Abstract
Dental hygienists in China face unique occupational challenges, with their job satisfaction being pivotal to performance. This study investigates the interplay between job satisfaction and occupational stress, burnout, and musculoskeletal disorders (MSDs) among this group. A cross-sectional survey was conducted involving 21 female dental hygienists from Sir Run Run Shaw Hospital. Data were collected on general information, occupational stress (using the Perceived Stress Scale), burnout (Maslach Burnout Inventory), MSDs, and job satisfaction. High levels of occupational stress and burnout were reported, yet these did not significantly correlate with job satisfaction (P > .05). In contrast, MSDs showed a significant negative correlation with job satisfaction (P = .004). Factors significantly associated with job satisfaction included effective collaboration, quality of work, institutional support, patient care, and work flexibility. While stress and burnout are prevalent among Chinese dental hygienists, they do not directly impact job satisfaction. MSDs, however, significantly affect satisfaction levels. The study suggests that addressing MSDs and enhancing workplace factors can improve job satisfaction and retention in the profession.
Keywords: burnout, dental hygienists, job satisfaction, musculoskeletal disorders, occupational stress
1. Introduction
Dental hygienists play a crucial role in promoting oral health by providing preventive dental care services and patient education.[1,2] However, in mainland China, dentists were historically the only legally recognized oral healthcare practitioners. Responsibilities typically carried out by dental hygienists, such as dental prophylaxis, scaling, radiography, and assisting dentists, have historically been performed by dentists and nurses. Fortunately, in recent years, dental hygienists have gradually begun to assume these duties in a limited number of medical institutions domestically. In the field of oral healthcare, the job satisfaction of dental hygienists is paramount as it directly impacts their job performance. As a nascent professional category, our understanding of their job satisfaction and its determinants remains limited.
Dental work is widely regarded as a stressful occupation.[3,4] The dental profession is characterized by a disproportionately high rate of early retirement, largely attributed to stress-induced chronic illnesses.[5] Dental hygienists work in demanding environments requiring a solid theoretical and clinical knowledge base and direct interaction with patients. Stress and burnout are considered psychosocial occupational hazards.[6] Previous research has demonstrated their pervasiveness and profound consequences, disrupting individual and societal functioning, leading to decreased job performance, and compromised mental health,[7] not to mention diminished job satisfaction. In severe cases, there is an increased likelihood of accident occurrence.[8]
Musculoskeletal disorders (MSDs) refer to injuries affecting the musculoskeletal system, with substantial evidence indicating their significance as occupational health issues in the dental industry.[9,10] These conditions are often caused by awkward postures, prolonged static positions, repetitive and/or forceful motions, poorly designed dental equipment, and genetic predispositions. Previous studies have shown that dental hygienists are as susceptible to MSDs as dentists.[11] These diseases primarily manifest in the neck, upper back, and wrists. The presence of work-related illnesses significantly diminishes the job satisfaction of dental hygienists. Furthermore, work-related stress and burnout also contribute to an increased incidence of musculoskeletal disorders among patients.[12–14]
Given these considerations, this study aims to investigate the complex relationships among job satisfaction, occupational stress, burnout, and musculoskeletal disorders among dental hygienists. Through a comprehensive examination of these factors, the ultimate goal of this research is to design effective measures to enhance job satisfaction,[15] improve job attractiveness, and ensure the stability of dental healthcare personnel.
2. Materials and methods
2.1. Study design and participants
The study received approval from the Institutional Review Board of Sir Run Run Shaw Hospital (2024-2499-01) and adhered to the principles outlined in the Helsinki Declaration. Confidentiality and anonymity of participants were rigorously upheld throughout the study. The survey questionnaire was completed voluntarily by the respondents. Completion of the questionnaire by the participants is considered to signify informed consent.
A cross-sectional design was employed in this study to examine the interplay between job satisfaction, occupational stress, and MSDs among dental hygienists in the Department of Dentistry at Sir Run Run Shaw Hospital.
The study population consisted of dental hygienists employed at Sir Run Run Shaw Hospital’s dental department in 2024, encompassing individuals of any age and gender. Given the relatively small number of professionals in this occupation, questionnaires were administered to all dental hygienists working at Sir Run Run Shaw Hospital.
