Posture and Prevention: Evaluating an Exercise Program for Dental Students

Musculoskeletal disorders (MSDs) are recognized as a growing global public health concern, encompassing a range of inflammatory and degenerative conditions that affect the muscles, tendons, ligaments, nerves, bones, and joints. These disorders are commonly linked to repetitive strain, poor posture, and cumulative trauma resulting from non-ergonomic work environments. Dental professionals, particularly due to their constrained workspaces, prolonged procedures, and repetitive tasks, are among the most affected healthcare providers.

Numerous studies reveal that between 64% and 93% of dentists suffer from MSDs during their professional lives, with significant consequences including chronic pain, physical limitations, reduced productivity, and decreased quality of life. The root of the problem often begins during dental education, where students are first exposed to the physical demands of clinical practice without adequate ergonomic training. Dental education, unlike many other academic disciplines, combines theoretical and hands-on clinical learning from early years. Students are subjected to high physical strain, repetitive manual procedures, and poor working postures, particularly when clinical experience and ergonomic awareness are lacking.

Despite growing awareness of this issue, recent findings at Akdeniz University Faculty of Dentistry underscore the severity and prevalence of MSDs among students. A 2022 study, conducted within the framework of the "Ergonomics and Stretching Movements in Dentistry" course, showed that 90.8% of fourth- and fifth-year dental interns experienced MSD symptoms within the past year. The most commonly affected regions included the neck (80.9%), back (71.7%), lower back (69.1%), and shoulders (65%). Alarmingly, only 21.7% of these students reported engaging in regular physical activity, while a substantial 85.5% expressed interest in receiving education on preventive exercises and stretching techniques tailored to dental practice.

These findings highlight the critical need for early intervention in dental education to promote musculoskeletal health. The physical demands of dentistry, including static and asymmetrical postures, prolonged standing or sitting, and repetitive forceful movements, contribute to muscular fatigue and postural imbalances. Even when dentists maintain ideal working positions, over 50% of their muscles remain in a state of contraction to counteract gravitational forces, leading to long-term strain and discomfort.

In this context, structured physical activity-particularly posture-oriented stretching and strengthening exercises-emerges as an effective, low-cost, and easily applicable solution. Scientific studies have shown that regular stretching increases synovial fluid production for joint lubrication, improves circulation, reduces pain from trigger points, and relaxes overactive muscles. Moreover, short stretching sessions during clinical work have proven effective in decreasing MSD-related symptoms in dental professionals.

Drawing from these insights, our project proposes the implementation of a Posture-Oriented Exercise Program for dental students at Akdeniz University, developed under the guidance of an experienced physiotherapist. The initiative is supported by the Özlenen Student Scientific Research Project and also aims to function as a social responsibility project. The main goal is to raise awareness of the importance of physical activity in maintaining professional health, and to evaluate the benefits of a targeted exercise routine in preventing MSDs.

The proposed program will be integrated into the students' routine under supervision, focusing on practical and evidence-based stretching and posture-correction exercises. Through systematic monitoring, we aim to assess changes in posture, reduction in pain symptoms, and the students' overall ergonomic awareness. By instilling healthy habits and musculoskeletal care strategies during their formative years, this project aims to empower future dentists with tools to sustain long-term occupational health and well-being.

Ultimately, the findings of this project could serve as a model for incorporating ergonomics and physical activity education into dental curriculums more broadly, not only addressing an urgent health concern but also contributing to the sustainability and effectiveness of the dental profession in the long term.

Musculoskeletal disorders (MSDs), which are increasingly common worldwide and defined as a significant public health problem, include inflammatory and degenerative conditions affecting muscles, tendons, ligaments, nerves, bones, and joints. These problems, which mainly develop due to cumulative trauma from repetitive-strain movements and ergonomic deficiencies, negatively affect individuals' daily living activities by causing pain, restricted movement, and injuries.

Due to the limited working area of the oral cavity and long working hours, dentists are a high-risk group for MSDs. Working in a bent and overly strained posture during dental procedures, keeping the arm in fixed positions for long periods, making repetitive and usually forceful movements, sitting or standing for extended periods, using high-vibration tools, and being exposed to various psychosocial stressors all play a significant role in the development of MSDs in dentists. Literature shows that between 64% and 93% of dentists experience MSDs at some point in their careers. While these are common health problems, they can decrease healthcare workers' productivity, lead to high economic costs, and negatively affect individuals' quality of life.

