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PREVALENCE OF CARPEL TUNNEL SYNDROME IN THE DENTISTS WORKING IN KARACHI.

Byline: AFTAB AHMED KHAN ADEL ZIA SIDDIQUI MUHAMMAD RASHID AHMED HASAN ASKARI and AMBREEN ZAHID

ABSTRACT

Dentists are daily exposed to work-related vibrations in their practice. The forceful use of the hand during vibratory equipments such as scalar turbine slow speed hand-piece and grasping and working with other small instruments or objects such as endodontic files could all be the causative agents of Carpel Tunnel Syndrome. The aim of this study was to determine the prevalence of CTS in Karachi dentists. In this cross-sectional descriptive study 417 dentists were evaluated for CTS. Diagnosis was made on the basis of clinical symptoms. Participants' age gender years of experience working hours per day and the type of procedure were considered as dependent variables. Results found that percentage of CTS increases with the increasing working experience. The total prevalence among the dentists working in Karachi was 10.1%.

Dental professionals should realize that their occupation is a perpetuating factor for the development of this pain. Prevention is of great importance and intervention strategies should become an integral habit in the office and at home. Dentists should get their selves examined periodically for any sign and symptoms of CTS. Further studies are needed to confirm the present results with the use of electro diagnostic procedures and hand diagrams taking into account the possible synergistic effect of workload vibrations use of other gadgets and sports related activities.

Key Words: Dentists Carpel Tunnel Syndrome Numbness Pain Tingling Sensation. INTRODUCTION

Dentistry has advanced a great deal in recent years. Despite its technical advancement many occupation- al health problems still persist. Many occupational risks still remain in the field of dentistry which are challenging. One of them is musculoskeletal problem.

Musculoskeletal problems are high and well document- ed in dentists.24 A study shows that 87.2% dentists have at least one musculoskeletal complaint in the past 12 months.5 A large study conducted in Greece shows 62 percent of dentists reporting at least one musculoskeletal complaint.6 Among musculoskeletal problem carpel tunnel syndrome is also prevalent in dental professionals which is reported to be not very high about 5% in dentists.7

Dentists are exposed to work-related vibrations in their daily practice. The forceful use of the hand during vibratory equipments such as scalar turbine slow speed hand-piece and other vibrating ultrasonic instruments could all be causative agents of carpel Tunnel Syndrome.8 B. Valachi910 stated that the work carried out on certain specialties namely Endodon- tics Periodontics Prosthodontics and Oral Surgery in dentistry have increased incidence of carpal tunnel syndrome.

In dentistry type of movements and hand position are repetitive in daily practice. Dentists use their ring finger as a fulcrum when doing the procedures such as exfoliation extraction root canal preparation and during wrist movement. This constant pressure on fingers and repetitive movements of the wrist leads to the initiation of numbness and pain. Alleviation of the pain is very essential for continuation of the daily practice by the dentists.11

Carpel tunnel is a syndrome in which complex of symptoms arise due to compression of a median nerve at the carpel tunnel in hand.12 CTS results in considerable discomfort and pain limitation of activities of daily living loss of sleep and work disability.1 In dentistry repetitive movements of wrist during exfoliation and canal cleaning can compress median nerve leading to CTS. In this study prevalence of CTS has been evaluated among the dental practitioners working in Karachi. Moreover rate of CTS has been evaluated in different specialties of dentistry.

METHODOLOGY

This analytical descriptive study was conducted on 498 dentists practicing in different areas of Karachi. Study populations were the dentists working in Karachi with at least one year of clinical experience and were willing to participate in this study. Informed consent was obtained from the participants and the study was done between March 2014 and June 2014. Biographic and occupational information of dentists included gender age experience working hours per week type of activity and clinical symptoms of carpal tunnel syndrome such as pain and hand paresthesia were recorded. Dentists suffering from diabetics rheumatoid arthritis thyroid gland disease and wrist fractures were excluded from this study. Sampling strategy was randomized conve- nience sampling.

This cross-sectional study was performed to eval- uate the prevalence of CTS among dentists working in Karachi city. A questionnaire comprising of biographic and occupational information in the first part and in the second part the questions related to numbness tingling and pain in the fingers or hand during the day or night was get filled in by the participants. The questions assessing the difficulty in performing selected dental procedures were included to analyze the frequency of CTS in particular specialities. Finally all data were analyzed by SPSS software version.19

RESULTS

Out of 498 study subjects a total of 417 responded positively by participating in this study. In this way the response rate was 8.7%. Rest of the subjects either didn't participate or returned incomplete questionnaire. Missing data were excluded from the analysis.