2.2. Questionnaire
The questionnaire utilized in this study was developed via the Questionnaire Star platform (Changsha Ranxing Information Technology Co., Ltd, China). The questionnaire was distributed via the WeChat platform. It comprised 5 sections: “General Information Survey” (14 items); “Occupational Stress Assessment” (14 items); “Occupational Burnout Assessment” (15 items); “Musculoskeletal Disorders Survey” (10 items); and “Job Satisfaction Survey” (15 items). The General Information Survey encompassed demographic factors such as gender, age, educational background, marital status, number of children, duration of professional training, years of practice, weekly working hours, predominant types of dental practitioners collaborated with, and primary job responsibilities.
The Occupational Stress Assessment (Cronbach’s α = 0.877) was conducted using the Perceived Stress Scale (PSS),[16] consisting of 14 items. Participants rated their perceived stress levels on a Likert scale ranging from 0 (never) to 4 (very often). Higher scores indicated higher stress levels, with 22 being considered the threshold, as per prior research.[17] The Occupational Burnout Assessment (Cronbach’s α = 0.880) was based on Maslach and Jackson’s Maslach Burnout Inventory (MBI),[18] comprising 15 items. Respondents rated the frequency of experiencing burnout feelings on a 6-point Likert scale from 0 (never) to 5 (every day). Reported approximate thresholds for emotional exhaustion, cynicism, and professional efficacy were >12.5, >7.5, and <10.5, respectively.[19]
The Musculoskeletal Disorders Survey (Cronbach’s α = 0.780) was developed based on the Nordic Musculoskeletal Questionnaire,[20] investigating participants’ health symptoms in the neck, shoulders, elbows, hands and wrists, upper back, lower back, hips and thighs, and knees. Each region’s discomfort status over the past 12 months was rated as absent, present but not affecting work and life, or causing pain and affecting work and life, scored as 0, 1, or 2, respectively, with a total score calculated for each participant.
The Job Satisfaction Survey (Cronbach’s α = 0.970) assessed various factors, including effective collaboration among colleagues, adequacy of equipment and materials, quality of infection control, quality of dental work, support for further education by the institution, salary level, requirements for working hours and workload by the institution, ability to provide comprehensive healthcare to patients, flexibility of working hours, ease of employment and job transition, convenience of commuting to the workplace, ease of taking leave, comfortable working environment, stability of work, physical discomfort due to work, and participants’ evaluation of the impact of each factor on job satisfaction using a 5-point Likert scale from 0 (no impact) to 4 (significant impact). Finally, participants were asked to rate their satisfaction with their dental hygienist career from 1 (unsatisfied) to 5 (very satisfied). Additionally, a binary question was included, inquiring whether participants would choose the dental hygienist profession if given the opportunity for a career change.
2.3. Data analysis
Data analysis was conducted using IBM SPSS V25 (IBM Corp., Armonk). Descriptive statistics were calculated to summarize participant demographics and survey responses. Pearson correlation coefficients were computed to examine the relationships between job satisfaction, occupational stress, and MSDs. Multiple regression analysis was performed to identify predictors of job satisfaction among dental hygienists.
3. Results
3.1. Demographics
A total of 21 completed questionnaires were returned, all from female dental hygienists, with the majority falling within the age range of 18 to 25 years (42.8%). Of these respondents, 7 (33.3%) were married, while 15 (71.4%) reported no children. The majority of participants (17 individuals, 81.0%) held a bachelor’s degree or higher. The duration of pre-employment training for dental hygienists varied, with a notable proportion (8 individuals, 38.0%) undergoing 1 to 3 years of training. The distribution of work experience in the dental hygiene industry is approximately equal for those with <2 years and >4 years of experience (42.8%, respectively). The predominant range of weekly working hours was 31 to 40 hours (11 individuals, 52.3%). Ultrasonic scaling emerged as the most frequently performed task, with 16 participants (76.1%) having experience in this area, while only 9 individuals (42.85%) had experience in dental X-ray imaging. The average job satisfaction score was 3.52 ± 0.93, with 12 participants (57.1%) indicating satisfaction or partial satisfaction. Interestingly, when asked if they would choose to work in the dental industry again, the affirmative response rate increased (16 individuals, 76.1%). The detailed demographic information is provided in Table 1.
