|Year : 2013 | Volume
| Issue : 2 | Page : 109-113
Assessment of knowledge, practices, and work place condition related to ergonomics among dental students of Bhopal city - A questionnaire study
Swapna Munaga1, Manjusha Rawtiya1, Sheeba Khan1, Rajkiran Chitumalla2, Satheesh Kumar Reddy Kubagiri3, Parappa Sajjan4
1 Department of Conservative Dentistry and Endodontics, Peoples College of Dental Sciences, Bhopal, Madhya Pradesh, India
2 Department of Prosthodontics, Crown, Bridge and Implantology, Peoples College of Dental Sciences, Bhopal, Madhya Pradesh, India
3 Department of Preventive and Community Dentistry, Mamatha Dental College, Khammam, Andhra Pradesh, India
4 Department of Preventive and Community Dentistry, Paruthagouda Mallangouda Nadagouda Memorial Dental College and Hospital, Bagalkot, Karnataka, India
|Date of Web Publication||3-Jan-2014|
Department of Conservative Dentistry and Endodontics, Peoples College of Dental Sciences, Bhanpur, Bhopal-462 037, Madhya Pradesh
Source of Support: None, Conflict of Interest: None
Background: Dental profession is susceptible to various postural and nonpostural occupational risks. Aim : To determine knowledge, practice, and condition of work place regarding ergonomic posture among dental students from Bhopal city, Central India. Also to observe any correlation among knowledge, practice, and condition of work place scores. Materials and Methods : A self-administered questionnaire study was conducted among 231 dental students. The questionnaire consisted of three parts: Knowledge, practice, and condition of work place. Analysis of variance was used to compare mean of knowledge, practice of clinical posture, and condition of work place. Pearson's correlation coefficient has been applied to compute correlation among knowledge, practice, and condition of work place scores. A P value < 0.05 was considered significant for all statistical analyses. Results : We found that 70% of dental students perform torsion of the body and cervical flexion to improve vision and prefer direct vision when working. Only 59% reported that they are working with ergonomically designed dental unit and instruments. Most of them reported that the work stool is not comfortable. Mean knowledge, practice, and condition of work place scores were 3.93 (1.26), 5.01 (1.58), and 2.60 (1.14), respectively. Significant differences between the groups were noted for means of practice scores (P ≤ 0.01). Significant linear correlation was seen between knowledge-practice scores (r = 0.20) (P ≤ 0.01), practice-condition of work place scores (r = 0.14) (P ≤ 0.05), and knowledge-condition of work place scores (r = 0.14) (P ≤ 0.05). Conclusion : The knowledge of ergonomic postural requirements and their clinical application among the dental students surveyed were not satisfactory. A multifactorial approach that includes preventive education, postural and positioning strategies, proper selection, and use of ergonomic equipment should be employed.
Keywords: Condition of work place, ergonomics, knowledge, musculoskeletal disorders, practice
|How to cite this article:|
Munaga S, Rawtiya M, Khan S, Chitumalla R, Kubagiri SR, Sajjan P. Assessment of knowledge, practices, and work place condition related to ergonomics among dental students of Bhopal city - A questionnaire study. J Orofac Sci 2013;5:109-13
|How to cite this URL:|
Munaga S, Rawtiya M, Khan S, Chitumalla R, Kubagiri SR, Sajjan P. Assessment of knowledge, practices, and work place condition related to ergonomics among dental students of Bhopal city - A questionnaire study. J Orofac Sci [serial online] 2013 [cited 2020 Feb 23];5:109-13. Available from: http://www.jofs.in/text.asp?2013/5/2/109/124254
| Introduction|| |
The nature of the dental profession demands fixed posture, repetitive, and/or unnatural movements resulting in occupational health problems in dentists, dental students, and dental auxiliaries. ,, They are at greater risk of work-related musculoskeletal disorders (WMSD) than the general population. 
These disorders can result in pain and dysfunction of the neck, back, hands, and fingers. 
It has been reported that WMSD injuries occur in 54%-93% of dental professionals, with most frequency occurring in back (55%), neck (38.3%) and, with close association with sitting time.  Symptoms of WMSD affect quality of work, productivity, and comfortable working. 
Factors such as improper physical conditions of the environment, inadequate equipment design with improper anthropometric requirements, and unhealthy postures can be responsible for WMSD in dental health care workers. Working ergonomically helps to prevent work-related injuries. 
Ergonomics is the discipline which proposes the provision of working conditions that promote workers welfare and facilitate the performance of labor. It also includes design of work spaces, environment, and the equipment.  In relation to dentistry, ergonomics seeks to reduce cognitive and physical stress, prevent occupational diseases, thereby improving productivity, with better quality and greater comfort for both the professional and patient. 
