Journal of Education and Ethics in Dentistry

: 2017  |  Volume : 7  |  Issue : 2  |  Page : 44--48

Evaluation of knowledge, attitude, and practices about the health-related occupational hazards among dental practitioners in Pondicherry, India

Sajani Ramachandran1, Usha Carounanidy2, S Manikandan3, Ranu Kumari4,  
1 Department of Dentistry, Pondicherry Institute of Medical Sciences, Pondicherry, India
2 Department of Endodontics and Conservative Dentistry, Indira Gandhi Institute of Dental Sciences, Pondicherry, India
3 Department of Community Medicine, Pondicherry Institute of Medical Sciences, Pondicherry, India
4 Department of Prosthodontics, MGPGI, Pondicherry, India

Correspondence Address:
Dr. Sajani Ramachandran
Department of Dentistry, Pondicherry Institute of Medical Sciences, Pondicherry


Aims and Objectives: The aim of the study was to evaluate the awareness of occupation-related health hazards among dentists practicing in and around Pondicherry and to investigate the various occupation-related health problems among the practicing dentists in Pondicherry. Methodology: A validated questionnaire was responded by 278 dentists. The data collected were statistically analyzed to find the mean and proportion. Results: Work-related stress was considered by 59.93% (163) dentists as a reason for taking a toll on the health of dentists. Respiratory problems were reported by 52.94% of those who had systemic problems. Needle stick injury during working was reported by 65.56% (177). Strained eyes at the end of a working day were reported by 44.85%, and eye injury due to projectiles at least once a year was reported by 24.26%. Conclusion: It is absolutely necessary for the dental professionals to be aware of the problems they might be exposed to in their practice so that adequate precautions can be taken to prevent them from early burnout.

How to cite this article:
Ramachandran S, Carounanidy U, Manikandan S, Kumari R. Evaluation of knowledge, attitude, and practices about the health-related occupational hazards among dental practitioners in Pondicherry, India.J Educ Ethics Dent 2017;7:44-48

How to cite this URL:
Ramachandran S, Carounanidy U, Manikandan S, Kumari R. Evaluation of knowledge, attitude, and practices about the health-related occupational hazards among dental practitioners in Pondicherry, India. J Educ Ethics Dent [serial online] 2017 [cited 2019 Jan 19 ];7:44-48
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Dental professionals are exposed to various health hazards in their day-to-day practice. They are prone to be affected by constant exposure to various dental materials, noise from various equipment besides work-related stress directly related to patient management. These could have an effect on the health of the practicing dentists and can lead to an early burnout. Dentistry is recognized worldwide to be associated with debilitating repercussions from associated occupational hazards and is acknowledged as a high-risk profession.[1] A comprehensive survey involving multifactorial elements of occupational hazards would help dentists in taking adequate precautions during their work as well as modifying their working environment accordingly.


To evaluate the occupation-related health problems of dental practitioners in PondicherryTo investigate the knowledge, attitude, and practice about the occupation-related health hazards among dentists in Pondicherry.


A pretested and validated questionnaire was used to collect the data. A pilot study was done, and the questionnaires were administered to 10 dentists and were asked to comment on comprehensibility, language used, and length of questionnaire and were asked for any suggestions to be accommodated in the questionnaire and accordingly the questionnaire was modified. The inclusion criteria were the practicing dentists in Pondicherry with at least 1 year of working experience. Exclusion criteria were those who were not willing to participate. Sample size was calculated using the formula 4 pq/d2 (P = 67.5% at 5% absolute precision) Nokhostin and Zafarmand, 2016. The Institution Scientific and Ethics Committee clearance was obtained for the study. A cross-sectional study was done among the practicing dentists in and around Pondicherry. A convenient sampling was done, and the questionnaires were sent to dentists as a link to the Google form. Informed consent was obtained from all the participants. The questionnaire included demographic details as well as opinion about the factors affecting the health of dentists in their working environment, queries about systemic problems, and practice details about the use of various dental materials and equipment. The limitation of the study was that it being a questionnaire-based study and we assume that the respondents have answered truthfully and conscientiously. Two hundred and seventy-eight dentists responded to the study out of which 6 were excluded as they had <1 year of experience. Data analysis using the software SPSS version 20 (IBM, Armonk, NY, USA).


