Work 68 (2021) 213–221 213

DOI:10.3233/WOR-203369
IOS Press

Risk factors for work-related

musculoskeletal disorders of dentists in
Kuwait and the impact on health and
economic status
Musaed Z. Alnasera,∗ , Alaa M. Almaqsiedb and Shaimaa A. Alshattib
a Occupational Therapy Department, Faculty of Allied Health Sciences, Kuwait University, Kuwait
b Occupational Therapy Department, Physical Medicine and Rehabilitation Hospital Sulaibikhat, Kuwait

Received 5 February 2019

Accepted 10 February 2020

Abstract.
BACKGROUND: Work-related musculoskeletal disorders have become a great health issue among dentists. However, it is
never been examined among dentists in the State of Kuwait.
OBJECTIVE: The purposes of this study were to define the prevalence of work-related musculoskeletal disorders (WMSD)
among dentists in the State of Kuwait, to identify risk factors for WMSD, and to explore relationships between WMSD and
absenteeism/productivity.
METHODS: A descriptive cross-sectional design was used in this study. A self-administered questionnaire was distributed
to dentists at government, private, and academic dental clinics.
RESULTS: A total of 186 questionnaires were returned (80% response rate). The results showed that 88 (47%) of responding
dentists experienced WMSDs. Dentists self-reporting WMSD were older (36.4 (10.3) years vs. 32.6 (9.33); P = 0.01), in
practice longer (11.7 (10.4) years vs. 8.2 (8.4); P = 0.013), and worked longer hours (34.9 (10.6) hours vs. 30.4 (11.5);
 than dentists not reporting WMSD.
P = 0.08)  A significant association was found between rating of pain and lost days from
work x2 (10, n = 85) = 20.96, ρ = 0.021 .
CONCLUSION: Dentists’ occupational procedures expose their bodies to prolonged and awkward postures, thereby sub-
jecting the dentists to unnatural forces and stresses on crucial movement and functioning joints. Cumulative exposures to such
postures lead to WMSDs. Generally, WMSD has a considerable impact on the health and economic status of the individual,
family, and workplace. WMSD increases absenteeism and reduces productivity.

Keywords: Musculoskeletal injuries, ergonomics, occupational injuries, work incidence, posture

1. Introduction workplace injuries occurred in service-providing

The U.S. Bureau of Labor Statistics reported 2.9
million nonfatal workplace injuries in 2016, cor-
responding to an incidence of 2.9 cases per 100
equivalent full-time workers [1]. Most (75%) nonfatal
∗ Address for correspondence: Musaed Z. Alnaser, PhD, OT,
Occupational Therapy Department, Faculty of Allied Health
Sciences, Kuwait University, P.O. Box 31470, Sulaibikhat,
Kuwait City 90805, Kuwait. Tel.:+965 9757 5556; E-mail:
ot alnaser@hsc.edu.kw.
industries, in which the health care industry was
listed second (562,000 cases per year) after the trade,
transportation and utility industry (774,000 cases per
year). In addition, the health care industry reported
more than 100,000 days away from work due to work-
place injury, with a median of six days away from
work for each case [2]. These data also showed that
31% of workplace injuries affected the musculoskele-
tal system (primarily sprains, strains and tears) [2].
Given the nature of occupations affected and the high

ISSN 1051-9815/21/$35.00 © 2021 – IOS Press. All rights reserved.

