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Ergonomic Risks and Prevalence of Musculoskeletal Disorders Among Dental

Surgeons in Nigeria: A Descriptive Survey

Article in Journal of International Oral Health · October 2021

DOI: 10.4103/jioh.jioh_39_21

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 Original Research

Ergonomic Risks and Prevalence of Musculoskeletal Disorders

Among Dental Surgeons in Nigeria: A Descriptive Survey
Lillian Lami Enone1, Afolabi Oyapero2, Olabode Ijarogbe3, Tope Emmanuel Adeyemi4, Rasheedat Oluwakemi Ojikutu5
Department of Restorative Dentistry, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria, 2Department of Preventive Dentistry, Faculty of Dentistry, Lagos
1

State University College of Medicine, Ikeja, Lagos, Nigeria, 3Department of Restorative Dentistry, Faculty of Dental Sciences, College of Medicine University of Lagos,
Nigeria, 4Department of Child Dental Health, Bayero University, Kano/Aminu Kano Teaching Hospital, Kano, Nigeria, 5Department of Oral and Maxillofacial Surgery,
Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria

Abstract
Aim: To determine the prevalence of musculoskeletal disorders (MSDs) among dentists in Nigeria, where it is underreported, and
to correlate these MSDs with occupational and stress-related ergonomic challenges. Materials and Methods: This descriptive study
was conducted among randomly selected dentists in Nigeria. A modification of the validated Nordic questionnaire was utilized to
determine the prevalence of MSDs. Paired t-tests and analysis of variance tests were used to determine statistical differences between
numerical variables. The logistic regression analysis was used to confirm significant effect of predictor variables on work-related
MSDs (WMSDs). Difference at the 5% level was accepted as significant. Results: Most of the participants were males (58.8%), aged
between 26 and 30 years (37.2%), had <5 years of experience (38.2%), and worked an average of 31–40 min for each patient. Eighty-
eight participants (44.2%) had WMSDs within 7 days, whereas 126 (63.3%) had in the preceding year. Within a 12-month period,
however, neck pain was the commonest complaint (22.2%), followed by lower back (20.6%) and upper back pain (18.3%). The linear
regression analysis showed that age of participants: >40 years [Exp β: 1.003; confidence interval (CI): 0.848–1.187; P = 0.020], body
mass index: obese (Exp β: 1.079; CI: 0.733–1.589; P = 0.027), average time spent on each patient: >50 min (Exp β: 0.903; CI: 0.313–
2.609; P = 0.049), having dental nurses in the clinic: >10 (Exp β: 0.959; CI: 0.410–2.243; P = 0.000), and a high level of environmental
stress (Exp β: 1.092; CI: 0.862–1.384; P = 0.029) were significantly associated with MSDs. Conclusion: Our study showed that dentists
who were older than 40 years, those who were obese, those who spent an average of 50 min on each patient, and those who had few
dental nurses in the clinic and had a high level of environmental stress had a significantly higher prevalence of MSDs. Modifiable
chairs, correct sitting postures by the dental surgeon and the patient, adequate lighting, use of indirect vision, use of magnification
loupes, and sufficient rest and breaks at work could help to ameliorate these conditions.

Keywords: Dentists, Ergonomics, Musculoskeletal Disorders (MSDs)

Received: 15-02-2021, Revised: 04-08-2021, Accepted: 23-06-2021, Published: 11-10-2021.

Introduction atypical facial pain, etc.[2] In 2015, musculoskeletal pain

In spite of contemporary technological advancements,
dentists still remain susceptible to many work-related risks.
These hazards encompass cross infections, ocular trauma,
harmful irradiation, allergies and reactions to dental
materials, psychological distress, and musculoskeletal
disorders (MSDs).[1] MSDs are complaints, symptoms,
or pain that include a number of conditions such as neck
pain, back pain, shoulder pain, pain of limbs, carpal
tunnel syndrome, myofacial dysfunction syndrome,
Access this article online
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(MSP) affected over 94 million people globally, resulting in
a form of disability.[3] In several professions, work-related
MSDs (WMSDs) are common and are major reasons for
Address for correspondence: Dr. Afolabi Oyapero,
Department of Preventive Dentistry, Faculty of Dentistry,
Lagos State University College of Medicine, Ikeja, Lagos, Nigeria.
E-mail: fola_ba@yahoo.com
This is an open access journal, and articles are distributed under the terms of the
Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows
others to remix, tweak, and build upon the work non-commercially, as long as
appropriate credit is given and the new creations are licensed under the identical terms.
For reprints contact: reprints@medknow.com

