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PROFESSIONAL RISKS OF STOMATOLOGISTS TO OBTAIN MUSCULAR-FASCIAL PAIN SYNDROMES

PROFESSIONAL RISKS OF STOMATOLOGISTS TO OBTAIN MUSCULAR-FASCIAL PAIN SYNDROMES
Didenko Natalia, candidate of medicine

Irkutsk State Medical University, Russia

Alexander Stefanidy, doctor of medicine

Irkutsk State Medical Academy of Postgraduate Education (ISMAPE)

Arkady Vyazmin, doctor of medicine

Championship participant: the National Research Analytics Championship - "Russia";

To detect risk factors of muscular fascial pain syndrome origin, we carried out single-step examination of 206 Stomatology Department students, stomatologists and dentalprothetists. It was detected that 63% of students and 92% of stomatologists and dentalprothetists have intermittent headache and pain in neck, and 7% of students and 17% Faculty Stomatology Clinic employees have constant pain. Those having disturbed occlusion (DO) complained about headache 2,5 times and neck pain 2 times more often than people with neutrocclusion. Head and posture malposition in shoulder girdle are professional risk factors of origin of masticatory complex (MC) dysfunction, headache and neck pain of stomatologists and dentalprothetists.

Keywords:  prevalence, risk factors, muscular-fascial pain,  visual and manual diagnostics methods.

 

Muscular fascial painful syndrome (MFPS) is general term to define muscular pain, meaning regional chronic muscular pain connected with localized area of pain sensitivity changes caused by trigger point [5]. It is proved that influence of stressful factors in the case of locomotor apparatus disorder leads to musculoskeletal pain [6]. There is interdependency  of functional condition of locomotor apparatus and disturbed occlusion detected in domestic and foreign authors works [2,3,4,7,8,9,10,11,12]. MFPS prevalence in different populations vary considerably and depends to a large extent on life-style and working conditions of different population groups. Stomatologists professional activity is characterized with high psycho-emotional tension. Moreover, most of these specialists have low-activity and have to keep static pose for a long time.  

Purpose: to studyrisk factors of MFPS origin of students, stomatologists and dentalprothetists.

Material and methods

To detect prevalence of pain in head, neck, scapulohumeral and pelvic areas we carried out single-step examination of 206 people in the course of annual medical examination of Stomatology Department students of Irkutsk State Medical University, and stomatologists and dentalprothetists of Faculty Clinics. The participants of the study were 136 students (64 men and 72 women) aged 18-27 (average age – 20,1), 70 stomatologists and dentalprothetists (34 men and 36 women) aged 23-63 (average age – 41,4) (table 1).

Table 1

Prevalence of questioned students and clinic employees according to gender and age

Age, years old

Stomatology Department students (quantity of examined people)

Stomatologists and dentalprothetists (quantity of examined people)

men

women

men

women

<20

7

11

-

-

20-29

57

62

7

9

30-39

-

-

               11

12

40—49

-

-

8

9

50-59

-

-

7

5

60 и >

-

-

1

1

Total

64

72

34

36

To carry out the research everybody was offered to answer specially devised standardizated questionnaire on the basis of modified rate questionnaire and detection of index of vital activity disturbance with neck pain [1].

Before being included into the group of examined, everybody was given the information about purpose, methods, expected benefit, potential risks and discomfort possible to appear after participation in research, and about other significant aspects of the research. Examined had the right to reject taking part in the research or to recall agreement at any moment without reason explanation. Voluntary well-informed agreement to take part in the research was signed after potential participant acquaintance with given information.  After voluntary well-informed agreement signing medical examination including oral cavity examination and diagnostics provided for our research plan was taken.

To standardize material gathering, there is devised structured scheme of examination attached to the questionnaire. There are a visually-analog pain scale (0 – no pain, 10 - unbearable pain) and sections with visual and manual diagnostics results.

Character of teeth rows closure was studied directly in oral cavity.  Pain and trigger points (TP) existence in mastication muscle were detected. Muscular-articulate dysfunction (MAD) of masticatory complex (MC), such as deviation of lower jaw, tongue, click in temporomandibular joint (TMJ) area, mouth opening degree were studied.  

Posture condition was examined. Front and side posture disorder was detected. Frontal and sagittal body deviation (BD) relative to pressure center was detected. Head position (HP), symmetry and proportionality of anatomical landmarks on face (FAL), of shoulder girdle (SG) and pelvic girdle (PG), pressure foot distribution were appraised.

Resultsand discussion

As a result of the research it was found out, that 62% of students and 94% of stomatologists and dentalprothetists have periodical headache and neck pain, while  7% of students and 19% of Faculty Stomatology Clinic employees have constant pain. Average intensity of pain syndrome according to 10-point visually-analog pain scalein these groups are 3,4 and 4,2 points. Average duration of pain attack predominately varies from some hours to several days (table 2).

