Research Article

Prevalence of carpal tunnel syndrome among dentists in

Chennai, India
Dipika Inbasekaran1, M. Sankari2, S. Gopal Nambi3*

ABSTRACT

Introduction: Carpal tunnel syndrome (CTS) is a neuromuscular disorder, which commonly affects the dentists.
Aim:  The aim of this study is to determine the prevalence of probable CTS among various branches of specialties
practiced by dentists in Chennai, India. Materials and Methods: A cross-sectional study was conducted on 120 dentists
practicing in Chennai, India. A self-administered two-part questionnaire consisting of demographic of the individual and
work characteristics in the first part and the Boston CTS questionnaire consisted of the second part of the questionnaire
was used. Data were analyzed by multiple logistic regression analysis using SPSS software 20. Results: Among the
dentists who participated in the study, 63.3% were females, the maximum number of dentists was in the age group
of 30–40 years, and 52.5% held a master degree. 61.7% of dentists work for 7–8 h a day. A total of 25.7% of dentists
reported with symptoms of CTS, among them 15% reported mild disability, 9.1% reported moderate disability, and 1.6%
reported severe disability. Periodontics was most affected specialty (41.66%) followed by endodontics (33.33%). Oral
medicine, oral pathology, and public health dentistry were specialties who were unaffected in this study. Conclusion: The
prevalence of CTS among dentists in this study population is relatively high, and awareness of the condition and method
to prevent it need to be implemented.

KEY WORDS: Boston carpal tunnel questionnaire, carpal tunnel syndrome, dentist, neuromuscular disorders, risk factors

INTRODUCTION Dentist surgeons and dental hygienists have

Carpal tunnel syndrome (CTS) arises from
compression of the median nerve where it passes
through the carpal tunnel in the wrist which results in a
subsequent functional impairment and local ischemia
of the nerve within the tunnel.[1] The carpal tunnel is a
narrow passage formed by the deep arch anteriorly at
the wrist by the carpal bones and flexor retinaculum.
Compression of the median nerve results in symptoms
that are characteristic of the syndrome, namely;
numbness, tingling pain and eventually weakness
involving the palmar surface of the thumb, index,
and middle finger. The classical presentations are
burning sensations, tingling, and/or numbness in the
distribution of the median nerve. This typically occurs
initially at night, and then as severity progresses,
throughout the day.
Access this article online
Website: jprsolutions.info ISSN: 0975-7619
been reported to have a high prevalence of upper
extremity musculoskeletal disorders (MSDs),
including CTS.[2,3,5] The ergonomic risk factors for
CTS are repetitive nature of work, forceful exertions,
mechanical stress, incorrect posture, and the vibration
from ultrasonic scalers and Low and high-speed
handpieces.[4] In addition, several anthropometric
factors such as age, sex, body mass index, and
medical conditions associated with an increased
risk of developing such as chronic diseases such
as diabetes, thyroid, rheumatoid arthritis, obesity,
and use of oral contraceptives are indicated.[6] The
occurrence of MSD affects work practices and leads
to lost work time or inefficient productivity. Dentists
with more clinical experience were diagnosed with
CTS.[7] This was supported by Lalumandier and
McPhee who found that dental hygienists who
practiced for >10 years were more likely to develop
CTS.[8] Although CTS if left untreated, it can lead
to complete, irreversible median nerve damage, with
severe loss of hand function.[9]

1
Department of Periodontics, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha
University, Chennai, Tamil Nadu, India, 2Department of Periodontics, Saveetha Dental College, Saveetha Institute of Medical
and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India, 3Department of Physical Therapy, College of
Applied Medical Sciences, Prince Sattam Bin Abdul Aziz University, Al-Kharj, Saudi Arabia

*Corresponding author: Dr. S. Gopal Nambi, Department of Physical Therapy, College of Applied Medical Sciences, Prince
Sattam Bin Abdul Aziz University, Al-Kharj, Saudi Arabia. Phone: +96-6501878382. E-mail: physio_gopal@rediffmail.com

Received on: 15-06-2018; Revised on: 28-07-2018; Accepted on: 20-08-2018

3262 Drug Invention Today | Vol 10 • Special Issue 3 • 2018

 Dipika Inbasekaran, et al.