214 M.Z. Alnaser et al. / Work-related musculoskeletal of dentists
prevalence of workplace injury, work-related muscu-
loskeletal disorders (WMSDs) has become an urgent
and serious occupational health issue among health-
care practitioners [3–5], including dentists [3, 6–11].
Ayatollahi et al. [12], Tirgar et al. [6], Ganiyu et
al. [13] and Nermin [8] described the nature and
characteristics of work-related physical activities and
procedures inherent in the practice of dentistry as
occupational hazards. Other research has showed that
dentists have a higher incidence and prevalence of
musculoskeletal symptoms than other occupational
groups [3, 7, 9, 10].
2. Background
2.1. Nature of dentists’ work practices and
postures
Marshal et al. [14] suggested that occupations
requiring maintenance of static posture for pro-
longed intervals were most at risk for WMSD. Risk
would be even greater when occupational activities
required unnatural anatomic alignment. Work prac-
tices of dentists mandate high level skills including
intense concentration and attention to detail, visual
and depth perception, and fine and gross motor
control [15] keen accuracy [6] in prolonged static pos-
tures [6, 16]. Valachi and Valachi [17, 18] described
the unbalanced forward positioning of the head and
neck that dentists must maintain while performing
dental procedures. This awkward positioning places
the spinal column in improper alignment inade-
quate for head support, which causes upper thoracic
and cervical muscles to contract continuously to
maintain head position. Over time, muscles adjust
to inappropriate postures, thereby leading to struc-
tural changes and chronic musculoskeletal damage.
This results in locoregional pain, headaches and
fatigue.
2.2. Prevalence of WRMDs among dentists
A systematic review of 23 articles from 8 dif-
ferent countries reporting on musculoskeletal pain
in dentists estimated a prevalence of 64–93% [3].
The back and neck were the anatomic areas most
commonly affected. Leggat and Smith [19] surveyed
dentists in the Queensland Branch of the Australian
Dental Association and found that 87% of respon-
dents reported having at least one WMSD symptom
in previous 12 months, most often affecting the neck,
shoulders, or low back. Similar prevalence of WMSD
in dentists from Thailand, Serbia, Turkey, Australia,
India and Iran have been reported [6, 11, 14, 20–23].
Headache was also reported as a common symptom
as well [14, 23]. Leggat et al. [7] also performed an
extensive literature review examining occupational
health problems and WMSDs. They concluded that,
despite technical advances in recent years, WMSD
remains a major occupational health problem in mod-
ern dentistry.
2.3. Causes of WMSD among dentists
Performance of dental procedures requires pro-
longed maintenance of posture, resulting in pro-
longed contraction of multiple core stabilizer muscles
[5, 8, 18]. Most muscular stress is incurred during
trunk flexion, which causes strain and overexertion
of the lower back musculature. WMSD in dentists
and similar occupations primarily results from the
cumulative effects of prolonged work practices and
repetitive motor activities performed while maintain-
ing a static posture [3, 6, 11, 14, 20, 21]. Moreover,
Valachi and Valachi [18] pointed out that WMSD
developed in dentists whether they preferred working
while standing or sitting- the only observed difference
was the anatomic site affected by WMSD.
In reviewing studies of potential causative factors
of WMSD in dental operators, Valachi and Valachi
[18] found that causes of musculoskeletal pain are
multifactorial and include prolonged static posture,
imbalanced posture, hypomobile joints, and one-
sided weight bearing. Valachi and Valachi [18] also
found that weak postural muscles of the trunk and
shoulder may lead to poor operator posture. In addi-
tion, they describe a relationship between prolonged,
static muscle contractions and muscle ischemia and
myonecrosis [18]. Ayatollahi et al. [12] reported that
dentists tend to work in strained postures that promote
musculoskeletal malalignment, Lindfors et al. [24]
related strenuous work posture, meticulous motor
activity, and muscle fatigue to musculoskeletal dis-
orders of the upper extremities in dentists and Tirgar
et al. [6] concluded that fatigue in the deep cervical
flexor muscles associated with MSD in the cervical
region.
2.4. After-effect of WRMDs
Hayes et al. [3] recognized that WMSD in den-
tistry contributes considerably to increased use of sick