Table 2

Frequency of headache and neck pain attacks appearance (%)

Pain origin frequency

Students-stomatologists

   Clinic employees

Practicallyconstantly

7

17

1-2 times a week

15

20

1-2 times a month

30

                     40

1-2 times ayear

11

12

Onceinsomeyears

-

3

Don’t have pain

37

8

TOTAL

100

100

83% students, complaining about headache and neck pain consider to have suffered from them for more than a year, when 23 % of them for more than 5 years.  Pain origin anamnesis in head and neck area for clinic employees is more durable:   38% of them suffer from headache and neck pain for 10 years, 28% – for 5 years, 25% – for about a year.

Headache and neck pain origin are connected with long stay in a same pose for 11% of students and 33% of stomatologists; connected with psycho-emotional tension for 8% of students and 18% of clinic employees; connected with supercooling and draught for 21% and 19% respectively; connected with hard physical work for 6 % of medical employees (physical labor was mentioned as non-main activity); connected with exacerbation of gastrointestinal tract diseases and malnutrition for 9% of students.

Taking into consideration multyfactors of cephalgia and cervicalgia aetiology, we analyzed concomitant complaints of respondents having headaches and neck pain (table 3).

Table 3

Prevalence of questioned students and clinic employees having headache and neck pain according to concomitant pathology (%)

Concomitant pathology

Students-stomatologists

Clinic employees

 Ear, nose, throat (ENT organs) diseases

23

51

Bad sight

28

48

Maxillofacial traumas

5

12

Birth injury

9

1

Tooth extraction

11

23

 Habit of  one side chewing

29

14

 Platypodia

12

37

Comparison of concomitantpathology of examined having pain and examined having no pain shown significant differences(pic. 1). Thus, those suffering from headache and neck pain 2,7 times more often had maxillofacial traumas in both research groups;  students had birth injury – 2,5 times; students had tooth extraction 2 times often; habit of chewing  one side – 2,4 times more often in both groups; platypodia  –  1,7 times more often for  clinic employees.

Pic. 1. Concomitantpathologyof students-stomatologists and clinic employees

Masticatory complex (MC) examination detected that 62% people have anomalies and deformity of occlusion. In comparison of occlusion condition of respondents complaining about pain and having no pain there are significant differences. Thus, examined with occlusion disorder (OD) complained about headaches 2,5 times and about neck pain 2 times more often, then examined with neutrocclusion (NO). There were no significant differences in scapulohumeral and pelvic areas according to frequency of origin for respondents with OD and NO (Pic. 2).

Pic. 2. Complains of respondents about pain depending on occlusion condition

 

As shown on the picture 2, 3 % of students and 12% of clinic employees with NO have pain and TP in mastication muscles. Also 6 % of students and 27 % of employees with NO have MAD symptoms of MC. Moreover, it is important to mention, that there were FAL symmetry and proportionality changes detected for examined with OD (33%) as well as for those with NO (31%). According to the received data, people with NO also can have MAD symptoms of MC.

Table 4

Visual and manual diagnostics methods results after examination of students and Faculty Stomatology Clinic employees

 

Disorders (%) of MC and face area

Disorders (%) of posture and spatial postural pose

TP

MAD

FAL

HP

SG

PG

BD

PF

Students with OD

9

11

12

12

12

10

28

31

Employees with OD

26

34

21

32

35

20

30

33

Students with NO

3

7

6

8

10

7

5

5

Employees with NO 

12

15

25

33

34

20

29

31

Totaln = 204

50

67

66

85

93

56

91

100

OD – occlusion disorder, NO – neutrocclusion, MC – masticatory complex, TP – trigger points, MAD – muscular-articulate dysfunction, FAL – anatomical landmarks on face, HP – Head position ,  SG – shoulder girdle, PG – pelvic girdle, BD – body deviation, PF – pressure foot.

Analysis of the results of visual diagnostics in standing position found out, that total rating of HP (85%) and SG disorders (92%) relative to PG disorder (56%) are reliably more often detected for the examined. Besides, HP (65%) and SG disorders (68%) are detected for clinic employees more often than for students (20% и18% respectively). Apparently, it is connected with working conditions of students and clinic employees. In this case, applied load on the spinal column takes place, primarily it is “long-forced posture” and evident psycho-emotional tension. At the same time, BD relative to pressure centre is reliably more often detected for examined with OD (59% and 36).  Though, for all examined PF distribution is (table 2).  However, this indicator was reliably more often determined (64% and 36% respectively) among examined with OD (comparing with examined with NO).

