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Table of Contents
ORIGINAL ARTICLE
Year : 2021  |  Volume : 9  |  Issue : 3  |  Page : 79-82

Paradigm shift in dental practice ergonomics during coronavirus disease 2019 (COVID-19) and its effects on dental practitioners of Kerala: A cross-sectional study


1 Department of Conservative Dentistry and Endodontics, Government Dental College, Alappuzha, Kerala, India
2 Department of Community Medicine, Government Medical College, Thiruvananthapuram, Kerala, India

Date of Submission25-Jun-2021
Date of Acceptance10-Aug-2021
Date of Web Publication27-Sep-2021

Correspondence Address:
Dr. Mridula Parameswaran
Department of Conservative Dentistry and Endodontics, Government Dental College, Alappuzha, Kerala 688005.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/INJO.INJO_24_21

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  Abstract 

Introduction: Dental practitioners, being the highest risk category of healthcare workers for contracting COVID-19, are required to practice in compliance with the revised infection control guidelines as recommended by the Centers for Disease Control and Prevention (CDC). Objectives: The objectives of this study were to assess the compliance of general dental practitioners of Kerala toward the CDC infection control guidelines, especially personal protective equipment (PPE) usage, and if such modifications had any effect on the occurrence of musculoskeletal (MS) pain, accessibility, visibility, and overall operator efficiency. Materials and Methods: This cross-sectional study using a structured questionnaire prepared in Google forms was conducted among 49 dental practitioners across Kerala who were selected by simple random sampling. Data were entered into Excel sheets, and analysis of data was done using IBM SPSS Statistics for Windows (Version 25.0, IBM Corp., Armonk, NY, USA). Results: There was a statistically significant (P-value=.001) increase in the usage of PPE from 20.8% (n = 10) during the pre-COVID period to 67.3% (n = 33) during the pandemic. About 85.7% (n = 42) of the practitioners reported to have difficulty using PPE mostly attributed to decreased visibility, accessibility, and communication gap. About 67.3% (n = 33) of the participants experienced an onset or increase in MS pain while practicing with PPE, head and neck region (81.8%, n = 27) being most affected. About 32.7% (n = 16) of the dental practitioners did not receive any form of training to work with PPE, and 56.5% (n = 26) were physically strained, whereas 43.5% (n = 20) were physically and emotionally strained while working with PPE. Conclusion: The results of the study suggest that lack of proper training, cumbersome nature of PPE, long procedures demanding increased accessibility and visibility, and extra time spent on donning and doffing have all added to increased strain on dental practitioners and occurrence of MS pain and affected their operative efficiency.

Keywords: Cross-infection, dentistry, efficiency, infection control, masks, musculoskeletal pain, personal protective equipment


How to cite this article:
Parameswaran M, Mohanan RP, Prajitha KC, Sam Joseph VG, Sreeja J. Paradigm shift in dental practice ergonomics during coronavirus disease 2019 (COVID-19) and its effects on dental practitioners of Kerala: A cross-sectional study. Int J Oral Care Res 2021;9:79-82

How to cite this URL:
Parameswaran M, Mohanan RP, Prajitha KC, Sam Joseph VG, Sreeja J. Paradigm shift in dental practice ergonomics during coronavirus disease 2019 (COVID-19) and its effects on dental practitioners of Kerala: A cross-sectional study. Int J Oral Care Res [serial online] 2021 [cited 2021 Nov 29];9:79-82. Available from: https://www.ijocr.org/text.asp?2021/9/3/79/326823




  Introduction Top


Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 virus has influenced and affected various strata of life in different dimensions.[1] Dentistry is one of the specialties that is at immense risk of contagion from the disease due to the exposure to saliva, blood, and aerosol/droplet production during dental procedures.[2] According to the revised Centers for Disease Control and Prevention (CDC) guidelines for Dental Health Care Personnel (DHCP) during the COVID-19 pandemic, the dental practitioner should wear personal protective equipment (PPE) which includes protective gown or clothing, surgical mask, N95 respirator especially while doing procedures that are likely to generate aerosol, use of universal eye protection with goggles and/or face shield in addition to their surgical mask.[3] Hence, the general dental practitioner has been forced to adapt to an entirely new work environment which can have an impact on various aspects of this profession. In a study, it was stated that while dental professionals must follow OSHA guidelines to protect themselves from blood-borne pathogens, the protective equipment, if not properly selected, can resist or interfere with movements during instrumentation and 96% experienced pain during or after work.[4] According to another study, among the health practitioners, dentists are most vulnerable toward the threat of a musculoskeletal (MS) disorder.[5] The prevalence of MS pain among dentists in India was as high as 81.06%.[6] A review of literature has not found any studies that looked into the aspect of how well the general dental practitioners have adapted to this modified practice ergonomics for infection control during the COVID-19 pandemic. We conducted a questionnaire-based survey among the dental practitioners currently practicing in different parts of Kerala, the southernmost state of India, to assess the percentage of dental practitioners who were working in compliance with the revised CDC infection control regimes for DHCP, especially the use of PPE during the COVID-19 pandemic, and to know the ergonomic issues faced by the general dentists when they are forced to adapt to this new clinical scenario, with emphasis on the occurrence of MS pain, effect on accessibility, visibility, and overall operator efficiency.