How to cite this article: Enone LL, Oyapero A, Ijarogbe O, Adeyemi TE,
DOI: Ojikutu RO. Ergonomic risks and prevalence of musculoskeletal
10.4103/jioh.jioh_39_21 disorders among dental surgeons in Nigeria: A descriptive survey. J Int
Oral Health 2021;13:441-8.

      © 2021 Journal of International Oral Health | Published by Wolters Kluwer ‑ Medknow 441  
 Enone, et al.: Ergonomic risks among dental surgeons in Nigeria
reduced productivity, human injuries, delay in the work
time, and absence from work.[4]
Various researchers have documented WMSDs as a
prevalent source of occupational health disorders.[5]
In the field of dentistry, WMSDs frequently affect
professionals; recognizing the ergonomic risk factors and
its potential harms are of utmost importance.[6] Some
of the documented common risk factors include use of
certain work tools (vibrating instruments), pattern of
work or body position such as concentrated force or
movement of specific body parts, reduced resting period,
and repetitive movements.[7,8] Although WMSDs may
differ between dental professionals due to the variations
in physical activity, the frequently associated symptoms
of WMSDs include discomfort, tiredness or fatigue,
restricted movement, and pain of muscles, tendons, and
joints.[9]
Over the past decade, WMSDs have gradually increased in
prevalence across the world and there are extensive, well-
documented literature on occurrence of WMSD and its
associated risk factors among dentists.[10-12] A secondary
publication in 2009 documented a prevalence range of
64–93% for WMSDs in the dental profession, which is a
high percentage of workers.[13] Rambabu and Suneetha[14]
in 2014, in a descriptive study comparing the WMSDs
among physicians, surgeons, and dentists observed that
the highest occurrence of WMSDs was among dentists
(61%) when compared with surgeons (37%) and physicians
(20%). Another study by Kierklo et al.[15] on WMSDs
among 220 dentists found that over 92% of the dentists
had WMSDs, especially in the neck (47%) and lower
back (35%). More than 29% experienced issues with their
fingers and 23% had issues with their hip.
Several studies have concluded that the high prevalence
of WMSDs among dental surgeons could be due to poor
ergonomics maintained by them while working with poor
illumination, insufficient magnification, and a limited
operating field and in some cases the inability to perform
“6-handed dentistry.”[13-17] Dental surgeons operate
within the mouth which is a small field of operation and
they often assume unsuitable postures while providing
treatment. These harmful postures create strain and stress
in the muscles and joints, with the greatest impact felt in
the neck, back, shoulder, and waist. This ultimately leads
to limited work productivity and disability.[18]
However, most dentists are not adequately knowledgeable
about ergonomics and its impact on musculoskeletal well-
being.[2] Providentially, good ergonomics can significantly
decrease the risk and severity of WMSDs. An outline of
the prevalence of WMSD complaints among healthcare
providers including dentists may help to significantly
prevent WMSDs and therefore provide a healthier and
safer environment for them. Therefore, the aim of this
study is to determine the prevalence of MSDs among
442 442  Journal of International Oral Health ¦ Volume 13 ¦ Issue 5 ¦ September-October 2021
dentists in Nigeria, where it is underreported, and to
correlate these MSDs with occupational and stress-related
ergonomic challenges.
Materials and Methods
This descriptive, cross-sectional study was reviewed by
the Institutional Ethics Committee of the Lagos State
University Teaching Hospital, and ethical approval was
obtained before commencement of the study. The study
was conducted in full accordance with ethical principles
including the World Medical Association Declaration of
Helsinki.
The inclusion criteria for the participants included
being a dental house officer, dental officer/general
dental practitioner who performs composite restoration
procedure on a routine basis, junior registrar, senior
registrar, and Specialist Dental Surgeons. Dentists who
had spinal deformities, osteoporosis, cancer, or multiple
sclerosis and those who had any injuries or disabling
conditions in the head or neck were also excluded from the
study. Dental students and dentists who did not consent
to participate in the study were also excluded from the
study. A simple random sampling procedure was used in
the selection of government hospitals and private dental
clinics, representing the different regions of Nigeria.
Measurement and devices
A modification of the standardized Nordic questionnaire,
validated by Kuorinka et al.,[19] was used to determine
the occurrence of MSDs. The self-administered survey
instrument, with many multiple options and with every
question indicated as mandatory, was randomly distributed
to willing participants (interns, dental officers, resident
doctors, and dental specialists in the selected Nigerian
dental clinics). The questionnaire encompassed socio-
demographic variables such as sex, age, height, weight,
hand dominance, smoking and alcohol habits, duration of
work, duration spent in treating each patient, work hours
per week, and percentage of the day spent sitting. Body
mass index (BMI) was determined from height and weight
recorded. The incidence of ache, pain, and discomfort
within the preceding 12 months and within 7 days was
also obtained.
Statistical analysis
Subsequent to data collation, statistical analysis was
performed using IBM SPSS Statistics 22.0 (IBM Corp.,
Armonk, NY, USA). Frequency distribution tables and
cross-tabulations were generated for all inputs provided
by participants. Descriptive statistics were generated,
whereas means and standard deviations (SDs) were used
to describe the demographic details such as age, height,
weight, number of years practice, number of hours work
per week, and percentage of day spent sitting. χ2 and
Fisher’s exact tests were done on all categorical variables
 Enone, et al.: Ergonomic risks among dental surgeons in Nigeria