This cross-sectional study aims to assess the the respondents with a master’s degree, 14.1% were
prevalence of CTS among dentists and in different orthodontists, 10.8% were prosthodontists, and 10%
specialties in dentistry in Chennai city, due to shortage were periodontists. 61.7% of dentists worked for
of local studies that prove this finding. an average of 7–8 h a day, and the hour of practice
ranged from 5 to 10 h. The relation between number
MATERIALS AND METHODS of working hours and CTS is represented in Table 3.
The average duration of an appointment was 30 min,
The cross-sectional study was conducted from with a duration range of 15–120 min. Only 57.8% of
August 2017 to January 2018, among dentists in dentists admitted to take a break between patients,
Chennai, India. A  total of 120 dentists who had work with the duration of break ranging from 5 to 15 min
experience of minimum 1 year and practicing in Chennai {Figure 3]. A  total of 25.7% of dentists reported
city were included in the study, and dentists who were CTS pain, among them 15% reported mild disability,
full-time academicians were excluded from the study. 9.1% reported moderate disability, and 1.6% reported
severe disability [Table 4 and Figure 4]. Periodontics
A self-administered two-part questionnaire was used.
The first part consisting of sociodemographic data,
individual factors, work characteristics, psychosocial
job factors, and clinical diagnosis questionnaire
was used. Demographic data consisted of questions
related to age, sex, marital status, education level, and
area of specialization of the respondents. The work
characteristics questions were adopted from Samat
et al.[10] Through these questions, respondents were
asked about total work duration, duration of use of
dental instruments, work-rest pattern, and duration of
the use of computer in a day during office hour and
after office hour. The second part of the questionnaire
consisted of the validated Boston CTS questionnaire
which consists of symptoms severity (11 items) and
functional status (8 items) scores.[11] All data were
analyzed by multiple logistic regression analysis using
Figure 1: Gender distribution
SPSS software, version 20 (α = 0.05).

RESULTS
A total of 120 dentists were participated in this
questionnaire-based cross-sectional study. The
population consisted of 36.7% males and 63.3% of
females [Figure  1]. Among the males, 31.8% were
affected by CTS, while 22% females were affected
[Table  1]. The participants were aged between 24
and 70  years of age, and the maximum number of
dentists (42%) was in the age group of 30–40 years,
with the mean age of 36 years [Figure 3]. The years
of dental practice ranged from 1 to 36  years, with
the mean of 13  years [Figure  4]. Table  2 shows the
relation of years of the dental practice and CTS.
47.5% of the participants had a bachelor’s degree
and 52.5% had a master’s degree [Figure  2]; among Figure 2: Qualification

Table: 1: Gender distribution

Gender*stages of CTS
Gender Stages Total
Asymptomatic Mild CTS Moderate CTS Severe CTS
Male 30 7 7 0 44
Female 59 11 4 2 76
Total 89 18 11 2 120
CTS: Carpal tunnel syndrome

Drug Invention Today | Vol 10 • Special Issue 3 • 2018 3263

 Dipika Inbasekaran, et al.

Table 2: Years of experience distribution

Years of experience*stages of CTS
Years of experience Stages Total
Asymptomatic Mild CTS Moderate CTS Severe CTS
0–10 46 9 2 0 57
11–20 23 6 0 0 29
21–30 15 3 4 2 24
31–40 5 0 3 0 8
41–50 0 0 2 0 2
Total 89 18 11 2 120
CTS: Carpal tunnel syndrome

Table 3: Number of working hours per day distribution

Number of working hours per day*stages of CTS
Working hours/day Stages Total
Asymptomatic Mild CTS Moderate CTS Severe CTS
5–6 20 3 2 0 25
7–8 53 14 7 2 76
9–10 15 1 2 0 18
11–12 1 0 0 0 1
Total 89 18 11 2 120
CTS: Carpal tunnel syndrome

Table 4: Stages of CTS

Stage of CTS Frequency (%) Valid Cumulative
percent percentage
Asymptomatic 89 (74.2) 74.2 74.2
Mild CTS 18 (15.0) 15.0 89.2
Moderate CTS 11 (9.2) 9.2 98.3
Severe CTS 2 (1.7) 1.7 100.0
Total 120 (100.0) 100.0
CTS: Carpal tunnel syndrome

was most affected specialty (41.66%) followed by

endodontics (33.33%). Oral medicine, oral pathology,
and public health dentistry were specialties who were
Figure 3: Age distribution
unaffected in this study. Among the general dentists,
12.7% were affected by CTS [Table 5].

DISCUSSION
According to this study, the prevalence of CTS among
dentists in Chennai city is 17.5%, with an increased
prevalence among periodontist and endodontist when
compared to other specialties of dentistry. This is more
than the values seen by Hamann et al. who showed
that the prevalence of dentists with CTS was 2.9% as
defined by 0.8-ms prolongation of electrodiagnostic
criterion and had symptoms consistent with CTS.[7]
Haghighat et al. reported a probable prevalence of Figure 4: Years of clinical practice
16.7% of CTS among dentists in Isfahan, Iran. The
diagnosis of CTS was based on numbness or pain pain in the hand and wrist using a standardized Nordic
in territory of the median nerve and positive Phalen questionnaire to measure musculoskeletal complaints
and Tinel clinical tests.[12] This value is similar to the among dentists.[13] In a study conducted among
results derived by us. the United States Army dentists by Lalumandier
and McPhee, the prevalence of CTS was 28%.[8]
In contrast, Alexopoulos et al. found that 26.0% of Leggat et al. reported a 34% prevalence of hand
dentists in Thessaloniki, Greece, had complaints of and wrist pain which was also found in Australian