The number of respondents for the questionnaire was 278 out of which 6 were excluded as they had <1 year of work experience. The age of the respondents ranged from 25 to 65 years. A maximum number of respondents were in the age group of 25–35 years (53.3%, 145). The number of male respondents was 141 (51.8%) [Table 1]. The number of dentists with postgraduate qualification was 118 (43.38%). The number of years of practice of the respondents ranged from 1 to 35 years. The number of practicing hours per day was reported by 64.34% (175) as 6–12 h. More than 12 h of practice a day was reported by 1.47% (4) [Table 2]. The awareness that dentists can be exposed to some occupational hazards was among 96.69% (263) of the respondents. Among the factors that affected the health of the dentists, work-related postures were considered by maximum respondents (175, 64.34%) as a problem causing long-term effect on health. This was followed by work-related stress (163, 59.93%) as a reason taking a toll on the health. The other factors reported to cause health problems were problematic patients, working hours, working environment, finance, and family or personal problems [Table 3]. On evaluating the various systemic problems, 144 (52.94%) respondents often had some respiratory-associated problems. Sinusitis was reported by 46 (16.91%), and frequent common colds were reported by 44 (16.18%) [Table 4]. These problems were reported to be increasing over the years by 46 (31.94%) of those who had respiratory problems, and 43 out of 144 respondents (29.86%) had their problems increasing since practice. The use of mouth mask during all patient procedures was reported by 98.53% (268). During denture adjustment, 50.74% (135) respondents used mouth mask. The masks were used rarely by 1.47% (4) respondents. Gypsum products were reported to be handled by mechanics or technicians by 88 (32.35%), whereas it was handled by 70 (25.74%) dentists. Assistants handled it according to 25.74% (70). About 16.18% reported that anyone handled it. Acrylic work was done by mechanics/technicians according to 60.29% (164), whereas assistants handled it according to 11.77% and dentists handled acrylic according to 27.94%. The use of suction during the removal of amalgam fillings was reported by 72.79% (198). As regards to disposing the scrap amalgam, 45.96% (125) stored in a bottle with water, whereas 41 (15.07%) threw it in washbasin and 38.97% (106) threw in waste bin.{Table 1}{Table 2}{Table 3}{Table 4}

Dental practice involves long hours of precision work and exposure to visible lights during various procedures. Long-term exposure to this working condition may affect the health of eyes. In the present study, 47.4% (129) respondents used glasses out of which 38 (13.97%) had been using after starting their clinical practice. Blurring of vision was reported by 45 (16.54%). Strained eyes at the end of a working day were reported by 122 (44.85%). Magnifying loupes during procedures were used by 35 (12.87%). During the use of light-cured restorations, orange protective shields were used by 190 (69.85%). Indirect vision during procedures was used by 236 (86.76%). Protective glasses during working were used by 135 (49.63%). Light-cure restorations were used 1–7 times a week by 189 (69.49%). Eye injuries with projectiles are quite common during dental practice. Injury to the eye once in a while was reported by 40 (14.81%), once a month by 60 (22.06%), and once a year by 66 (24.26%). After the injury, 234 (86.03%) rinsed with water, whereas 11 (4.04%) washed with saline. Cotton was used to clean by 6 (2.21%), whereas 21 (7.72%) never bothered.

Tinnitus was reported by 30 (11.03%), and 60% of these had this problem since practice. The complaint was reported to be increasing by 16.67% (5). On enquiring about the noise that bothers the dentist most in a clinical environment, 55.52% reported the noise of suction bothered them the most, whereas 130 (47.79%) reported the noise of compressor to be most annoying. The chairside compressor was used by 43.75% (119). Noise-free compressor was used by 43.75% (119).