to determine whether any significant associations existed. (82.4%), took break in-between patients’ work (54.3),
Paired t-tests and analysis of variance tests were done to and were exposed to moderate stress (65.8%). There was
determine association between numerical variables. The a significant association among the age group, years of
logistic regression analysis was used to confirm significant experience, average working time with patients, working
effect of predictor variables on WMSD. Difference at the hours per week, and hand dominance with the occurrence
5% level was accepted as significant. of MSDs. Those aged >40 years, with 15–19 years of
experience, who worked an average of >50 min per patient
Results and an average of >50 h per week and who had a dominant
left hand had a higher prevalence of MDS [Table 3].
A total of 240 questionnaires were administered, of which
199 were satisfactorily completed and returned, giving Table 4 presents the 7-day and 12-month prevalence
a response rate of 82.9%. Most of the participants were of complaints of back, neck, shoulder, knees, ankle,
males (58.8%), aged between 26 and 30 years (37.2%), and and hand/wrist among the respondents. Eighty-eight
had <5 years of experience (38.2%). Most of them were participants (44.2%) had MSD within 7 days, whereas 126
general practitioners (44.1%), had normal BMI (60.8%), (63.3%) had in the preceding year. Low-back pain was the
and were non-smokers (99.5%) [Table 1]. most prevalent musculoskeletal complaint, reported by
26.1% of the respondents within the last 7 days; this was
Table 2 displays the work-related characteristics of the
closely followed by upper back pain. Within a 12-month
study population. The highest proportion (39.2%) worked
period, however, neck pain was the most prevalent
between 30 and 40 h per week and worked for an average
complaint (22.2%), followed by lower back (20.6%) and
of 21–30 min for each patient (32.2%). Majority of them
upper back pain (18.3%).
had right-hand dominance (85.4%), used direct vision
The correlation between environmental stress and age
showed a moderate positive correlation (P = 0.027,
Table 1: Personal characteristics data of the study population r = 0.35), whereas a weak, positive correlation was
Variable Frequency Percentage observed between environmental stress and BMI
(n=199) (P = 0.016, r = 0.187). The 12-month prevalence of MSDs
Gender
Male 117 58.8
Female 82 41.2 Table 2: Work-related characteristics of the study population
Age group (years) Working hours per week
21–25 24 12.1 1–10 6 3.0
26–30 74 37.2 11–20 17 8.5
31–35 49 24.6 21–30 22 11.1
36–40 29 14.6 31–40 78 39.2
>40 23 11.6 41–50 49 24.6
Years of experience >50 27 13.6
<5 76 38.2 Average working time with patients (min)
5–9 60 30.2 1–10 17 8.5
10–14 36 19.1 11–20 25 12.6
15–19 19 9.5 21–30 64 32.2
≥20 8 4.0 31–40 55 27.6
Specialty 41–50 19 9.5
General practitioner 88 44.1 >50 19 9.5
Oral and maxillofacial surgery 21 10.7 Hand dominance
Restorative dentistry 16 8.0 Right 170 85.4
Child dental health/orthodontics 23 11.4 Left 15 7.5
Periodontics 4 2.0 Bilateral 14 7.0
Dental public health 9 4.4 Vision during treatment
Oral Medicine/oral pathology 9 4.4 Direct 164 82.4
BMI Indirect 35 17.6
Underweight 6 3.0 Taking break in-between patients
Normal 121 60.8 Yes 108 54.3
Overweight 40 20.1 No 91 45.7
Obese 32 16.1 Level of stress in the environment
Smoking status No stress 15 7.5
Yes 1 0.5 Moderate stress 131 65.8
No 198 99.5 Severe stress 53 26.7

