ergonomic factors that cause the presence of pain muscle in students of dentistry .Med Oral Patol Oral Cir Bucal 2010;15:e906-911
  15. MellisM ,Abou-AtmeYs ,Cottognol,Pittau R :Upper Body musculoskeletal symptoms in Sardinian dental Students .J Can Dent Assoc 2004;70:306-310
  16. Kierklo A, Kobus A, Jaworska M, Botulinski B :Work-related musculoskeletal disorder among dentist; a questionnaire survey, Anb Argic Environ Med 2011; 18:79-84
  17. Shrestha BP, Singh GK,  Niraula SR ;Work Related Complaints among Dentists .J Nepal Med Assoc 2008;47(170):77-81.
  18. Kanteshwari K, Sridhar R, Mishra AK: Correlation of awareness and practice of working postures with prevalence of musculoskeletal disorders among dental professionals. Gen Dent 2011;59:476-483.
  19. Kumar VK, Kumar SP, Baliga MR. Prevalence of work-related musculoskeletal complaints among dentists in India: .A national cross-sectional survey. Indian J Dent Res 2013;24:428-438
  20. Gupta S. Ergonomic applications to dental practice. Indian J Dent Res 2011;22:816-822.

  1. Assistant Professor MDS Supervisor &MDS Subject Coordinator Department of Science of Dental Materials Dr.Ishrat-ul-Ebad Khan Institute of Oral Health Sciences Dow University of Health Sciences.
  2. Dr.Ishrat-ul-Ebad Khan Institute of Oral Health Sciences Dow University of Health Sciences.  < >
  3. Dr.Ishrat-ul-Ebad Khan Institute of Oral Health Sciences Dow University of Health Sciences.  < >
  4. Dr.Ishrat-ul-Ebad Khan Institute of Oral Health Sciences Dow University of Health Sciences.  < >

Corresponding author: “Dr Khurram Parvez Sardar ”< >