Musculoskeletal problems were reported by 230 (84.56%). Lower back pain was reported by 52.21% (142) and neck pain in 136 (50.1%) [Table 5]. The increase in musculoskeletal pain over the years was reported by 57.83% (133), and 70.87% reported that their pain started since their practice. Sitting working posture was used by 49.26% (134). Standing practice was done by 4.78% (13). Four-handed dentistry with one assistant was practiced by 73.9% (201) and six-handed dentistry with two assistants by 3.31% (9). It was reported that 22.79% of the respondents worked with no assistants. Queries about other physical activities showed that 51.84% (141) practiced some kind of physical activities or exercises. Yoga was practiced by 33.33% (47), aerobic exercise by 31.91% (45), sports activities by 29.79% (42), and body massage and physiotherapy by 42 (29.78%).{Table 5}

Needle prick injury was reported during practice by 65.07% (177). The first procedure done by all of them was to bleed and rinse. Immediate screening for self and patient was done by 42.55%, but 21.28% never bothered to screen blood. To prevent injuries from sharp, 52.78% of respondents chased the needle to shaft, whereas 8.82% recapped the needle after each use. It was reported that 38.89% used appropriate instruments such as tissue holding forceps to prevent needle prick and 15.28% used double gloves. According to respondents, the procedure for disposing the needles was disposing into sharps container (37.22%), followed by incineration after use (28.44%). Bending and breaking the needle were done by 23.09% and 11.25% only bend the needle after use.


Dental profession is such that it involves physical and mental involvement in their work practice. Many dentists are aware of the repercussions of the work-related problems that may have an impact on their life. Although there has been much advancement in treatment modalities and equipment, dentists are still exposed to various occupational hazards which include exposure to percutaneous injuries, infectious agents, musculoskeletal disorders, exposure to noises, and dental materials. Overstrained and awkward work postures, overstretching of certain joint movements, and psychological factors may be some risk factors.[2]

Dental profession is reported to be a high-risk profession for developing work-related musculoskeletal disorders. A relationship has been found between the biomechanics of repeated unidirectional twisting of the trunk and working postures in the same position for a long period of time and musculoskeletal problems which develop over a period of time.[3] On studying the work-related musculoskeletal problems among dentists in Saudi Arabia, 85% reported that they developed some musculoskeletal problems after joining dental profession. Maximum pain was reported in the lower back and neck and shoulders. The symptoms of musculoskeletal disorders were found to be increasing with the number of years of practice as reported by the dentists in Ha'il in Saudi Arabia.[4] The prevalence of musculoskeletal disorders was 77.9%. The most affected area was lower back 73.5%, followed by 66% neck pain. This is in congruence with our study which showed 84.56% had musculoskeletal problems, and lower back pain was reported by maximum number of respondents (52.21%). In Belgium, a study done among the Flemish dentists revealed lower back pain in 54%.[5] In a study done in Australia, musculoskeletal problems were reported in 64%. Moreover, the most common problem was low back pain.[6] In a study done in Bhopal, 92% of dentists reported pain and discomfort of at least one part of the body. Major affected part was the neck 88.17%, followed by lower back 86.02% and wrist 54.8%.[7] In a study done among Iranian dentists, wrist pain was found in 92.96% and neck pain in 51.87%. The different postures, while practicing used by dentists, were either standing, sitting, or both standing and sitting.[8] In the present study, sitting practice was done by 134 (49.26%) and standing practice was done by 4.78% (13). The most common postures adopted by the dentists in a study in Saudi Arabia were reported to be sitting 79% and 20% standing.[2] Dental professionals develop the musculoskeletal problems due to bad working postures causing discomfort and fatigue. Maintaining good physical and mental health should be emphasized to dentists to enjoy and be satisfied with professional and personal lives. Considering ergonomics would be very helpful.[9] Physical exercises are often recommended to practicing dentists, and it can help to reduce the damage caused to the body due to their workloads. Chairside stretching exercises may be practiced as well as aerobics can be performed at least 3–4 h a week at least for 20 min. This will increase the blood flow to all the tissues and muscles of the body and improve their ability to use oxygen.[10]

