DOI: 10.

17354/ijss/2015/511
Origi na l A r tic le

Prevalence of Neck and Lower Back Pain among

Dentists from Three Dental Colleges in Patna City:
A Questionnaire Study
Subhash Chandra1, Ajoy Kumar Shahi2, Rajat Bhargava3
1
Professor, Department of Orthodontia and Dentofacial Orthopedics, Buddha Institute of Dental Sciences and Hospital, Patna, Bihar, India,
2
Professor, Department of Oral and Maxillofacial Surgery, Buddha Institute of Dental Sciences and Hospital, Patna, Bihar, India, 3Reader,
Department of Public Health Dentistry, Buddha Institute of Dental Sciences and Hospital, Patna, Bihar, India

Abstract
Introduction: In the practice of dentistry, stress, tension, and postural practices can contribute to neck and lower backache
problems. Considering the importance of this problem, we considered it was necessary to investigate the prevalence and
severity of these problems in this part of eastern India.
Purpose: To assess the prevalence, severity, and extent of lower back and neck pain among dentists of three dental colleges
of Patna and to suggest/advice preventive measures.
Materials and Methods: 121 dentists from three dental colleges in Patna were surveyed to determine the prevalence of neck
and lower back pain (73 males and 48 females). The dentists were interviewed with the help of a questionnaire.
Result: The data obtained and showed that (88) 72.80% of the dentists had suffered with the problem, sometimes during their
practice of dentistry. 38.01% of dentists complained of the lumbar pain. 13.02% had pain in the cervical area, and 24.04% of the
dentists had pain in both the areas. Only 39.54% of those complaining of a backache sought medical help. 57.85% of dentists
opted exercise and yoga as treatment modalities to relieve the pain.
Conclusion: The neck and lower back pain is largely prevalent in dental practitioners though not of very severe degree. Preventive
aerobic and relaxation exercises should be included in weekly activities of dentists to prevent recurrence of this problem.

Key words: Dentists, Exercise, Low back pain, Musculoskeletal disorder, Neck pain

INTRODUCTION cannot avoid prolonged static postures. Even in optimal

seated postures, more than one-half of the body’s muscles
The dentists are at high risk of neck and lower backache are contracted statically, and there is little movement of the
problems due to the limited work area with a limited vertebral joints. This may result in damaging physiological
scope of movement and narrow visual field associated changes (micro changes) that can lead to back, neck or
with the oral cavity. These working restrictions frequently shoulder pain or musculoskeletal disorders (MSDs) (macro
cause a clinician to assume stressful body positions to changes)2 in dentistry, overstrained and awkward postures,
achieve good access and visibility inside the oral cavity. repetitiveness of different joint movements, use of high
Furthermore, dental procedures are usually long; require frequency vibration tools, and psychological stress have
much more concentration during work.1 Dentist often been identified as risk factors.3,4 Studies have shown that
dentists report more frequent musculoskeletal pain5,6
Access this article online particularly back and neck pain, has been found to be a
major health problem for dental practitioners.7,8 its exact
Month of Submission : 09-2015 causes are legion, and an exact diagnosis is often difficult.
Month of Peer Review : 10-2015
Month of Acceptance : 11-2015 It has been stated that the most common sites of pain
Month of Publishing : 11-2015 among dentists are in the areas of the cervical and lumbar
www.ijss-sn.com
vertebrae.9-11 It has been pointed out that common postural
Corresponding Author: Dr. Subhash Chandra, Department of Orthodontia and Dentofacial Orthopedics, Buddha Institute of Dental Sciences
and Hospital, West of T.V. Tower, Kankarbagh, Patna - 800 020, Bihar, India. Phone: +91-9955393983. E-mail: [email protected]

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 Chandra, et al.: Prevalence of Neck and Lower Back Pain among Dentists from Three Dental Colleges in Patna City

faults among dentists are craning and/or excessive bending The questionnaire used for the study consisted of
and twisting of neck, bending forward from the waist, 6 questions about general information and 14 questions
elevation of shoulders, and general bending or twisting about specific information on neck and lower back pain.
of the back and neck.12 The dentists were also enquired about any treatment
modality opted.
As preventive measure dentists should be taught relaxation
techniques early in clinical training, and they should be The questionnaire was printed in the English language. All
taught correct working posture at chair side. questions were the close ended type.