Musculoskeletal disorders can begin during dental school and continue throughout professional life if preventive and corrective measures are not taken. Unlike other disciplines, dental education includes both theoretical and clinical training concurrently over five years. Students practice hand-eye coordination-based applications during the first three years through preclinical education alongside theoretical courses. In the final two years, they begin physically demanding clinical internships. At this stage, without sufficient clinical experience and ergonomic awareness, students may ignore physical warning signs to gain a better field of view, leading to improper repetitive movements and maintaining abnormal or static postures for extended durations.

Even in ideal working positions, dentists must contract over 50% of their muscles to maintain a stable posture against gravity. Any deviation from the spine's natural four curves - cervical lordosis, thoracic kyphosis, lumbar lordosis, and sacral kyphosis - places extra stress on muscles, ligaments, or soft tissue to keep the spine upright. These postures lead to prolonged, repetitive muscle contractions typical among dentists, causing muscle imbalances. Incorrect posture accelerates degeneration in vertebrae, discs, muscles, and ligaments, leading to pain.

Research from various countries has shown that MSD symptoms can begin during dental education. For example, a study on Australian dental students found that 84.6% had MSDs caused by clinical internships. The same study revealed that 61% of students had incorrect posture. Therefore, it's crucial to raise awareness about the prevalence of MSDs and ergonomic principles starting from dental school years.

In 2022, as part of the "Ergonomics and Stretching Movements in Dentistry" course within the Special Study Module of the Department of Periodontology, we conducted a study with third-year students. Among the fourth- and fifth-year dental interns who participated, 90.8% reported musculoskeletal complaints in at least one body region over the past 12 months. The most frequently affected areas were the neck (80.9%), back (71.7%), lower back (69.1%), and shoulders (65%). Additionally, 14.5% had visited a doctor due to pain, 9.2% had taken leave or received a medical report, and 4% had used medication. Alarmingly, only 21.7% of the participants reported engaging in regular physical activity, and nearly all (85.5%) expressed a desire for training on preventive stretching and exercises in dentistry.

By nature, the human body needs to move. Yet, technological advancements have led people toward sedentary lifestyles, which are incompatible with human physiology and increase the risk of disease. Regular and conscious physical activity not only promotes a healthy body structure but also releases hormones that make individuals more energetic, happier, and psychologically balanced. For a healthier society, the habit of daily physical activity should be taught from a young age as an indispensable part of life. Unfortunately, the increasingly demanding theoretical and clinical training in dentistry leaves students with little time for hobbies. Similar studies in other countries have also reported that dental students struggle to maintain regular exercise routines. As a result, dentists are now among the professionals who increasingly seek physical therapy and ergonomic advice.

Recent studies have shown growing interest in regular exercise programs to reduce work-related MSD risk among dentists. Stretching exercises are known to improve blood circulation, increase synovial fluid for joint lubrication, reduce painful trigger points, and help relax muscles. These benefits can significantly impact both the personal and professional lives of dentists. Research indicates that stretching exercises performed during periodic chairside breaks can reduce MSD-related complaints. A randomized controlled study showed that six weeks of neck exercises in women with chronic neck pain significantly improved cervical angles and posture, as observed via imaging systems. Similarly, a 10-week neck and shoulder exercise program positively affected the working posture of dental students.

Considering all of this, we believe that raising awareness among young dental students about the importance of regular physical activity can help prevent future MSDs. For this purpose, in our study - supported by the Özlenen Student Scientific Research Project and designed as a social responsibility initiative - we aim to implement a posture-focused exercise program for dental students at Akdeniz University Faculty of Dentistry, guided by an experienced physiotherapist, and evaluate the outcomes of these physical activities.

Eligibility Criteria:
Inclusion Criteria:

* Being a student studying at Akdeniz University Faculty of Dentistry
* Individuals who volunteer to participate in the study
* No harm to exercise by the doctor
* Participants who experienced musculoskeletal pain during the past 3 month, at least in one of the examined body regions (i.e., the neck, shoulders, upper back and lower back)

Exclusion Criteria:

* History of traumatic or surgical intervention of spine
* Any orthopedic, neurological, respiratory, or circulatory disorders
* Participation in professional sports training or a structured exercise program within the previous six months
* The current use of pain medications or muscle relaxants.
* Being over 25 years