The working environment of dentists involves the use of compressors, turbine handpiece, suction, and other equipment which produce sound continuously, and this can affect the hearing of the dentists on exposure over a long period of time.[10] Few dentists have reported some hearing problems.[11] Auditory disorders were reported in 20% of the dentists studied in Belgium.[5] In the present study, tinnitus was reported by 30 (11.03%), and 60% of these had this problem since practice. The complaint was reported to be increasing for 16.67% (5). The sounds in the working environment that might cause hearing loss may be from high-speed turbine handpieces, low-speed handpieces, high-velocity suction, compressors, ultrasonic instruments, model trimmers, vibrators, and other mixing devices.[12] The noise levels of modern dental equipment have now fallen below 85 db. Although hearing loss may not be symptomatic, the first symptom which might come onto notice could be tinnitus. Dentists have to be aware of the hearing problems they might have due to constant exposure to noisy working equipment and should seek medical attention in case of any tinnitus which could be one of the earlier symptoms.[11]

Dental restorations may require the use of light-curing units. Both the patient and the dentist should wear eye protection glasses. Curing lights are potential hazard to eyes and may cause phototoxic and photoallergic reaction originating from abnormal radiation. Color vision has been shown to be affected on exposure to solvents and heavy metals. Protective orange eye shields have shown to be effective in protecting eyes from exposure to harmful lights in the dental working environment.[13]

Dental practitioners have a high risk of occupational exposure to blood-borne pathogens such as human immune virus and hepatitis virus due to percutaneous injuries. Percutaneous injuries were reported by dental professionals in a dental school in Bristol in 50% of the dental profession.[14] In the UK and Thailand, about half of the dentists surveyed had some percutaneous exposure.[15] In a study done in Queensland, the prevalence of needlestick injury among dentists was found to be 28%.[6] In the present study, needle prick injury was reported during practice by 65.07% (177). The fact for concern is that the needle prick injury often happens after the injection is given during which the needle will have some residual body fluids on it.[16] Here, it is important that strict infection control guidelines are adhered to following any sharp injury during dental procedure. Measures such as use of safety syringes though expensive have been shown to reduce needle prick injuries.[17] The risks of exposure to blood-borne pathogens should be emphasized during clinical training. Routine use of latex gloves and personal protective equipment may significantly reduce the chance of HIV and other blood-borne disease transmission. Awareness should be created about the consequences of nonreporting as well as lack of appropriate follow-up. In addition to effective hepatitis B vaccination program, measuring of anti-HB antibody response is also needed for high-risk professions.[18]

Many dental materials are used in dental practice, some of these dental materials may be inhaled during their use in dental practice, and these can lead to respiratory problems. About 144 (52.94%) respondents in the present study often had some respiratory-associated problems. Sinusitis was reported by 46 (16.91%), and frequent common colds were reported by 44 (16.18%). These problems were reported to be increasing over the years by 46 (31.94%) of those who had respiratory problems. Further studies need to be done to evaluate if the chronic exposure to dental materials could be a cause for respiratory problems among dentists. The use of mouth masks during all the procedures might lessen this to a great degree.

Dental amalgam is very commonly used in dental practice. Storage of dental amalgam varied in many studies. Guidelines show that storing in a closed container under a fixer would be ideal.[18] Disposal in a bin was done by nearly half the dentists in a study done in Thailand.[9] The use of suction during the removal of amalgam fillings was reported in the present study by 72.79% (198). As regards to disposing the scrap amalgam, 45.96% (125) stored in a bottle with water, whereas 41 (15.07%) threw it in washbasin and 38.97% (106) threw in waste bin. The right procedure should be encouraged and ensured in dental practice.

A multicentric study in a large scale should be conducted to understand the real impact of the work-related risks on the health of the dentists. This will definitely help us to take adequate precautions in the day-to-day practice.


Dental profession is recognized as a profession with high risks affecting the health of the practicing dentists over a period of time. Ergonomic principles if applied will help to reduce stress and eliminate many potential injuries and disorders associated with overuse of muscles, bad posture, and repeated tasks. The preventive strategies are awareness of the risks involved and to manage the injuries effectively. Applying ergonomics to the practice provides safety and improves performance and productivity, adaptation to the workspace, and equipment to help in work being performed with comfortable body postures. The working environment may be optimized to help avoid awkward positions, physical wear and tear, and fatigue. Working protocols should be formulated to decrease the effect of occupation-related health hazards among dentists. The need for inclusion of safe and healthy dental practice should be given importance right from the dental training days and may be included in the dental curriculum and should be ensured that it is practiced. Long-term observational studies need to be done to find the impact of occupational environment on the health of dentists.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.


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