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 Enone, et al.: Ergonomic risks among dental surgeons in Nigeria

Table 3: Socio-demographic and work-related characteristics and its association with MSD
Variable Frequency (n=199) Percentage % with MSD χ2 P-value
Gender
Male 117 58.8 34.5 2.795 0.064
Female 82 41.2 29.4
Age group (years)
21–25 24 12.1 6.1 24.327 0.002
26–30 74 37.2 24.3
31–35 49 24.6 16.5
36–40 29 14.6 10.3
>40 23 11.6 8.4
Years of experience
<5 76 38.2 23.2 20.963 0.009
5–9 60 30.2 20.0
10–14 36 19.1 10.7
15–19 19 9.5 6.5
≥20 8 4.0 2.6
Average working time with patients (min)
1–10 17 8.5 6.6 7.802 0.029
11–20 25 12.6 6.6
21–30 64 32.2 20.4
31–40 55 27.6 19.4
41–50 19 9.5 4.1
>50 19 9.5 6.9
Working hours per week
1–10 6 3.0 2.1 8.616 0.045
11–20 17 8.5 4.7
21–30 22 11.1 7.3
31–40 78 39.2 25.5
41–50 49 24.6 12.5
>50 27 13.6 9.9
Hand dominance
Right 170 85.4 51.3 13.141 0.004
Left 15 7.5 7.4
Bilateral 14 7.0 4.8
Vision during treatment
Direct 164 82.4 51.1 1.195 0.210
Indirect 35 17.6 13.2
Take break in-between patients
Yes 108 54.3 36.1 1.023 0.486
No 91 45.7 27.3
Smoking status
Yes 1 0.5 0.5 3.536 0.767
No 198 99.5 62.8

correlated significantly with age (P = 0.041, r = 0.10),
BMI (P = 0.000, r = 0.191), body weight (P = 0.007,
r = 0.173), and body height (P = 0.038, r = 0.128). The
7-day prevalence of MSD showed a significant positive
(weak) correlation with age (P = 0.002, r = 0.123) and
BMI (P = 0.001, r = 0.178) [Table 5].
The linear regression analysis showed that age of
participants: >40 years [vs. other age categories, Exp β:
1.003; confidence interval (CI): 0.848–1.187; P = 0.020],
BMI: obese (vs. normal weight, Exp β: 1.079; CI: 0.733–
1.589; P = 0.027), average time spent on each patient:
>50 min (vs. 1–10 min, Exp β: 0.903; CI: 0.313–2.609;
P = 0.049), having dental nurses in the clinic: >10 (vs.
none, β: 0.959; CI: 0.410–2.243; P = 0.000), and a high
level of environmental stress (vs. low level, β: 1.092; CI:
0.862–1.384; P = 0.029) were significantly associated with
MSDs [Table 6].
Discussion
Ergonomics is the systematic assessment of human
work environments, particularly the interface between
humans and equipment. An increase has been observed