3264 Drug Invention Today | Vol 10 • Special Issue 3 • 2018

 Dipika Inbasekaran, et al.
Table 5: Amount of disability with respect to specialty
Specialty
None (%)
BDS 41 (87.23)
Orthodontics 15 (88.23)
Endodontics 4 (66.66)
Prosthodontics 11 (84.61)
Periodontics 7 (58.33)
Pedodontics 2 (100)
Oral surgery 8 (80)
Oral medicine 7 100)
Oral pathology 4 (100)
Public dentistry 2 (100)
Total 99
dentists.[14] Similarly, Puriene et al. reported much
higher prevalence of 83.1% of hand pain and CTS
among Lithuanian dentists.[15]
The repetitive movements performed during scaling
and root planning or the vibration of the ultrasonic
scaler could be the possible reason for the increased
prevalence among periodontists. The vibrations of
the high-  as well as low-speed handpieces during
tooth preparation as well as the repetitive movements
performed during the biomechanical process of clean
and shaping of the root canal are the probable cause of
increased prevalence in endodontists.
As this cross-sectional study is questionnaire based,
recall bias by the participants could be a limitation of
the study; furthermore, nerve conduction tests of the
participants would provide more accurate results, but
this method is time-consuming and requires a great
deal of cooperation from study respondents.
CONCLUSION
There is a relatively high prevalence of CTS among
dentists in Chennai city. Increasing the awareness of
the syndrome and its risk factors could potentially
reduce the incidence of CTS. The importance of
ergonomics and its application in dentistry is another
possible intervention. The prevention of CTS would
result in better quality of dental service being provided.
REFERENCES
1. Luchetti R, Amadio P. Carpal Tunnel Syndrome. New  York:
Springer-Verlag Berlin Heidelberg; 2007.
2. Osborn JB, Newell KJ, Rudney JD, Stoltenberg JL. Carpal
tunnel syndrome among Minnesota dental hygienists. J  Dent
Hyg 1990;64:79-85.
Drug Invention Today | Vol 10 • Special Issue 3 • 2018
Disability Total
Mild (%) Moderate (%)
6 (12.7) 0 47
2 (11.76) 0 17
2 (33.33) 0 6
2 (15.38) 0 13
5 (41.66) 0 12
0 0 2
1 (10) 1 (10) 10
0 0 7
0 0 4
0 0 2
18 3 120
3. Fish DR, Morris-Allen DM. Musculoskeletal disorders in
dentists. N Y State Dent J 1998;64:44-8.
4. Werner RA, Armstrong TJ. Carpal tunnel syndrome: Ergonomic
risk factors and intracarpal canal pressure. Phys Med Rehabil
Clin N Am 1997;8:555-69.
5. Hamann C, Werner RA, Franzblau A, Rodgers PA, Siew C,
Gruninger S, et al. Prevalence of carpal tunnel syndrome and
median mononeuropathy among dentists. J  Am Dent Assoc
2001;132:163-70.
6. National Institute of Occupational Safety and Health. Carpal
tunnel syndrome. In: Bernard BP, editor. Musculoskeletal
Disorders and Workplace Factors. Washington: U.S.
Department of Health and Human Services Publication No. 97-
144; 1997. p. 1-29.
7. Durgha K, Sakthi DR. Occupational hazards and its impact on
quality of life of dentists. IOSR J Dent Med Sci 2014;13:53-6.
8. Lalumandier JA, McPhee SD. Prevalence and risk factors
of hand problems and carpal tunnel syndrome among dental
hygienists. J Dent Hyg 2001;75:130-4.
9. Arthisri AS, Jain AR, Philip JM, Krishnan CV, Chandran CR.
A novel method for the risk assessment of dental practitioners
in Chennai city for occupational musculoskeletal disorders.
Biol Med 2016;8:1.
10. Samat RA, Shafei MN, Yaacob NA, Yusoff A. Prevalence
and associated factors of back pain among dental personnel
in North-Eastern state of Malaysia. J  Collab Res Intern Med
Public Health 2011;3:576-86.
11. Leite JC, Jerosch-Herold C, Song F. A  systematic review
of the psychometric properties of the Boston carpal tunnel
questionnaire. BMC Musculoskelet Disord 2006;7:78.
12. Haghighat A, Khosrawi S, Kelishadi A, Sajadieh S, Badrian H.
Prevalence of clinical findings of carpal tunnel syndrome in
isfahanian dentists. Adv Biomed Res 2012;1:13.
13. Alexopoulos EC, Stathi IC, Charizani F. Prevalence of
musculoskeletal disorders in dentists. BMC Musculoskelet
Disord 2004;5:16.
14. Leggat PA, Kedjarune U, Smith DR. Occupational health
problems in modern dentistry: A  review. Ind Health
2007;45:611-21.
15. Puriene A, Aleksejuniene J, Petrauskiene J, Balciuniene I,
Janulyte V. Self-reported occupational health issues among
Lithuanian dentists. Ind Health 2008;46:369-74.
Source of support: Nil; Conflict of interest: None Declared
3265
Copyright of Drug Invention Today is the property of Journal of Pharmacy Research and its
content may not be copied or emailed to multiple sites or posted to a listserv without the
copyright holder's express written permission. However, users may print, download, or email
articles for individual use.