Rising et al., reported that more than 70% of dental students reported neck, shoulder, and lower back pain by their third year of dental school due to the inadequacies in their knowledge of ergonomic posture during clinical practice. These WMSD's could begin to appear at the beginning of their clinical practice as students and accompany them for the rest of their professional life. Dental education can play an important role in training the dental students, helping them to adopt adequate knowledge related to ergonomic posture.  Occupational health programs are not being carried out in a satisfactory manner and adequate training activities are not being promoted.  Injury prevention and dental ergonomics education is still in its infancy in India. With this in mind, the aim of this work is to analyze knowledge, practice, and condition of work place regarding ergonomics among dental students in Bhopal city, Central India.
| Materials and Methods|| |
A transversal descriptive study was carried out among dental students (third, fourth year, and interns) of Peoples College of Dental Sciences and Research Centre, Bhopal city, Central India. The sample comprised of -66 third year dental students, 71 final year students, and 94 interns. Interns are graduates from the same school, with postings equally distributed in various departments during the stipulated 1 year. Training ergonomics is provided in second (preclinics) and third years of dental school. The study population of 231 dental students voluntarily completed a questionnaire consisting of 18 questions. The percentages of students in third year, fourth year, and internship who responded were 91.1%, 92.5%, and 98.8% respectively.
The questionnaire framed was evidence-based and also had inclusion of the open-ended responses of a few selected students on the topic. The questionnaire kept the study group in mind, and questions were linked to curriculum content of dental ergonomics. A self-processing questionnaire consisting of 18 multiple choice close-ended items was used for data collection. The dental students were given the questionnaire in the classrooms and asked to fill it out without discussing it in 18 minutes. The interns were given the same questions in various departments. There were five questions to assess the knowledge, nine questions to assess practice of clinical posture, and four questions to assess the condition of work place.
After obtaining ethical clearance for the study, the questionnaire was pretested on a random sample of dental students to ensure practicability, validity, and interpretation of responses. The validity of the questionnaire was assessed using Cronbach's alpha internal consistency coefficient. Variables included in study were age (only quantitative variable), gender, class of study, knowledge, and practice of ergonomic posture and condition of work place. Chi-square test was used to compare categorical qualitative variables. Because of the large size of the sample, the data are taken as normal and parametric tests have been used. Analysis of variance was used to compare mean of knowledge, practice of clinical posture, and work place condition. Pearson's correlation coefficient has been applied to compute correlation among knowledge, practice, and condition of work place scores. Tukey's post hoc test was applied for multiple comparisons. A P value < 0.05 was considered significant for all statistical analyses. Statistical analysis was performed using the statistical package for social sciences (SPSS) software for windows version 17.
| Results|| |
Of the 231 dental students, 63% correspond to females and 37% were males. No significant differences were noted between males and females [Table 1].
|Table 1: Distribution of dental students in study according to gender and class, by number and percentage of respondents in each group|
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A total of 89% of the participants related ergonomics to posture. A total of 70.5% of the students confirmed that ergonomics prevents occupational disease and 74% responded that they are familiar with ergonomic posture.
It was found that 73% of students usually work with their legs slightly separated, with feet flat on floor and (upright back position) spine resting on the back of the stool when working. A large majority (85%) orient the operating field to the elbow level of their working hand.
Surprisingly, most of the students (70%) perform torsion of the body and cervical flexion to improve vision and prefer direct vision when working. A total of 61% responded that they orient beam of light perpendicular to the observational direction.
Only 59% reported that they are working with ergonomically designed dental unit and instruments.
Condition of work place
A total of 72% of students consider that they have enough space in their work place and position their chair to maintain an ergonomic posture when starting to work on patients. Most of them reported that the work stool is not comfortable.
Knowledge, practice, and condition of work place scores were calculated separately. Each correct response added a score of 1. Mean knowledge, practice, and condition of work place scores were 3.93 (1.26), 5.01 (1.58), and 2.60 (1.14), respectively. Significant differences between the groups were noted for means of practice scores (P ≤ 0.01) [Table 2]. Significant linear correlation was seen between knowledge-practice scores (r = 0.20) (P ≤ 0.01), practice-condition of work place scores (r = 0.15) (P ≤ 0.05), and knowledge-condition of work place scores (r = 0.14) (P ≤ 0.05) [Table 3]. There was a significant difference in practice scores of third year students-interns and final year students-interns (≤0.01). Interns were performing significantly better than third and final year students regarding practice of ergonomic posture in clinics (≤0.01).
|Table 2: Mean (standard deviation) of knowledge, practice, and condition of work place regarding ergonomics|
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|Table 3: Pearson's correlation among knowledge, practice, and condition of work place|
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| Discussion|| |
The level of knowledge about ergonomics was good (87.3%) among the students. Majority believed that ergonomics prevents musculoskeletal disorders, provides comfortable working, and improves productivity and quality of work. Similar results were found in studies by Garbin et al., and Diaz-Caballero et al., regarding dental students in Brazil and Columbia.
