The role of overweight and obesity in shoulder, arm, and hand disability in young dentists: a cross-sectional study in the peruvian andes

Introduction

Conditions affecting the musculoskeletal system constitute a worrying collective health issue due to their implication in considerable costs for both the affected personnel and the entities for which they work.^1,2 The World Health Organization states that these ailments represent the second largest reason for disability in the workplace globally.^3,4 Musculoskeletal disorders comprise injuries that limit the ability of the human body to move and include elements such as muscles, tendons, and ligaments. They are considered significant problems within the practice of clinical dentistry, arising mainly because of physical overload resulting from dynamic and static activities.⁵ In addition, it is recognized that 60% of dentists will experience some type of disorder of this type during their professional career. Of particular importance is the prolonged posture, whether standing or sitting, that is adopted during the execution of tasks of great precision in an area as limited as the mouth.^6–8 Overweight is a factor that can have a significant impact on the onset and severity of musculoskeletal disorders. For dentists, an elevated BMI could compromise musculoskeletal integrity by increasing pressure on joints, unbalancing posture, and promoting inflammation.^9,10 The aim of the research was to evaluate the relationship between shoulder, arm, and hand disability and body mass index in young dentists.

Methods

Results

The analysis involved 222 dental professionals. The group is relatively young, with a median age of 31 and a slight female majority (56.3%). Most professionals were early in their careers, having a median of 3 years in practice. A vast majority (95.5%) are general dentists, indicating a dominance of general practice. Work hours average 40 per week, and daily procedures stand at 6.0 on average, with collaboration with assistants varying widely. The study also delves into anthropometric data and physical activity profiles, important for understanding factors that might affect disability related to BMI. Most participants are either overweight (59.5%) or of normal weight (38.3%), with a median BMI of 25.6. Physical activity levels are low, with 63.5% not exercising regularly; among those who do, exercise is mainly moderate and performed for about 60 minutes weekly. Disability scores reveal variability in functional limitations, with a median score of 12.5, indicating a range of experiences from little to moderate difficulty in shoulder, arm, and hand functions. Work-specific disability also shows varied impact, with a broader range reflecting a spectrum from no to significant work-related disability. (Extended data - Table 1)

The study reveals no significant gender differences in functional disability among dental professionals, although men report higher work-related disability than women. Age and professional experience correlate positively with disability, indicating that longer careers and aging increase the risk of functional and work-related limitations. Specialization does not significantly affect disability levels, showing that general dentists and specialists face similar risks. Occupational stress, indicated by longer work hours and more procedures, correlates with higher disability scores, highlighting the role of physical demand on dentists' musculoskeletal health. Contrary to expectations, four-handed work doesn't lessen disability, suggesting complex work dynamics may influence disability development. Body weight, but not height, is linked to increased disability, pointing to weight management as crucial for preventing occupational disabilities. Physical activity is protective, with active individuals reporting lower disability levels, emphasizing the importance of exercise in preventing functional and occupational disabilities. The research also confirms a significant relationship between BMI and disability, with higher scores among those overweight or obese, aligning with the study's hypothesis on BMI's importance in managing and preventing disability in dental surgeons. (Extended data - Table 2)

The scatter plots illustrate a positive correlation between BMI and both general and work-related disability scores, with a best-fit line indicating that higher BMI is associated with increased disability. This trend suggests BMI as a potential risk factor for disability in this profession. (Figure 1 and 2)

Figure 1. Scatterplot of shoulder, arm and hand disability score and BMI.

Figure 2. Scatterplot of shoulder, arm and hand work disability score and BMI.

Table 3 reveals that dentist with overweight or obesity have a significantly higher risk of functional work disability compared to those of normal weight, with the risk being 7.80 times higher in a simple model and 442.67 times higher in an adjusted model, both statistically significant. Workload over 42 hours per week significantly increases disability risk, while regular physical activity substantially reduces it.

Table 4 confirms similar trends for work-related disability, with overweight or obese individuals facing a 12.74 times higher risk in a simple model and an astonishing 10544.08 times higher risk in an adjusted model. Professional experience and daily workload are linked to increased disability risk, whereas regular physical exercise offers a profound protective effect, dramatically lowering the risk of work disability among dental surgeons.

Discussion

This research delves into the link between body mass index (BMI) and functional disability in the upper limbs of dentists, uncovering a significant association between higher BMI and an increased prevalence of functional disability, even when accounting for variables such as work intensity and physical activity levels. The discussion contrasts these findings with existing studies to enrich the understanding of the impacts of BMI on musculoskeletal health in the dental profession.

Studies like those by Chaiklieng and Poochadal,⁴ and Sukmasari et al.⁷ support our observations on the prevalence of musculoskeletal pain and its correlation with physical activity, highlighting the impact of overweight on functional disability. These align with our findings, emphasizing the pattern of musculoskeletal issues in dentistry, yet our study adds a new dimension by focusing on BMI's specific role. Conversely, Meisha D et al.'s work⁸ on musculoskeletal disorders and the importance of ergonomic training complements our recommendations for promoting healthy lifestyles and occupational wellness.

The high prevalence of musculoskeletal disorders among dental professionals in various studies, such as those by Ohlendorf D et al.,⁶ Sarwar S et al.,¹² and Asma S et al.,¹³ echoes our findings, underlining the need for ergonomic interventions and health programs tailored to the dental sector. Our study contributes to this body of knowledge by highlighting BMI's influence on both functional and work disability, urging a multifaceted approach that includes weight management and improved working conditions.¹⁴

A significant portion of dental professionals are overweight, with a low level of regular physical activity, spotlighting a crucial health concern within this community. The implications of overweight and physical inactivity extend beyond general health, impacting susceptibility to musculoskeletal disabilities—conditions compounded in dentistry by the physical demands of the profession. This link between physical activity and musculoskeletal health, supported by our findings and existing literature, emphasizes the protective role of regular exercise and healthy living in preventing functional disabilities.^15,16

Our research also sheds light on demographic trends, revealing a female predominance and a younger professional population among dentists. This demographic makeup necessitates tailored occupational health and disease prevention strategies, considering gender-specific needs and the long-term exposure to occupational hazards.¹⁷

Despite the insights provided, our study's cross-sectional nature and reliance on self-reported data introduce limitations, such as the inability to establish causality and potential reporting biases. Nevertheless, the statistical robustness and representativeness of our sample lend credibility to our findings, which underline the significance of addressing overweight and obesity to prevent functional disabilities among dental professionals.

In addressing these challenges, the study underscores the importance of ergonomic interventions alongside strategies promoting healthy weight and physical activity as comprehensive measures to mitigate the risk of functional disabilities. These findings point towards the necessity of a complete approach to wellness in the dental profession, emphasizing the benefits of a healthy lifestyle and ergonomic workplace design in improving the health and well-being of dentists.¹⁸

Conclusively, this research not only highlights the relationship between BMI and functional disability in dental surgeons but also calls for further longitudinal studies to better understand causality and the effectiveness of interventions. Adopting preventive strategies based on our findings could markedly enhance the health and quality of life of dental professionals, paving the way for a healthier, more sustainable practice in dentistry.

Ethics and consent

The study was approved with Official Letter from the Research Ethics Committee of the School of Stomatology N° 0100-2023-/UCV/P dated December 20, 2023. We adhered to the principles of the Declaration of Helsinki. Written consent was obtained from all participants.