Dentistry is widely recognized as an occupation associated with a high risk of work-related musculoskeletal disorders (MSDs), largely due to prolonged static postures, repetitive movements, and suboptimal ergonomic conditions. ¹ Dental professionals frequently maintain sustained neck flexion and rotation to obtain adequate visualization of the operative field, placing considerable biomechanical stress on the cervical spine. ² Evidence suggests that the cervical region is among the most commonly affected anatomical areas, with symptoms often beginning during undergraduate clinical training. ^{2, 3}

Dental internship programs typically require interns to work for extended hours in constrained postures, potentially accelerating the onset of cervical pain and functional limitations. ⁴ In the United Arab Emirates, dental interns undergo a 12-month internship involving approximately 6–7 clinical hours per day, which may increase cumulative cervical loading. ⁵ While previous studies have documented the prevalence of neck pain among dentists and dental students, ^{6, 7} limited data exist regarding the early impact of prolonged dental chair use on cervical spine mobility during internship training. Therefore, this study aimed to evaluate changes in cervical ROM and neck pain associated with prolonged dental chair utilization among dental internship students.

The study included 40 dental internship students from Thumbay Dental Hospital, Ajman, United Arab Emirates. Demographic characteristics of the participants are presented in Table 1.

Comparison of cervical ROM between baseline and follow-up measurements demonstrated no statistically significant differences in cervical flexion, extension, left rotation, or bilateral lateral flexion following one month of routine dental clinical exposure. However, a statistically significant increase in right cervical rotation ROM was observed at follow-up assessment ( Table 2).

Pain assessment using the VAS revealed a statistically significant increase in neck pain intensity following the one-month clinical exposure period. These findings indicate that prolonged dental chair utilization during internship training was associated with increased cervical discomfort despite relatively preserved cervical mobility.

Figure 1 illustrates the comparison between baseline and follow-up cervical ROM measurements, while Figure 2 presents the comparison of neck pain intensity values between the two assessment periods. The results in Figure 1 indicated no significant changes in flexion, extension, right lateral flexion, or left lateral flexion. However, a significant change was observed in right rotation (p < 0.001), while left rotation showed no significant change (p = 0.076). A significant increase in pain levels was seen over time, with mean VAS scores rising from 3.92 ± 1.873 initially to 4.58 ± 1.259 (p < 0.001) ( Figure 2).

Inferential analysis demonstrated statistically significant increases in right cervical rotation (mean difference = 2.15°, 95% CI: 0.12 to 4.18, p = 0.038) and VAS pain scores (mean difference = 0.66, 95% CI: 0.08 to 1.24, p = 0.027) following one month of clinical exposure. No statistically significant differences were observed for cervical flexion, extension, bilateral lateral flexion, or left cervical rotation (p > 0.05) ( Table 3).

The present study evaluated the short-term effects of prolonged dental chair utilization on cervical spine mobility and pain among dental internship students. The principal findings indicate a significant increase in cervical pain over time, while cervical range of motion remained largely unchanged, except for a significant increase in right cervical rotation.

The absence of significant changes in cervical flexion, extension, and lateral flexion suggests that short-term exposure to prolonged static dental postures may not immediately compromise gross cervical mobility in young adults. This finding contrasts with reports of reduced cervical ROM among experienced dental professionals, suggesting that cumulative exposure over longer durations may be required for measurable mobility impairments to develop. ^{10, 11} The relatively short follow-up period and the adaptive capacity of younger musculoskeletal systems may partly explain these findings.

A statistically significant increase in right cervical rotation was observed. This may reflect adaptive or compensatory movement strategies adopted by interns to accommodate visual and ergonomic demands during dental procedures. Right-handed dental practitioners frequently assume asymmetric postures involving sustained rotation and side bending to optimize visibility within the oral cavity. ¹² Repetitive use of these postures may promote directional mobility adaptations, resulting in increased range in the dominant direction of movement.

Despite minimal changes in cervical mobility, a significant increase in neck pain intensity was observed over the one-month period. Prolonged static postures are known to impair muscle perfusion, reduce oxygen delivery, and promote accumulation of metabolic by-products, leading to muscle fatigue and pain. ¹³ Sustained low-level muscle contractions can also compress vascular structures and joint tissues, contributing to ischemia and nociceptive sensitization. ¹⁴ These mechanisms may explain the observed rise in pain scores despite preserved joint mobility.

The findings align with existing literature documenting a high prevalence of neck pain among dental professionals and students, ⁶ even in the absence of marked structural or functional impairments. Early onset of pain during internship training highlights the importance of addressing ergonomic risk factors at the beginning of professional practice. Without intervention, persistent pain may progress to chronic musculoskeletal disorders, reduced work capacity, and diminished quality of life.

The findings of the current study are consistent with recent systematic reviews reporting high rates of cervical pain among dental professionals and students exposed to prolonged static postures and repetitive occupational demands. A recent systematic review by Ehsan Rafeemanesh identified poor cervical posture, prolonged working duration, inadequate rest intervals, and increased patient load as major contributors to neck pain among dentists. ¹⁵ Similarly, another systematic review demonstrated that sustained forward head posture and asymmetric trunk positioning substantially increase cervical muscular loading and cumulative trauma exposure among dental practitioners. ¹

The present findings also align with evidence suggesting that musculoskeletal pain may emerge before measurable functional limitation develops. Young clinicians may initially compensate through adaptive neuromuscular strategies and preserved tissue flexibility, thereby maintaining cervical ROM despite increasing pain symptoms. This may explain why cervical mobility remained largely unaffected in the present study despite significant increases in pain intensity. Recent ergonomic intervention reviews have additionally emphasized the protective role of stretching exercises, ergonomic education, indirect visualization techniques, and scheduled rest breaks in reducing occupational cervical strain among dental professionals. ¹⁶ These findings support the integration of preventive ergonomic training during undergraduate and internship dental education.

Moreover, recent occupational health literature has highlighted that early-stage cervical symptoms among dental interns may progress into chronic work-related musculoskeletal disorders if preventive strategies are not implemented promptly. ¹⁷ The current study therefore contributes important preliminary evidence regarding the early onset of occupational cervical pain during internship training. Practical ergonomic challenges experienced by dental professionals have also been reflected in contemporary professional discussions emphasizing the importance of appropriate patient positioning, neutral posture maintenance, and avoidance of excessive cervical flexion during clinical procedures.

Prolonged dental chair utilization during internship training was associated with a significant increase in neck pain among dental interns, while cervical spine mobility remained largely preserved over the short-term observational period. The findings suggest that pain symptoms may develop before measurable functional mobility impairments become apparent. Early implementation of ergonomic education, posture correction strategies, and preventive physiotherapy interventions within dental training programs is strongly recommended to minimize occupational cervical stress and reduce the future burden of musculoskeletal disorders among dental professionals.

The study was conducted in line with the Declaration of Helsinki for human participants and approved by the Institutional Ethics Committee, Gulf Medical University, Ajman, United Arab Emirates (IRB-COHS-STD-103-APR-2024).