Table 1.
Baseline characteristics of patients.
| Characteristic | Dental hygienists (n = 21) |
|---|---|
| Age (%) | |
| Under 18 yr old | 0 |
| 18~25 | 9 (42.9) |
| 26~30 | 4 (19.0) |
| 31~40 | 7 (33.3) |
| 41~50 | 1 (4.8) |
| 51~60 | 0 |
| 60 above | 0 |
| Gender (%) | |
| Male | 21 (100) |
| Female | 0 |
| Academic degree (%) | |
| Junior high school or below | 0 |
| High school/technical secondary school | 0 |
| College | 4 (19.0) |
| University | 17 (81.0) |
| Undergraduate graduate degree or above | 0 |
| Marital status (%) | |
| Married | 14 (66.7) |
| Unmarried | 7 (33.3) |
| Number of children (%) | |
| 0 | 15 (71.4) |
| 1 | 4 (19.0) |
| 2 | 2 (9.5) |
| Oral hygiene professional occupational experience (%) | |
| <2 yr | 9 (42.9) |
| ≥2 yr, <4 yr | 3 (14.3) |
| 4 yr or more | 9 (42.9) |
| Time for dental professional training before attending work (%) | |
| <1 yr | 7 (33.3) |
| ≥1 yr, <3 yr | 8 (38.1) |
| 3 yr or more | 6 (28.6) |
| Assist which type of dental surgeon (%) | |
| Dental general practitioner | 12 (57.1) |
| Periodontis | 5 (23.8) |
| Orthodontist | 4 (19.0) |
| Other | 0 |
| Weekly working hours (%) | |
| 30 h and less | 11 (52.4) |
| 31–40 h | 8 (38.1) |
| 41–50 h | 2 (9.5) |
| >50 h | 0 |
| Currently mainly engaged in the work (%) | |
| Ultrasonic cleaning | 16 (76.2) |
| Ultrasonic scraping | 10 (47.6) |
| Manual scraping | 15 (71.4) |
| Dental X-ray imaging | 9 (42.9) |
| Doctor assistant | 14 (66.7) |
| Other | 0 |
3.2. Work-related variables and job satisfaction
The correlation between work-related factors and job satisfaction is depicted in Table 2. Dental hygienists commonly perceive that “ salary level” have a greater impact on job satisfaction (mean 4.95 ± 1.40), while the influence of “ease of employment and job transition” is minimal (mean 3.90 ± 1.67). Correlation analysis results indicate that “effective collaboration among colleagues”, “quality of infection control,” “quality of dental work,” “support for further education by the institution,” “ability to provide comprehensive healthcare to patients,” “flexibility of working hours” is significantly correlated with job satisfaction (P < .05), whereas the remaining variables show no statistically significant correlation with job satisfaction.
Table 2.
The correlation between job-related factors and job satisfaction.
| Job-related factors | Statistical values | P value |
|---|---|---|
| Effective collaboration among colleagues | 0.626 | .001 |
| Adequacy of equipment and materials | 0.270 | .212 |
| Quality of infection control | 0.443 | .034 |
| Quality of dental work | 0.470 | .024 |
| Support for further education by the institution | 0.577 | .004 |
| Salary level | 0.125 | .569 |
| Requirements for working hours and workload by the institution | 0.206 | .346 |
| Ability to provide comprehensive healthcare to patients | 0.583 | .003 |
| Flexibility of working hours | 0.441 | .035 |
| Ease of employment and job transition | 0.385 | .069 |
| Convenience of commuting to the workplace | 0.389 | .066 |
| Ease of taking leave | 0.377 | .076 |
| Comfortable working environment | 0.184 | .400 |
| Stability of work | 0.282 | .193 |
| Physical discomfort due to work | 0.299 | .166 |
3.3. Occupational stress, burnout, and job satisfaction
Figure 1A, B present the specific situation for PSS and MBI, respectively. The mean perceived stress level among participants was 25.81 ± 5.21, with 16 participants (76.2%) scoring above 22. The average burnout score was 22.19 ± 10.80, with 18 participants (85.7%) having MBI scores exceeding 10.5. No significant statistical correlation was observed between occupational stress and burnout (P = .129). Furthermore, neither occupational stress nor burnout demonstrated a significant correlation with job satisfaction (P = .564 and .275, respectively).