      
444 444  Journal of International Oral Health ¦ Volume 13 ¦ Issue 5 ¦ September-October 2021
 Enone, et al.: Ergonomic risks among dental surgeons in Nigeria

in WMSDs due to prolonged work hours, poorly designed professional is the most vulnerable to them.[20] Dental
seats, improper postures, and wrong instrumentation. procedures often involve precise manipulation of the
Prolonged standing and sitting position was the most wrists and digits, awkward posturing, use of drills and
common form of improper posture identified by the ultrasonic scalers which transmit vibrations vibrating
participants in our study, followed by monotonous dental instruments, and monotonous repetitive duties
repetitive movement. Eighty-four respondents (42.2%) over a prolonged period.[21] This often leads to strain and
rated their work environment as highly stressful, whereas long-lasting muscular weakness, discomfort, and chronic
the highest proportion of participants rated their work as pain.[22]
moderately demanding. Dental surgeons are particularly
The prevalence of MSD among our study participants
vulnerable to musculoskeletal symptoms because the
within the preceding year was 63.3%. This was similar
nature of their work exposes them to risk factors for
to findings from a study among New Zealand dentists,
conditions such as tendinitis, synovitis, tenosynovitis,
who had a high yearly prevalence of MSD; 63% of them
and bursitis. Indeed, a review of about 1000 professions
had lower back or neck discomfort, 49% experienced
regarding these risk factors concluded that the dental
shoulder discomfort, whereas 42% had symptoms in
wrists and hands.[23] In our study, low-back pain was the
Table 4: Total prevalence of MSDs shown in 12-month and most commonest MSD and it was reported by 26.1% of
7-day prevalence (in %) the respondents within the last 7 days; this was closely
7-day chronic complaints, n=88 (44.2% of sample) followed by upper back pain. Within a 12-month period,
n % however, neck pain was the most prevalent complaint
Wrist/hand 9 10.2 (22.2%), followed by lower back (20.6%) and upper back
Shoulder 13 14.8 pain (18.3%). In a systematic review, WMSDs were most
Neck 9 10.2 frequently experienced in the neck (58.5%), lower back
Upper back 21 23.9 (56.4%), shoulder (43.1%), and upper back (41.1%) among
Lower back 23 26.1 dentists.[21] The review also documented a prevalence of
Knees 6 6.8 57% in Australia, 56% in Poland, 51% in the Netherlands,
Hip/thigh 3 3.4 and 20% in Saudi Arabia, respectively. Among German
Ankle/feet 3 3.4 dentists, 86.7% had complaints from the spine in the
Elbow 1 1.1 preceding year, primarily in the neck and upper back.[22]
Total 88 100.0 Likewise, Chinese dentists had neck (83.8%), shoulders
12-month chronic complaints, n=126 (63.3% of sample) (40.1%), hand (18.4%), and elbow (15.1%) symptoms in
n % the preceding year.[22] Extended periods of sitting while
Wrist/hand 13 10.3
treating patients in addition to bending movements as well
Shoulder 22 17.5
as lateral flexions of the torso[24] are obvious predisposing
Neck 28 22.2
factors for these observations.
Upper back 23 18.3 There was a significant association among the age
Lower back 26 20.6 group, years of experience, average working time with
Knees 6 4.8 patients, working hours per week, hand dominance,
Hip/thigh 1 0.8 and the occurrence of MSDs. Those aged >40 years,
Ankle/feet 6 4.8 with 15–19 years of experience, who worked an average
Elbow 1 0.8 of >50 min per patient and an average of >50 h per
Total 126 100.0 week and who had a dominant left hand, had a higher