  Materials and Methods Top


This study was conducted by the Department of Conservative Dentistry and Endodontics, Government Dental College Alappuzha. All procedures performed in the study were conducted in accordance with the ethics standards given in 1964 Declaration of Helsinki, as revised in 2013. The study proposal was submitted for approval and clearance was obtained from the ethical committee of our institution. A written informed consent was obtained from each participant. The study population included 49 general dental practitioners (n = 49) who had an overall clinical experience of 5 years or more and currently practicing across Kerala. The sample size was calculated using the formula 4 PQ/d2 and proportion of practicing dentists using PPE was taken as 72.8% from the study done by Estrich et al.,[7] using a relative precision of 20%. The Kerala Dental Council registry was used as the sampling frame, and simple random sampling using random number tables was used to identify the participants and to avoid any bias. A structured questionnaire prepared in Google forms along with electronic informed consent was emailed to the dental practitioners who assured willingness to participate in the study. This cross-sectional study conforms to STROBE guidelines for human observational studies.

Statistical analysis

Data were entered into Excel sheets and analysis of data was done using IBM SPSS Statistics for Windows (Version 25.0, IBM Corp., Armonk, NY, USA). Proportion of dental practitioners using all modified ergonomics as per CDC guidelines was estimated. Proportion of dental practitioners with MS pain was estimated, and the χ2 test was done to identify any association with the MS pain and modifications in ergonomics. Significance level of 95% confidence interval was determined for all analyses.


  Results Top


A total of 49 general dental practitioners participated in this web-based online survey conducted from December 8, 2020 to January 9, 2021. The mean age of the study participants was 36 years, of which 55.1% (n = 27) were male and 44.9% (n = 22) were female. The median hours of practice during a 6-day work week were 30 h (range 3–51 h), and the median number of times the respondents performed aerosol-generating procedures over a 6-day work week was 6 (range 0–300 times). The PPE usage among dental practitioners increased significantly during the pandemic, from 20.8% (n = 10) during the pre-COVID period to 67.3% (n = 33) during the pandemic (P-value=0.001) [Table 1]. About 67.3% (n = 33) of the participants experienced an onset or increase in MS pain while practicing with PPE, the most affected area being head and neck region (81.8%, n = 27) [Table 2]. Nearly half of the study participants received training to work with PPE, out of which 51.9% (n = 14) received training from the government sector, 44.4% (n = 12) received training by attending online webinars, whereas 3.7% (n = 1) received training from their acquaintances. However, 18.4% (n = 9) did self-learning via googling and 32.7% (n = 16) of the dental practitioners did not receive any form of training to work in the present clinical scenario. About 57.1% (n = 28) were anxious about contracting COVID-19 infection, especially while doffing.
Table 1: Usage of PPE before and during COVID-19 pandemic in routine dental practice

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Table 2: Difficulties encountered with PPE and effect of modified ergonomics during dental treatment procedures

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  Discussion Top


The statistically significant increase in PPE usage during this pandemic (67.3%) reported in this study reflects the compliance and awareness of the dental practitioners of Kerala toward the revised CDC guidelines for infection control. In this study, 67.3% of the dental practitioners reported an onset or increase in MS pain during/after working with PPE, of which majority (81.8%) experienced pain in the head and neck region which is similar to other studies.[8],[9] However, the association of MS pain with usage of PPE was not assessed in these studies. High prevalence of MS pain was noted among dentists who did not take a break during work and who worked continuously for 6–8 h a day.[10] This finding could be of very high significance while working with PPE, as majority of the practitioners in our study doffed the whole PPE only at the end of all appointments, which means they are forced to work for long hours without intermittent breaks. About 20.7% were not confident that they were performing donning and doffing correctly. It has been emphasized in a review that “training in donning and doffing is particularly important for dental teams who may not wear this type of PPE for routine practice.”[11] Another concern reflected in a study was that a significant proportion of dental clinics in India are not geared for ideal donning and doffing of PPE.[12] In our study, 56.5% were physically strained, whereas 43.5% were strained both physically and emotionally while working with PPE. There have been many studies that reported the levels of physical and psychological stress among dental fraternities in which several causative factors such as financial uncertainty, risk of cross infection, risk of their families contracting COVID-19, subjective overload, decreased job satisfaction, etc. were actively discussed and studied.[13],[14] However, studies that correlated the mental and physical stress among DHCP as a result of adapting to the current infection control regimes during COVID-19 were not found for comparison with our findings. The worrying part of this survey was that more than half of the respondents have not received any form of professional training to work in the modified clinical scenario. This issue can have gross repercussions in the dental profession, which can have unfavorable effect on the general health, skill, and efficiency of the common dental practitioners. A systematic review on PPE stated that “it is unclear which type of PPE protects best, what is the best way to remove PPE, and how to make sure HCWs use PPE as instructed.”[15] The silver lining of our study was the fact that despite all these difficulties encountered, 100% of the respondents realized the need and necessity to use PPE in the dental setting during the COVID-19 pandemic and were fully compliant with the revised CDC guidelines for infection control in the dental setting.


  Conclusion Top


Lack of proper training, the cumbersome nature of PPE, the nature of work that demands static postures, long working hours, procedures demanding increased accessibility and visibility, extra time spent on donning and doffing have all added to increased strain on general dental practitioners and occurrence of MS pain and affected their operative efficiency which is gross and needs further evaluation.

Acknowledgements

We wish to extend our special thanks to all the dental practitioners who took their valuable time and knowledge to have selflessly participated in this study. We would also like to extend our sincere gratitude toward the faculties of Government Dental College Alappuzha, especially Dr V. Prasanth, Associate Professor, Department of Prosthodontics for his invaluable support and guidance that made this study happen.

Financial support and sponsorship

This study was not funded by any grants, institutions, or organizations.

Conflicts of interest

There are no conflicts of interests in this study.

Author contributions

The first two authors have equal contribution in developing concept, design, data collection, analysis, writing, and editing of the article and should be considered as primary authors. All authors gave their final approval and agree to be accountable for all aspects of the work.



 
  References Top

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