Figure 1.
The specific situation of PSS (A) and MBI (B). MBI = Maslach Burnout Inventory, PSS = Perceived Stress Scale.
3.4. Musculoskeletal disorders and job satisfaction
Two participants reported job transitions due to musculoskeletal reasons. The mean body mass index (BMI) of the participants was 20.25 ± 2.34, ranging from 18 to 27. A majority (66.7%) of the participants reported engaging in physical activity less than once a week. Figure 2 illustrates the overall prevalence of musculoskeletal disorders by body region among participants over the past 12 months and the past 7 days. All dental hygienists reported suffering from musculoskeletal ailments over the past year, with the most commonly affected area being the shoulders (90.4%), only 2 (9.5%) hygienists reporting discomfort in the upper back. Approximately 47.6% of hygienists claimed that their musculoskeletal ailments hindered their normal work and life over the past year, with the shoulders being the most common site (33.3%), while the least common site was the upper back, with no hygienists reporting work impairment due to it. A total of 76.1% of respondents reported at least 1 complaint in the past 7 days, with the shoulders remaining the most prevalent site (71.4%). Correlation analysis between the musculoskeletal system scores obtained from each body region and job satisfaction revealed a statistically significant correlation (P = .004). We also assessed the correlation between exercise habits/frequency and other relief methods with the occurrence of musculoskeletal diseases, showing that more frequent weekly exercise did not effectively reduce the frequency of musculoskeletal disease occurrence (P = .486). Furthermore, there was a statistically significant correlation between musculoskeletal system diseases and BMI (P = .037), with hygienists having lower BMI experiencing milder musculoskeletal ailments.
Figure 2.
The overall prevalence of musculoskeletal disorders by body region among participants over the past 12 months (A) and the past 7 days (B).
4. Discussion
This study represents the first investigation into the correlation between work environment, occupational stress, burnout, musculoskeletal disorders, and job satisfaction among dental hygienists practicing in mainland China. Survey findings reveal that factors such as “effective collaboration among colleagues,” “quality of infection control,” “quality of dental work,” “support for further education by the institution,” “ability to provide comprehensive healthcare to patients,” and “flexibility of working hours” are significantly associated with job satisfaction. Despite elevated levels of occupational stress and burnout among participants, neither demonstrated a statistically significant correlation with job satisfaction in this study. Musculoskeletal disorders exhibit a notably high prevalence among dental hygienists, with all participants experiencing at least 1 episode over the past year. The severity of these disorders significantly impacts job satisfaction. Interestingly, maintaining a lower BMI appears to be beneficial in mitigating the severity of musculoskeletal disorder episodes.
In the realm of dental hygiene, job satisfaction is a multifaceted construct influenced by various workplace factors. Rederiene et al[21] reported on a survey examining the job satisfaction among dental hygienists in Lithuania. Their study revealed that factors influencing job satisfaction encompassed relationships with colleagues and patients, work environment, income, health and well-being associated with work, social protection, and the balance between work and family life. A majority of these factors closely align with the results of our research. Effective collaboration among colleagues serves as the cornerstone of a harmonious work environment, significantly impacting job satisfaction, as emphasized in the study by Collins and Beauregard.[22] Furthermore, infection control and the quality of dental work further enhance job satisfaction, given their direct correlation with professional ethics and the ability to provide high-standard care to patients.[23,24] Institutional support for continuing education represents another critical factor, reflecting the organization’s commitment to the professional development of its staff,[25] which is crucial for the career advancement and satisfaction of dental hygienists. The ability to provide comprehensive healthcare to patients is also paramount, as it aligns with the professional mission of dental hygienists to promote the overall health of the community. Lastly, flexibility in work hours is a significant determinant of job satisfaction, enabling dental hygienists to balance their professional and personal lives, a factor associated with increased job satisfaction and reduced burnout.[26] Contrary to the findings from Lithuanian studies, our dental hygienists did not express dissatisfaction with their income, which may be attributed to the fact that they are employed by the same health institution that offers relatively equitable remuneration for their labor.