Table 5: Correlation between age/BMI/body height/body weight, level of stress, number of complaint regions in 12-month and
7-day prevalence of MSD
Correlation Age BMI Body weight Height
parameter Spearman’s P-value Spearman’s P-value Spearman’s P-value Spearman’s P-value
correlation correlation correlation correlation
coefficient, r coefficient, r coefficient, r coefficient, r
Level of stress in 0.351 0.027 0.187 0.016 −0.034 0.085 −0.097 0.204
the environment
12-month preva‑ 0.474 0.041 0.191 0.000 0.173 0.007 0.128 0.038
lence of MSD (in
total)
7-day prevalence 0.123 0.002 0.178 0.001 0.037 0.607 0.049 0.549
of MSD (in total)

      Journal of International Oral Health ¦ Volume 13 ¦ Issue 5 ¦ September-October 2021 445  

 Enone, et al.: Ergonomic risks among dental surgeons in Nigeria

Table 6: Logistic regression analysis showing the predictors of MSDs among the study participants
Variables B SE Wald df Sig. Exp (B) 95% CI
Lower Upper
Gender 0.589 0.543 1.176 1 0.278 1.802 0.622 5.227
Age 0.003 0.086 0.001 1 0.020 1.003 0.848 1.187
Years of practice 0.050 0.104 0.231 1 0.631 0.951 0.775 1.167
BMI −0.520 0.236 4.868 1 0.027 1.079 0.733 1.589
Average time spent with patients −0.272 0.169 2.593 1 0.049 0.903 0.313 2.609
Hours of work per week −0.108 0.202 .283 1 0.595 0.898 0.604 1.335
Dominant hand −0.616 0.416 2.192 1 0.139 0.540 0.239 1.221
Number of dental nurses −0.753 0.269 7.871 1 0.000 0.959 0.410 2.243
Work days/week 0.053 0.304 0.030 1 0.863 0.949 0.523 1.720
Type of vision 0.415 0.631 0.432 1 0.511 1.514 0.440 5.212
Exercise −0.042 0.140 0.092 1 0.762 0.959 0.729 1.261
Break between patients 0.042 0.433 0.009 1 0.923 0.959 0.410 2.243
Alcohol use −0.526 0.586 0.806 1 0.369 0.591 0.187 1.864
Environmental stress 0.088 0.121 0.531 1 0.029 1.092 0.862 1.384
Physical demands of work 0.035 0.138 0.066 1 0.797 1.036 0.791 1.358
Constant 6.218 3.656 2.893 1 0.089 501.59