Most students (82%) in our study responded that they adopt upright back position when start to work, with feet flat on floor (89%) and with their legs slightly separated (73.2%). Good positioning of the feet and legs broadens the support base of the body, avoiding possible changes in the circulatory system such as varicose veins, edema, pain, and inflammation because of muscle compression on the lower extremities impeding the venous return. The lower limbs are the second most likely body region to experience pain because of poor positioning during sitting, with reported pain occurring within the lower limbs and 81% with the neck and back. 
Surprisingly, most of the students (70.5%) perform torsion of the body and cervical flexion to improve vision and prefer direct vision (76.6%) while working. Similar results were observed in a previous study that evaluated posture by 1250 dentists and found that 89% of dentists showed a forward bending of the head exceeding the 20-25° healthy postural limit, 63% had a cervical spine flexion exceeding 20°.  In another study by Garcia et al., found that 11.7% of dental students adopt a malaligned right-tilted posterior column to improve viewing.
During clinical practice, the reflector should be oriented such that the light beam is parallel to the observational direction, thus maintaining shadow free lighting, with a good distance between the light and the mouth of patient. Incorrect positioning of light results in tilt of head and upper limbs. In the present study, most students (61%) responded that they orient the light beam perpendicular to the observational direction. The findings are in accordance to study by Garbin et al., and project Sonde. 
A total of 59% of students in the study reported that they were not working with ergonomically designed dental unit and instruments. Cost might be one of the major barriers. The dental institutions should focus more to provide students the ergonomic dental units.
Dental stool must fit correctly; it must offer neutral back, neck, and shoulder support for optimal posture, be at the correct height and tilt, and offer optimal arm and elbow support.  A total of 62% of the students in our study consider that their work stool is uncomfortable. About 70% of students consider that they have sufficient light in work place.
Means of knowledge, practice, and work place condition scores were 3.93 (1.26), 5.01 (1.58), and 2.60 (1.14), respectively. Significant differences between the groups (third year, fourth year, and interns) were noted for practice scores (P ≤ 0.01). Also significant linear correlations between knowledge, practice, and work place condition scores (P ≤ 0.05, P ≤ 0.01) were observed. This indicates that the knowledge was not reflected entirely on the correct posture during clinical procedures. This might be due to a poor understanding of ergonomics theory, lack of training, a gap between the theoretical discipline and its clinical application and social desirability bias might have also lead to an increase in the knowledge scores. Also, a working environment unsuitable for ergonomically correct dental work may be interfering in learning ergonomic principles. 
Interns were performing better practice of ergonomics than third and fourth years (P ≤ 0.01). This might have been due to cumulative increase in knowledge through all these years on the ergonomic positions during patient practice created a change toward betterment in practice scores among the interns.
These findings should alert dental educators about the importance of educating their students clearly and comprehensively about dental ergonomics, injury prevention, and musculoskeletal health. They need to be educated regarding the advantages of practice of ergonomics like:
- Long-term strain-free practice of dentistry can be done.
- Increase in comfort levels of the dentist and patient.
- Increasing the number of patients treated per day.
Continuous monitoring and reinforcement overweighs the barriers like cost.
To see if this school is an anomaly or if the lack of training in ergonomics is common in India, studies should be conducted in other dental schools. One of the limitations to our study was the method for assessing the practice of ergonomics. We could not supervise the responder's practice and, therefore, had to rely on their self-assessment. Therefore, the responses might have not accurately reflected the true practice and the reported level of practice might have been lower than the real level. The study aims only at assessing the knowledge, practice, and condition of the work place among the dental students; barriers for the lack of use of ergonomically designed units and instruments need to be evaluated in detail in further studies.
Injury prevention and dental ergonomics education still is in its infancy.  A multifactorial approach that includes preventive education, postural and positioning strategies, proper selection and use of ergonomic equipment should be employed. The acquisition of ergonomics knowledge can occur at any time; however, their early installation results in improved assimilation and incorporation, preventing deleterious habit formation. ,
| Conclusion|| |
The ergonomic posturing was not appropriate not only in a large percentage of our dental students, but also in graduate students who took part in the study. This indicates that they are subject to develop WMSD's. It is necessary to investigate reasons for the difficulties encountered during learning process. It is of vital importance to promote occupational health training and prevention programs regarding ergonomic postures. Attention should be given to changing destructive postural habits and selecting equipment conducive to good posture.
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[Table 1], [Table 2], [Table 3]