leave and reduced clinical productivity; it even forces
 M.Z. Alnaser et al. / Work-related musculoskeletal of dentists
some practitioners to leave the profession. Also, Leg-
gat and Smith [19] found that nearly 10% of dentists
reported taking leave from work due to WMSD.
Those who took sick leave for WMSD reported that
their daily activities were also restricted because
of WMSDs primarily affecting the back, neck, or
shoulder [19]. Almost 40% of dentists seek medi-
cal attention because of the severity of WMSD [19,
25]. Muralidharan et al. [21] described the impact
of WMSD in dentists in terms of increased absen-
teeism or sick leaves, reduced clinical productivity,
and the need for medical consultation and alteration
of clinical duties.
2.5. WRMDs among dentists in Kuwait
In Kuwait, dentistry is a fast growing profession
in the government and the private sectors. How-
ever, we were unable to find previous reports on the
prevalence of WMSD and associated risk factors. In
Kuwait, primary prevention is rarely implemented
and, secondary prevention, in which change occurs
after concerns are raised, is mainly utilized. We seek
to bring awareness and knowledge about an alarm-
ing health issue among dentists in Kuwait and to
help prompting prevention measures. Therefore, the
aim of this study was to determine the prevalence
of WMSD among Kuwait dentists, its associated
risk factors, and to define the relationship between
WMSD and dentist absenteeism and workplace pro-
ductivity. We believed that the prevalence would be
high because the dental occupation necessitates per-
formance of recurring and repetitive physical tasks
on a daily basis.
3. Materials and methods
3.1. Participants
The questionnaire was distributed to 232 den-
tists working in government, private, or academic
clinics. A convenient sampling method was used
to identify participants. Inclusion criteria included
dentists with at least one year of clinical experi-
ence and at least one month of continuous practice
before data collection. Exclusion criteria included
having prior musculoskeletal surgery. Auxiliary den-
tal professionals (dental assistants, dental hygienists,
dental technicians, or dental therapists) were also
excluded.
215
3.2. Instrument
The questionnaire used was originally designed by
Holder et al. [26] and later adapted by Alnaser [27],
and is a self-reported survey with closed-ended ques-
tions. The original questionnaire established face and
content validity and an average of 98% test-retest
reliability. Additional modifications were made to
the questionnaire to fit the population in this study.
The original questionnaire was designed to exam-
ine musculoskeletal disorders in physical therapists.
Modification made to replace the word “physical ther-
apists” with “dentists” and to add areas of practice
relating to dentistry. The questionnaire included two
sections: Section I included 13 demographical items
such as age, sex, area of practice, weight, height,
hours in patient contact, and years of experience. Sec-
tion II was self-reporting of any WMSD experienced
during the past 12 months and the duration of sus-
tained WMSD was not specified. It included 13 items
such as types of injuries, affected anatomical areas,
activities that provoked or exacerbated symptoms of
WMSD, and dentist responses to injuries.
3.3. Procedure
The study had been conducted in full accordance
with the World Medical association Declaration of
Helsinki. Approvals from the Faculty of Allied Health
Sciences Institutional Review Board at Kuwait Uni-
versity and Ministry of Health of Kuwait were
obtained. Using a convenient sampling method, the
questionnaires and consent forms were distributed in
person to dentists in governmental, private, and aca-
demic dental clinics. Informed consent was obtained
from all individual participants before handing the
questionnaire. Some questionnaires were collected at
the time of distribution and others were collected one
week later in person.
3.4. Study design
A cross-sectional design was used for this
study. All variables relating to WMSD were self-
reported. The main variables of examination included
symptoms of WMSD, anatomic region injured, per-
formance of tasks and activities related to WMSD,
and responses taken after an incurring an injury.
Variables were measured on a nominal scale. Demo-
graphic data included both discrete and continuous
variables.
216 M.Z. Alnaser et al. / Work-related musculoskeletal of dentists