TABLE 2: FREQUENCY AND PERCENTAGE FREQUENCY OF GENERAL DENTISTS AND SPECIALISTS ACCORDING TO THEIR WORKING EXPERIENCE

Specialist###Working Experience

###1-5 years###6-10 years###11-15 years###16-20 years###Frequency###% Frequency

General dentist###23###190###2###1###216###51.79%

Periodontist###1###22###18###1###42###10.07%

Oral surgeon###2###30###9###7###48###11.51%

Endodontist###20###30###8###2###60###14.38%

Orthodotist###5###28###8###10###51###12.23%

Total###51###300###45###21###417###100%

TABLE 3: FREQUENCY OF CTS AMONG GENERAL DENTISTS AND SPECIALISTS

Specialist###Carpal Tunnel Syndrome CTS (Pain Numbness and Tingling Sensation)

###1-5 years###6-10 years###11-15 years###16-20 years###Frequency###% Frequency

General dentist###0###12###0###1###13###6.01%

Periodontist###1###3###2###0###6###14.28%

Oral surgeon###0###3###1###2###6###12.50%

Endodontist###2###9###2###2###15###25.00%

Orthodotist###0###1###1###1###3###5.88%

TABLE 4: PREVALENCE OF CTS AMONG PARTICIPATING DENTISTS ON THE BASIS OF NUMBER OF WORKING HOURS/DAY

Gender###Age Mean: 29 years Min 23 years Max 67 years

###Male###171###Male %###41%###Female###246###Female %###59%

###Working hours/day###Frequency###% Frequency###CTS %###CTS %

###3 hours###35###8.39%###1###2.85%

###5 hours###93###22.30%###10###10.75%

###8 hours###289###69.30%###32###11.07%

As shown in Table 1 the participating dentists were categorized into different working experience groups. Frequencies in these groups were 51 00 40 28. Results found that percentage of CTS increases with the increasing job or working experience. A good difference of 5.88% in dentists having 1-5 years working experience can be found against 28.57% CTS in 16-20 years working experience. No major difference could be found in the rate of CTS cases in both the genders. The total prevalence among the dentists working in Karachi was 10.1%.

Among the respondents the distribution of partici- pants' frequency is given in Table 2. Table shows the CTS syndrome according to different specialities among the participants. Endodontists were more prone to CTS i.e. 25.00%. Declining trend was shown in Periodontists i.e. 14.28% Oral Surgeons 12.50% General Dentists 6.01% and least affected were the orthodontists i.e. 5.88%. Table 4 shows the affect of working hours per day of the dental practitioners and its relation with incident of CTS.

DISCUSSION

In the present study the Boston Carpal Tunnel Questionnaire (BCTQ) was used to evaluate the prev- alence of Carpel Tunnel Syndrome among the dentists working in Karachi.

CTS is usually diagnosed on the basis of numb- ness tingling sensation and pain in the area where the median nerve's distribution in hand is present.14

In this study diagnosis of the CTS was based on these symptoms present in an individual. Dentists who had all the symptoms such as numbness tingling sensation and pain were diagnosed as having CTS. Distribution of clinical symptoms is a clinical challenge.

An association was focused to monitor relationship of CTS with working experience or age gender duration of work and hours of clinical practice. Interestingly relationships were found with all the variables. Un- surprisingly the frequency of CTS was seen higher in certain specialties due to repetitive stress and forceful working of the hand. As expected the frequency of CTS increased with the increasing working hours per day. Female gender was found to be more prone to this dis- ease. This predisposition could be due to small wrists and potentially smaller carpel tunnel volume.15 This disease is more commonly seen in elderly people16 and women are very much predisposed to this syndrome as compared to men.17 The results of this study is in close association with the previous studies.

In this study effort was made to figure out the relationship between type of activity and CTS. It was observed that those dentists who were practicing end- odontic were much prone to CTS (25.00%) as compared to general dentistry practitioners (6.01%). This differ- ence is not surprising as it is obvious that endodontic procedures require repetitive movements of wrists that makes the dental practitioners vulnerable to CTS.

This study examined the prevalence and distribu- tion of self-reported carpel tunnel syndrome among dentists working in Karachi. The response rate was satisfactory probably due to short questionnaire. The major limitation of this study is that what is reported has to be believed in; although actual situation may differ from the reported one. Karachi is a metropolitan city having a population of about 20 million. It has a large number of dental practitioners. Relatively limited geographical areas were sampled. Our sampled cohorts should have been a reasonable comprehensive group accurately representing Karachi dentists as a whole. This was another limitation of this study.

Although medical sciences have advanced marvel- ously yet there is no gold standard in the diagnosis of CTS. The sign and symptoms involving the lateral one third of the hand does not always necessarily mean CTS. Every pain mediated to the lateral three fingers could not always be due to CTS. It is suggested that for future studies the distribution of clinical symptoms in patients with CTS to be determined along with nerve conduction studies (NCS) for proper diagnosis.

CONCLUSION

Dentists should get themselves examined periodi- cally for any sign and symptoms of CTS. The surgical gloves that dentists wear should be of appropriate size. Dental professionals should realize that their occupa- tion is a perpetuating factor for the development of this pain. Prevention is of great importance and interven- tion strategies should become an integral habit in the operatory in the office and at home. Further studies are needed to confirm the present results with the use of electro diagnostic procedures and hand diagrams taking into account the possible synergistic effect of workload vibrations use of other gadgets and sports related activities. ACKNOWLEDGEMENT

The authors are greatly thankful to Dr Saba Junejo and Dr Iffat for their contribution in distributing the questionnaire and covering the large part of the city; making this study a successful.

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Publication:Pakistan Oral and Dental Journal
Article Type:Clinical report
Geographic Code:9PAKI
Date:Dec 31, 2014
Words:2273
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