prevalence of MDS. Zarra and Lambrianidis[25] correlated
the number of treated patients with the risk of suffering
from musculoskeletal diseases and obtained an odds ratio
of 3.52 for dental professionals who treated six to eight
patients per day compared with those who treated less
than six patients.[25] Hodacova et al.[26] similarly confirmed
this result among dentists who attended to 20 patients per
day.[26] The findings of our study also concur with a Tunisian
study, which reported a strong relationship between
long service employment and WMSD (P = 0.001).[27] In
addition, a study in Saudi Arabia found that the majority
of participants employed in the public sector for 5 years or
more had a high prevalence of WMSD.[28] These findings
demonstrate the cumulative effect of wrong posture
on WMSD.
Among the participants, 20.1% were overweight, whereas
16.1% of them were obese. The 12-month prevalence of
MSDs correlated significantly with body weight and body
height, whereas the 7-day prevalence of MSD showed
a significant positive (weak) correlation with BMI.
Moreover, the linear regression analysis showed that
obese participants had a higher prevalence of WMSD.
A longitudinal population study in Norway identified that
obese people had a 20% higher risk of experiencing chronic
MSP when compared with those of normal weight.[29]
Similarly, for dentists in an Indian study, overweight and
obesity were found to be associated with MSP.[30]
Furthermore, the average time spent on each patient
was significantly associated with WMSD. Pejčić et al.[31]
observed that dentists who did not take breaks in-between
patient appointments had significantly higher odds of
MSP.[31] Thus a careful schedule of breaks in-between
appointments will have an ameliorating effect on WMSD.
Another research among Danish dental surgeons also
revealed that the duration of each appointment has an
influence on neck pain.[32] This was further corroborated
by another study that showed that patient treatment time
is positively correlated with WMSD pain.[33] Furthermore,
having few dental nurses in the clinic and a high level
of environmental stress were significantly associated
with MSDs.
Established WMSDs cause discomfort, difficulty in
task performance, absenteeism, reduced productivity
and financial losses from lower working hours, medical
expenditure for therapy, and early retirement by dentists.
The main goal is to prevent progression of the said
changes to the chronic phase of disability.[34] Gupta
et al.[35] established that the incidence of MSDs (29.5%)
was the primary reason for early retirement among
dentists. Besides WMSDs, dental clinical personnel
are increasingly developing arthritis and tendinitis in
comparison to other occupational groups studied (e.g.,
doctors and lawyers).[36,37]
These identified risk factors for MSDs can be ameliorated
with good ergonomics practices.[38] In dentistry, the
recommendations to achieve good ergonomics include
the use of adjustable chairs with good support,
correct positioning of the dentist and patient, proper
lighting, indirect mirror viewing, magnification (using
loupes), using ergonomic instruments, and taking
regular rest breaks with exercise/stretching during
breaks.[38]
Limitation
Due to the self-reported nature of the study, the data
obtained are subject to recall bias. Similarly, it is possible
that we did not capture all psychosocial stressors, fitness
and health activities, job satisfaction, lack of social
support by colleagues, and subjective perception of work
load on perception about WMSD.

      
446 446  Journal of International Oral Health ¦ Volume 13 ¦ Issue 5 ¦ September-October 2021
 Enone, et al.: Ergonomic risks among dental surgeons in Nigeria
Conclusion
Our study showed that dentists who were older than
40 years, those who were obese, those who spent an average
of 50 min on each patient, and those who had few dental
nurses in the clinic and had a high level of environmental
stress had a significantly higher prevalence of MSDs.
Modifiable chairs, correct sitting postures by the dental
surgeon and the patient, adequate lighting, use of indirect
vision, use of magnification loupes, and sufficient rest and
breaks at work could help ameliorate these conditions.
Acknowledgements
The authors acknowledge the assistance of the resident
doctors who were involved in the dissemination of the
study questionnaires.
Financial support and sponsorship
This research did not receive any specific grant from
funding agencies in the public, commercial, or not-for-
profit sectors.
Conflicts of interest
There are no conflicts of interest with respect to the study.
Author contributions
E. L. L. conceived and designed the study, conducted research,
provided research materials, collected and organized data,
analyzed and interpreted data, and wrote the initial and final
draft of the article. O. A. conceived and designed the study,
conducted research, provided research materials, collected
and organized data, analyzed and interpreted data, and
wrote the initial and final draft of the article. I. O. designed
the study, conducted research, provided research materials,
collected and organized data, interpreted data, and wrote
the initial and final draft of the article. A. T. E. and O. R.
O. conducted research, provided research materials, collected
and organized data, interpreted data, and wrote the initial
and final draft of the article. All authors have critically
reviewed and approved the final draft and are responsible for
the content and similarity index of the manuscript.
Ethical policy and Institutional Review board statement
Approval for the study was obtained from the Health
Research and Ethics Committee of the Lagos State
University Teaching Hospital. The purpose of the
study was explained to the selected participants and
participation was voluntary. Written informed consent
was also obtained from all the participants.
Declaration of patient consent
Not applicable.
Data availability statement
The datasets will be made available from the corresponding
author on reasonable request.
      Journal of International Oral Health ¦ Volume 13 ¦ Issue 5 ¦ September-October 2021
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