Recently, “Ergonomics” has become a popular term. The The dentists were selected from the following three dental
term has been used in most professions, but increasingly in colleges of Patna city:
the dental profession. It is a discipline that studies workers 1. Buddha Institute of Dental Sciences and Hospital
and their relationship to their occupational environment. 2. B. R. Ambedkar Dental College
This includes many different concepts such as how dentists 3. Patna Dental College and Hospital.
position themselves and their patients, how they utilize
equipment, how work areas are designed, and how all of The study protocol was reviewed and approved by Ethical
these impact the health of dentists.2 Committee of the Institute.

It is very important to maintain an adequate work posture The selection of these colleges and Dentists was dependent
on the consent to participate in the study. During the
and that the instruments and furniture that the dentist
survey, the majority of dentists were enthusiastic and had
is working with have adequate working characteristics.13
a positive attitude.
Furthermore, they are exposed to biomechanical risk
factors, which indicate that work forced postures, would The questionnaire used to collect data for this study was
imply more risk of soreness and presence of skeletal based on similar studies published previously (2, 3, 5, 6).
muscle lesions. These lesions could begin to appear at The study fully complied with the ethical standards for
the beginning of their clinical practice as students, by human research. The questionnaire included 20 questions
acquiring inadequate postures and working habits that pertaining to three domains, demographic and professional
will accompany them for the rest of their professional characteristics, general medical history, and history of
life, acquiring an unhealthy lifestyle in their work MSD before and after joining the dental profession. These
environment.14 domains included questions pertaining to work setting
characteristics and the effect of MSD on dentists’ daily
However, there is a lack of data regarding musculoskeletal work and non-work activities. MSD was defined as any
pain among the Dentists in Bihar. Hence, the need was felt unpleasant sensation in the musculoskeletal system of
to conduct a study to check prevalence and risk factors the body developed after joining the dentistry profession.
associated with MSD among dentists.
The questionnaire was sent self along with a reply paid
This questionnaire study was taken to assess the prevalence, envelope and an explanation of the purpose of the study
severity, and extent of lower back and neck pain among to 132 dentists working in Dental colleges of Patna,
dentists from three dental colleges in Patna and propose inviting them to participate in the study. Respondents
some preventive measures. were assured of the confidentiality of their information.
Dental professionals involved in direct patient contact
for at least 10 h per week were eligible to participate. The
MATERIALS AND METHODS
participants had to complete the questionnaire. Incomplete
A “pilot” study was conducted on 21 dentists from three questionnaires were rejected. 126 dentists replied and
dental colleges in Patna. The survey was conducted on the participated in the study. After checking, we excluded
15th and 16th July 2015; using printed questionnaire. Based five questionnaires due to incomplete response. 121
questionnaires were complete and were used for analysis.
on the data obtained from ‘pilot’ survey, modifications were
made to make the main survey more reliable.
RESULTS
The main survey was a questionnaire study. The survey
was conducted from 7th August 2015 to 28th August 2015 • Figure 1 shows 73% of dentists complained of lower
on a sample of 132 dentists out of which 52 were females back and neck pain while 27% did not have lower back
and 80 were males. and neck pain

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 Chandra, et al.: Prevalence of Neck and Lower Back Pain among Dentists from Three Dental Colleges in Patna City

• Figure 2 shows 60% of males and 40% of females

Table 1: Prevalence of neck and lower back pain
suffered with neck and lowered back
among various age groups of dentists
• Graph 1 shows 38% complained lumbar pain, 13% of
cervical pain, 22% of both, and 27% were recorded as Age groups (years) Number Percentage