Thus, the research detected high prevalence of muscular fascial painful syndrome in the head, neck and humeroscapular areas for students-stomatologists  and Irkutsk Faculty Stomatology Clinic employees. Employees have more pain manifestation. It is found out, that pain syndromes are felt more often by people with concomitant pathology, such as maxillofacial traumas, birth injury, tooth extraction, habit of one side chewing, platypodia. Thus, these conditions can be considered as risk factors of head and neck pain syndromes origin. Headache and neck pains are reliably more often detected for people with OD. People with NO can have MC dysfunction. Malposture is reliably more often detected among people with OD (in comparison with examined having NO). HP disorder and malposture in SG are professional risk factors of MC dysfunction, headache and neck pain origin for stomatologists and dentalprothetists.

 

References:

1. Belova A.N. Neurorehabilitation: guidance for doctors. – 2nd edition, reprocessing and addition. – М: Antidor, 2002. – 736 p.

2. Badreddin D.M. Interdependence of postural pose in the space and occlusion. Ways of problem solving/ D.M. Badreddin, I.V.Malanyyn. – Natural science success. – 2007, №8.

3. Bugrovetskaya O.G. Postural equilibrium and temporal-mandibular joint. Postural imbalance in prosopalgiapathogenesis// Orthodontics, 2006. №3. – 21-26.

4. Bugrovetskaya E.A., Gvozdeva S.V., Didenko A.V. and others. Postural equilibrium and teeth occlusion. Role of occlusion disorder in postural disbalance origin in the case of neuro somatic diseases // Manual therapy. – 2008. - №2 (30). – P. 40-48.

5. Travell G.G., Simons D.G. Myofascial pain and dysfunctions: trigger points guidance.– Transl. fromEngl. – In2 vol.: V. 1. – М.: Medicine, 2005. – P. 

6. Fergusson L.U., Gervin R. Myofascial pain treatment: Clinical guidance. – М.: MEDpress-inform, 2008. – 544 p.

7. Khoroshilkina F. Bearing disorder with occlusion anomalies// Ortodent-Info. -2000.-№1-2.- P.40-47

8. Tsymbalistov A.V., Loushanskaya E.A., Chervotok A.E., Usachev V.I.,  Hudonogova E.Y. Comprehensive approach  to treatment of patients suffering from temporomandibular  joints dysfunction сдисфункцией// Materials from I international  symposium  «Clinical posturology, pose and bite». St.-Petersburg, 2004.

9. Chervotok A. E. Functional condicion of locomotor apparatus of patients with occlusion anomalies and deformity; author's abstract of dissertation of Candidate of Medical Science– St. Petersburg, 2009. – 22.

10. Yurov V. V. Manual therapy in restoring treatment of patients with pain syndroms caused by temporal-mandibular joint dysfunction: author's abstract of dissertation of Candidate of Medical Science – Moscow, 2006. - 25.

11. Gelb H. The temporomandibular joint syndrome. Patient communication and motivation // Dent. Clin. North Am., Apr, 1970 - №14. – P. 287-307.

12. Gagey P.M., Weber b. Posturologie. Regulation etderegliments la station debout. – Paris: Masson, 1995. - 145 p.

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Your rating: None Average: 5.7 (3 votes)
Comments: 2

Smetanina Ekaterina

извините, но работа с позиций фармацевтики нулевая. как исследовательская в области стоматологии - вне сомнений. вы просто разместили ее не в той секции. поэтому такая оценка

Lakhtin Yuriy Vladimirovich

Работа авторского коллектива основана на достаточном массиве данных. Актуальность темы вне сомнения, потому что статические нагрузки стоматологов приводят к развитию мышечно-фасциального болевого синдрома и тесно связанной с ним мышечно-суставной дисфункции височно-нижнечелюстного сустава, сопровождающегося цефалгиями и прозопалгиями. Хотелось бы рекомендовать авторам изучить еще и эргономические причины МФБС. Творческих успехов вам. С уважением, Лахтин Ю.
Comments: 2

Smetanina Ekaterina

извините, но работа с позиций фармацевтики нулевая. как исследовательская в области стоматологии - вне сомнений. вы просто разместили ее не в той секции. поэтому такая оценка

Lakhtin Yuriy Vladimirovich

Работа авторского коллектива основана на достаточном массиве данных. Актуальность темы вне сомнения, потому что статические нагрузки стоматологов приводят к развитию мышечно-фасциального болевого синдрома и тесно связанной с ним мышечно-суставной дисфункции височно-нижнечелюстного сустава, сопровождающегося цефалгиями и прозопалгиями. Хотелось бы рекомендовать авторам изучить еще и эргономические причины МФБС. Творческих успехов вам. С уважением, Лахтин Ю.
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