3.5. Data analysis Table 1

Times reporting and percentages of body area injured and types
of injuries among dentists respondents with WMSDs (N = 186)
The Statistical Package for the Social Sciences
Dentists with WMSDs (n = 89)
(SPSS) version 23 was used for analysis. Descriptive No. of times Percentage
statistics were used to summarize the demographics Body area injured
and frequencies of WMSD among respondents. An Neck 49 27.70
independent sample Student’s t test was conducted to Lower back 48 27.10
Shoulder 39 22.00
compare years of experience, age, and working hours Wrist/hand 19 10.75
between dentists with or without WMSD. The χ2 test Upper back 12 06.75
was conducted to determine the association between Elbow 06 03.40
Hip/thigh 03 01.70
independent factors and occurrence of WMSD. Alpha Ankle/foot 01 00.55
was set at P ≤ 0.05. Prevalence was calculated using Types of WMSDs
the following formula: Muscle spasm 33 30.85
Muscle strain 32 29.90
Prevalence = (Number of dentists with injuries ÷ Vertebral disk invol. 13 12.15
Ligament sprain 09 08.40
Number of dentists responding) × 100% Tendinitis 09 08.40
Degeneration 02 01.85
Carpel tunnel 02 01.85
Rotator cuff 02 01.85
4. Results Hand-arm vibration 01 00.95
Trigger finger 01 00.95
Other 03 02.80
4.1. Participants

A total of 186 dentists (80% response rate) com-
pleted the questionnaire and qualified for analysis.
Age ranged from 23 to 67 years with a mean of
34.3 ± 9.9 years. Of the respondents, 106 (57%) were
male and 78 (42%) were female (there were two miss-
ing responses for sex). Respondents mainly worked in
government clinics (75%), with 19% in private clin-
ics and 5% in academic clinics. Most reported being
in general practice (48%), with fewer in endodontics
(11%), dental public health (10%), pediatrics (6%),
orthodontics and dentofacial (5.5%), prosthodontics
(5.5%), or other subspecialties (16%). The number of
years in practice among respondents ranged from 1
to 45 years with a mean of 9.7 ± 9.5 years. Working
hours ranged from 3 to 72 hours per week with a mean
of 32.4 ± 11.3 hours and the number of patients seen
per day ranged from 2 to 28 with a mean of 10.7 ± 5.7.
4.2. Prevalence of WMSD
third most prevalent site of injury (Table 1). Also,
the dentists with injuries identified 10 WMSDs and
reported one or more type of injury 107 times. They
reported muscle spasm (30.85%, 33 reported) as the
most common injury, and followed by muscle strain
(29.90%, 32 reported) and vertebral disk involve-
ment (12.15%, 13 reported) (Table 1). Injuries were
reported most commonly for general practice (50%),
endodontics (22%), pediatric dentistry (8%), and
dental public health, oral and maxillofacial, and
prosthodontics (each 5%).
Dentists reporting injuries tended to be older
(36.4 ± 10.3 years vs. 32.6 ± 9.3 years; P = 0.01)
and in practice longer than dentists without injury
(11.7 ± 10.4 years vs. 8.2 ± 8.4 years; P = 0.013).
Although there was no difference in the number of
patients treated per day, dentists reporting injuries
worked more hours than those not reporting injury
(34.9 ± 10.6 hours vs. 30.4 ± 11.5 hours; P = 0.08).

Over the preceding 12-month period, 89 (48%) of
responding dentists reported experiencing a WMSD.
The dentists with injuries were asked to report
all possible anatomic sites affected, and each was
allowed to report one or more area with injury. They
identified 8 different body sites in a total of 177
times. They reported the highest level of WMSD in
the neck (27.7%, 49/177 reported), and they reported
the lower back (27.1%, 48/177 reported) and the
shoulder (22%, 39/177 reported) as their second and
4.3. Work tasks as risk factor
Dentists with injuries identified root canal
treatment (35%), teeth extraction (26%), crown
preparation (17%), and drilling and filling (12%) to
be most strenuous activities. Also, they identified
maintenance of a particular posture for a prolonged
period of time and bending or twisting as the most
common specific antecedent factors (Table 2). Over
half of dentists reporting WMSD (55%) testified that
 M.Z. Alnaser et al. / Work-related musculoskeletal of dentists 217