none 21-30 92 76.03

31-40 25 20.67
• Graph 2 shows 40% complained of mild pain in lower 40 4 3.30
back and neck region, 31% of moderate nature, 2% of Total 121 110
severe nature, 27% did not complained of any pain
• Table 1 shows 76.03% of dentists in 21-30 years age
group reported of pain in lower back and neck region Table 2: Neck and lower back pain affecting
20.67% in 31-40 years age group. Above 40 years were professional life of dentist
3.30% Areas Professional Life Sleep
• Table 2 shows in 38.84% of dentists professional life Yes No Yes No
was affected Cervical 09 08 06 10
• Table 3 shows 35.54% had consulted physician Lumbar 21 24 14 32
• Table 3 shows 74.38% dentists had taken precautionary Both 17 09 14 12
measures while 25.62% did not take any precautionary None - 33 - 33
Percentage 38.84 61.16 28.09 71.91
measure
• 57.85% of dentists opted exercise and yoga as
treatment modalities to relieve the pain.
Table 3: Dentist who have consulted or taken
precautionary measure for lower back pain
Areas Precautionary Consulted
Yes No Yes No
Cervical 11 5 8 8
Lumbar 38 8 22 24
Both 20 6 13 13
None 21 12 - 33
Total (%) 90 (74.38) 31 (25.62) 43 (35.54) 78 (64.46)

Figure 1: 73% of dentists complained of lower back and neck

pain while 27% did not have lower back and neck pain

Graph 1: Neck and lower back pain in relation to age groups

Figure 2: 60% of males and 40% of females suffered with neck Graph 2: Relation between severity of lower back and neck pain
and lower back with age groups

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 Chandra, et al.: Prevalence of Neck and Lower Back Pain among Dentists from Three Dental Colleges in Patna City

Graph 1 shows: (1) 38.01% of dentists complained of The most common site for MSDS was lower back (38%),
lumbar pain and 13.02% complained of cervical pain, i.e., lumbar pain. 13% experienced cervical pain while 22%
21.84% complained of both (lumbar and cervical), and experienced pain in both regions. These results are again
27.20% did not complain, (2) 33 dentists had lumbar pain, consistent with other studies where the most common area
15 had cervical pain, 20 had both, and 25 did not have any involved was lumbar region.19 On the contrary, Leggat and
pain in age group 21-30 years, (3) 13 dentists had lumbar Smith reported high incidence of cervical pain as compared
pain, one had cervical pain, 3 had both, and 7 did not have to lumbar pain.17
any pain in age group 31-40 years, (4) 3 had both (cervical
and lumbar pain) and 1 did not have any pain in age group The severity of pain encountered by dentists in our study
above 40 years. varied from mild to severe. The majority of the dentist
(40%) experienced mild pain which subsided with rest
Graph 2 shows: (1) 39.88% dentists had mild lower back and 2% experienced severe pain. The severity of MSDS
and neck pain, 30.98% had moderate pain, 1.88% had as found in our study was low as only 35.54% sought
severe pain, and 27.20% did not complain of any pain, medical intervention, and only 38.84% reported that their
(2) 39 dentists had mild lower back and neck pain, 27 had professional life was affected. Khalid et al., in their study,
moderate pain, 1 had severe, and 25 did not had any pain reported that only 37% of those suffering back and neck
in age group 21-30 years, (3) 8 dentists had mild lower back pain sought medical treatment and concluded that these
and neck pain, 8 had moderate pain, 1 had severe pain, and symptoms among dental personnel are not severe enough
7 did not complained of any pain in age group 21-30 years, to ask for medications.1
(4) 1 dentist had mild lower back and neck pain, 2 had
moderate pain, and 1 did not complained of any pain in Most of the respondent in our study were a young
age group 21-30 years. practitioner (21-30 years). However, no correlation was
found between age and severity or incidence of pain.
DISCUSSION The majority of the dentist opted exercise and yoga as
treatment modalities to relieve the pain and reported having
MSD have become increasingly common worldwide used precautionary measures like periodic breaks, working
during the past decades. It is a common cause of work- in indirect vision.
related disability among workers with substantial financial
consequences due to workers’ compensation and medical Recommendations
expenses.15 In dentists, overstrained and awkward back Within the limitations of this study, it might be concluded
postures for back pain, repetitiveness for neck and shoulder that neck and back pain among dental personnel of 3 dental
disorders, and psychosocial stressors for back, neck and colleges are not of a severe nature in Patna.
shoulder complaints.14 A slight hand neuropathy has also
been reported caused by exposure to high frequency However, to minimize or even prevent such ailments,
vibration tools.16 preventive aerobic and relaxation exercises should be
included in the weekly activities of dental personnel.
A cross-sectional study was carried out to assess the Such a practice would (1) help dental professionals avoid
prevalence of pain and risk factor associated with the future physical limitations or handicaps, (2) help them
MSDs among the dental surgeons of three dental colleges remain productive for longer periods of time during their
in Patna. professional lives, and (3) also help to improve the quality
of care during clinical procedures.
The majority of the patients (73%) surveyed were found to
be suffering from MSDS. Shaikh et al. also reported a high Aerobic Exercises
incidence (80%) of MSDS in their study in 30 dentists.16 Aerobic exercise has been reported to improve or prevent
Among the MSDS, the incidence of low back pain (73.3%) back pain. In general, exercise programs that facilitate
was highest. Various other studies also suggest high weight loss, trunk strengthening, and the stretching of
incidence of MSDS among dentists.17,18 musculotendinous structures appear to be helpful in
alleviating low back pain. A 30 min aerobic program three
60% of males and 40% of females suffered with neck times a week is ideal for overall fitness.
and lower back. These results are similar to the results
of study done by Al Wazzan et al., with findings - 58.24% Exercise to promote the strengthening of the muscles that
males and 41.75% females suffered with neck and lowered support the spine (i.e., the oblique abdominal and spinal
back pain.1 extensor muscles) should be considered (Figures 3 and 4).