In the field of oral health, the chronic presence of occupational stress can lead to burnout, which in turn affects the quality of work.[27] Our study, consistent with previous research, found that dental hygienists reported high levels of stress and burnout. However, contrary to expectations, we did not observe a statistically significant correlation between these factors or a connection to job satisfaction. One possible explanation for this finding could be the limited sample size, which may have affected the statistical power of our analysis. It’s important to note that job satisfaction is a complex construct influenced by various factors, including personal, professional, and environmental elements. The lack of correlation between stress, burnout, and job satisfaction might also suggest that dental hygienists possess coping mechanisms or that other factors not measured in our study could be contributing to their overall job satisfaction. Future research should aim to explore these relationships with larger sample sizes and incorporate a broader range of variables that could influence job satisfaction. Longitudinal studies could provide a more comprehensive understanding of how stress and burnout evolve over time and their impact on job satisfaction among dental professionals.
The prevalence of MSDs among dental hygienists is a significant occupational health concern, largely due to the physical demands of dental procedures.[28,29] Our study’s findings are in line with previous research, which has established a correlation between higher BMI and increased severity of MSDs in dental professionals.[30] This relationship underscores the importance of weight management as a preventive measure against work-related MSDs. Contrary to our expectations, the frequency of physical activity did not appear to be associated with a reduced incidence of MSDs. This may suggest that the specific types of physical activity or targeted exercises, rather than general fitness, are more relevant to the prevention of MSDs in this context. Our study revealed a correlation between the overall severity of MSDs and job satisfaction. This suggests that interventions aimed at reducing the occurrence and severity of MSDs could potentially enhance job satisfaction among dental hygienists.
This study has several limitations. Firstly, the small sample size and single-center design constrain the generalizability of our findings and limit further statistical analysis. The nascent status of dental hygienists as a profession in Mainland China poses challenges in recruiting a larger and more diverse sample, necessitating future research as the workforce expands. Another limitation is the study’s focus on a Chinese population, which precludes cross-cultural comparisons. As the field of dental hygiene matures, it will be important to include diverse cultural perspectives to better understand the global dimensions of job satisfaction in this profession.
In conclusion, our research has identified several workplace factors associated with job satisfaction in dental hygienists, including effective collaboration, infection control quality, dental work quality, institutional support for further education, comprehensive patient care, and work hour flexibility, as well as the overall score of musculoskeletal disorders. These findings suggest that employers should focus on these areas to enhance job satisfaction and staff retention, thereby improving the quality of dental care and the well-being of dental hygienists.
Author contributions
Conceptualization: Jingyi Wei.
Data curation: Jingyi Wei, Feiyang Zhong.
Investigation: Zheng Cao.
Methodology: Jingyi Wei.
Supervision: Zheng Cao.
Validation: Cheng-Yi Huang.
Visualization: Cheng-Yi Huang.
Writing – original draft: Jingyi Wei, Feiyang Zhong.
Writing – review & editing: Cheng-Yi Huang.
Abbreviations:
- BMI
- body mass index
- MBI
- Maslach Burnout Inventory
- MSDs
- musculoskeletal disorders
- PSS
- Perceived Stress Scale.
This retrospective study was approved by the Medical Ethics Committee of Sir Run Run Shaw Hospital and was conducted in accordance with the Declaration of Helsinki. The requirement for informed consent was waived by the Medical Ethics Committee of Sir Run Run Shaw Hospital owing to the retrospective nature of this study.
The authors have no funding and conflicts of interest to disclose.
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
How to cite this article: Wei J, Zhong F, Cao Z, Huang C-Y. Impact of occupational stress and musculoskeletal disorders on job satisfaction among Chinese dental hygienists: An observational study. Medicine 2024;103:51(e40967).
JW and FZ contributed to this article equally.
Contributor Information
Jingyi Wei, Email: jingyiwei2023@foxmail.com.
Feiyang Zhong, Email: feiyang.zhong@foxmail.com.
Zheng Cao, Email: caozhengm@hotmail.com.
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