Table 2
Activities caused injuries among responding dentists (N = 186)
Dentists with injuries (n = 89)
Reported (136) Percentage (%)
Maintaining a position for prolong period 41 30
Bending or twisting 27 20
Working when physically fatigued 17 13
Working in awkward or cramped position 16 12
Performing repetitive tasks 14 10
Slipping, tripping, falling 13 09
Responding to unanticipated or sudden 05 04
movement by a patient
Others 03 02

Table 3
Coping/adaptive strategies employed by responding dentists (N = 186)
Dentists with injuries (n = 89)
Reported (102) Percentage (%)
Change working position frequently 38 37
Take more rest breaks or pauses 14 14
Use improved body mechanics 13 13
Stop working when hurt or symptoms reoccur 13 13
Change work schedule 06 06
Increase use of mechanical aids 05 05
Increases administrative time 05 05
Increase use of other personnel 04 04
Other 04 04

continued clinical practice exacerbated their symp-
toms. Specific postures or motions that aggravated
their symptoms included maintaining a position for a
prolonged period of time (30%), bending and twist-
ing (21%), working in an awkward position (13%),
performing repetitive tasks (11%), and working when
physically fatigued (10%).
4.4. Responses to injuries
Dentists with injuries rated their pain when
experienced WMSD. On the pain scale (0–10),
they reported a mean score of 4.8 ± 2.2. How-
ever, only 23% (20 participants) of dentists with
WMSD report lost days from work due to their
injuries. Lost work days counted for 163 hours
that spent away from work. A significant associ-
ation was found between rating of pain and lost
days x2 (10, n = 85) = 20.96, ρ = 0.021 . More-
over, Most dentists reporting a WMSD in this survey
did not report their injury (78%; 69 participants) to the
appropriate occupational health personnel. Instead,
they stated that they were “too busy to report” (36%),
“becoming accustomed to injury” (30%), or reluc-
tant to report the injury “to avoid being perceived
as incompetent” (8%). Also, 59% of dentists with
injuries attempted to self-treat at some point and 50%
sought medical consultation.
4.5. Adaptation/coping with WMSDs
The results showed that 56% of dentists with
injuries applied some adaptive or coping strategies
to mitigate symptoms or avoid future recurrences.
Such strategies included changing working positions
frequently and taking more rest breaks or pauses
(Table 3). Also, they indicated limiting patient contact
time (14%), limiting their area of practice (13%), or
considering changing jobs (7%) because of WMSD.
5. Discussion
This study examined the prevalence and risk fac-
tors related to WMSD among a cross-section of
dentists in Kuwait. The results showed that over a
12-month period, almost half (48%) of responding
dentists experienced a WMSD. This prevalence is
considered very high, particularly given the relatively
small workforce of dentists in the State of Kuwait.
Long years in practice was an associated risk factor.
Neck and back were most common anatomical areas
injured and root canal treatment and teeth extraction
were most strenuous activities reported by dentists in
this study. Dentists with injury reported medium level
of pain, the majority did not report their injuries and
one-fourth lost days from work.
218 M.Z. Alnaser et al. / Work-related musculoskeletal of dentists
Around the world (including the USA, the Nether-
lands, Saudi Arabia, Denmark, and Australia),
reported prevalence range from 20% to 81% [3]. The
prevalence of WMSD reported here is not as high as
reported in India (100%, 78%, and 68%) [21, 28, 29],
Turkey (70% and 94%) [20, 30], Saudi Arabia (90%
and 85%) [31, 32], Australia (89%, 87% and 82%)
[14, 19, 33], China (88%) [34], Serbia (82% and 76%)
[11, 23], Thailand and Sweden (78%) [22, 24], Iran
(76%, 69% and 83%) [6, 35, 36], and Poland (60%)
[37]. These findings from several different countries
seem to indicate that WMSD among dentists may be
related to generally inherent occupational activities,
and not to different degrees of industrialization and/or
technological advances.
5.1. Postures and movements as risk factors
Neck, lower back, and shoulder regions were the
most commonly injured anatomic sites in this study as
well as several prior studies from different countries
[3, 6, 7, 10, 13, 15, 19–22, 25, 28, 31–33, 36, 38, 39].
This is likely directly related to dentist posture during
procedures, in which neck and lower back flexion is
prolonged. This is illustrated in Table 2 as dentists