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 Chandra, et al.: Prevalence of Neck and Lower Back Pain among Dentists from Three Dental Colleges in Patna City

serve to diminish this stress reaction. Below are some

brief relaxation exercise that dentists and their auxiliary
personnel may wish to employ any time during the day,
break time, or in among patients.

Exercise 1: Performing a breathing exercise is one of the

simplest ways to relax in any situation. Take 5-10 min to sit
quietly and breathe deeply. Here is an example. Close your
eyes and take a long, deep breath. Let it out very slowly.
Now, take a second long, deep breath, as you let it out, feel
yourself releasing the tensions in your mind and in your
Figure 3: Trunk muscles exercise. Lie in supine position with body. Just let yourself relax more and more, as you continue.
both hands behind back of your neck. Then up right yourself
to a sitting position. Legs should be on the floor during the up Exercise 2: Clench your hands. While keeping them
righting movement. You can asked somebody to stabilize your clenched, pull your forearms tightly up against your upper
legs. If you cannot reach the sitting position, you can do it half
way, i.e., to 45° arms and raise your shoulders against your neck. While
keeping those muscles tense, tense all the neck, back, and
leg muscles. While keeping all these tensed, shut your eyes
fairly tight and take deep breath and hold it for 5 s. Then, let
everything go all at once. Feel yourself letting your tensions.

CONCLUSION
The present study was conducted on 121 dentists from
three dental colleges in Patna to assess severity and area
of the neck and lower back pain.

For dentists, neck and lower back pain is not a new

problem, nearly most of the dentists have suffered from
Figure 4: Trunk muscle exercise: Lie in supine position AND, it sometimes during their practice of dentistry. Lower back
raise your legs up to 45° from the floor, without bending your
knees, make a circular movement of 30 cm. In diameter 5 times pain is more prevalent than neck pain mainly due to faulty
clockwise and 5 times counter clockwise. Take rest for few postural habits.
seconds, and then repeat the exercise
It can be concluded that neck and back pain among dentists
An effective program may include a warm-up period, about is not of severe nature. The neck and lower back pain is
30 min of aerobic activity, isolated muscle group work largely prevalent in dental practitioners. That brings along
(trunk muscle), and a cool-down period walking and/or with it a considerable amount of discomfort, lost working
water exercise are also recommended. time, and economic loss. What we need is not preventing its
incidence and recurrence by including preventive aerobic and
Dental professional may need to take a break from exercise relaxation exercises in weekly activities of dentists. This will
if it aggravates back pain. It is recommended that dental help in improving the quality of work in their clinical practice.
professionals confirm with their doctor regarding which
exercise should be used to relieve back pain, to stay fit, and
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How to cite this article: Chandra S, Shahi AK, Bhargava R. Prevalence of Neck and Lower Back Pain among Dentists from Three Dental
Colleges in Patna City: A Questionnaire Study. Int J Sci Stud 2015;3(8):71-76.

Source of Support: Nil, Conflict of Interest: None declared.

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