identified maintaining positions for prolonged peri-
ods as a common causative factor for their injuries.
Similar findings were reported by other investigators
[13, 15, 22, 29, 30, 34, 37, 39]. Other commonly
affected anatomic sites included the wrist and hand
[10, 14, 19, 21, 28, 31, 34, 37, 39].
In this study, dentists with injuries identified some
types of WMSDs not reported in prior studies. Muscle
spasm, muscle strain, vertebral disk involvement, lig-
ament sprain, and tendinitis were the most common
types of WMSD in this study population. These disor-
ders clearly point to awkward and prolonged posture,
excessive repetitive motor activity, and high physical
stresses and loads as occupational characteristics that
place dentists at risk of WMSD. Again, we note that
WMSD in dentists could not be related to industri-
alization and could not be limited to underdeveloped
environments.
5.2. Personal and working characteristics as
risk factors
Two previous studies found that more years of
practice and advanced age were associated with
WMSD [11, 37]. Conversely, other investigators have
reported that dentists with fewer years of expe-
rience were more likely to develop WMSD [19,
22, 38]. In this study, WMSD were reported more
often by older dentists with many years of clini-
cal practice and longer working hours. These three
factors may suggest that WMSD in dentists are
related to the cumulative effects of physical loads
and vibration, maintenance of unnatural postures for
prolonged intervals, and excessive repetitive move-
ments and activities for several hours a day over
many years. Similarly, Sakzewski and Naser-ud-Din
[33], Aminian et al. [35], and Rafie et al. [36] inde-
pendently concluded that high levels of physical
work-related stress over several years was the main
predictor of WMSD in dentists. In addition, den-
tists with injuries reported that continuing clinical
practice, including maintenance of awkward postures
and performance of repetitive tasks, exacerbated the
symptoms of WMSD. They also report that root canal
treatment, teeth extraction, crown preparation, and
drilling and filling worsened their symptoms. This
could be an indication that dentists with WMSD
continued their clinical practice despite pain and dis-
comfort. Continuing clinical practice with an injury
may be indicative of denial of the injury or be moti-
vated by avoidance of being perceived as incompetent
or uncaring—particularly for foreign dentists with
contracts or those under observation. Regardless,
continuing clinical practice for whatever reason does
not allow affected joints and muscle groups to rest
and recuperate.
5.3. Culture and behaviors toward WMSDs
Despite experiencing moderate to severe levels
of pain due to WMSD, the majority of dentists did
not report their injuries to appropriate occupational
health personnel. They often indicated that they were
too busy to report their injuries, which could reflect
the high level of their work demands. Another com-
mon reason was being accustomed to the injury,
which may reflect an occupational culture among
dentists to accept injuries as an expected occupational
hazard. The “culture of selflessness” makes it diffi-
cult for dentists to admit suffering from work-related
injury. Approximately half of dentists with WMSD
sought medical attention in this and other previous
studies [19, 21, 23, 25]. This behavior may indicate
that dentists, as healthcare providers often do, per-
ceive that seeking medical treatment is unfitting or
embarrassing.
More than half of dentists reporting WMSD rec-
ognized their injuries and attempted various coping
strategies to reduce pain and discomfort and to pre-
 M.Z. Alnaser et al. / Work-related musculoskeletal of dentists
vent future episodes. They seemed to recognize the
effect of static and prolonged postures by chang-
ing work positions frequently and using improved
body mechanics. Also, they seemed to be more con-
scious about preventative measures by taking more
rest breaks, stopping work when feeling hurt, request-
ing assistance from other personnel, and increasing
use of mechanical aids.
5.4. Effects of WMSDs on the individual and
work practices
Nermin [5] explains that WMSD is a costly health
problem to the individual, his/her family and the
workplace. WMSD leads medical cost including
medical and rehabilitation expenses and economical
cost such as lost production, stopped wages, and find-
ing and training replacement. Because of WMSD,
approximately 25% of respondents lost days from
work that significantly associated with a higher rating
of pain. A previous study reported that 12% of den-
tists with pain took sick leave [30]. Often these leaves
are quite extended. Muralidharan et al. [21] and Leg-
gat and Smith [19] have both reported that sick leaves
average around 2 weeks duration. Absenteeism, sub-
optimal efficiency, and lack of concentration during
task performance due to injury all effect clinical pro-
ductivity and quality of patient care [21]. As reported
by the Bureau of Labor Statistics, millions of dollars
are lost because of absenteeism caused by work-
related injuries. Moreover, patient satisfaction and
trust may suffer because of chronic absenteeism and
delayed dental appointments.
The Bureau of Labor Statistics reported that
injured workers older than 45 years of age tended to
take more days away from work than younger work-
ers, and injured workers older than 55 years of age had
the highest incident rate [2]. In this study, older den-
tists experienced more WMSDs, which may in turn
explain why they also were absent from work longer.
Similar finding was also observed among dentists in
India, Lithuania, and Poland [21, 40, 41]. This could
impose a high financial cost to dental clinics that
rely on dentists to treat patients. Additional financial
costs may also be incurred, such as supplying replace-
ment staff, making overtime payments, loss of clinic
productivity, and possibly paying compensation on
injury claims.
Alnaser [4] explains that WMSD can have psy-
chosocial consequences including fear, anger, and
isolation, and limited performance of personal and
family roles and restricted participation in social and
219
leisure activities, in addition, Leggat et al. [42] found
high prevalence of stress among dentists. Radanović
et al. [23], Muralidharan et al. [21], Feng et. al. [34],
and Taib et al. [43] showed that WMSD lead to a
reduction in engaging in normal activity of daily
living and leisure activity, as well as increased physi-
cian consultations, hospitalizations, and sick leaves.
Muralidharan et al. [21] and Leggat and Smith [19]
believe that WMSD do not solely affect the physical
well-being of the dental practitioner but can affect
psychological and social well-being as well. Muralid-
haran et al. [21] suggest that these non-physical
effects may contribute to a decreased quality of life.
This may explain why some dentists with WMSD in
this study have since limited the number of patients
they treat or fields in which they practice; some have
even considered quitting dentistry. Likewise, Rafie et
al. [36] and Pourabbas et al. [44] also found dentists
with WMSD tend to reduce their work hours, utilize
sick leave, or leave their practices.
In conclusion, dentists in Kuwait and other coun-
tries face a major problem with respect to WMSD.
This occupational hazard is common in industrial-
ized, industrially developing, and underdeveloped
countries. The main cause of WMSD could be the dif-
ficult nature of dental practice requiring long hours of
precise, meticulous, repetitive tasks and motor activ-
ities that subject the body to unnatural and awkward
anatomic postures which impose increased force and
load bearing on stressed muscles and joints of the
neck, shoulders, low back, wrists, and hands. More-
over, WMSDs, in particular with a higher level of
pain symptom, could result in increased absenteeism,
reduced clinical productivity, and in turn, higher eco-
nomical costs. Finally, dentistry education programs
should include courses in ergonomics and biome-
chanics. Dentists should also consider participating
in continuing education programs in ergonomics.
New ergonomically designed dental instruments that
allow for more natural body positioning are needed
as well.
6. Limitations
This study used a self-report questionnaire. It is
possible that respondents under- or overestimated
their past experiences with WMSD. Interviews of a
small sample of dentists with WMSD may provide
a better understanding of individual dentist expe-
riences. The generalizability of the study may be
limited given the survey population (dentists within
220 M.Z. Alnaser et al. / Work-related musculoskeletal of dentists
the State of Kuwait). An international sample is likely
to provide more robust findings.
Conflict of interest
The authors have no conflicts of interest or sources
of funding to declare.
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