ABSTRACT
Background
Dentists are at greater risk of work‐related musculoskeletal disorders (WMSDs) which can be caused by repetitive movements, improper posture and long working hours. If ergonomic principles are applied in the field of dentistry, they help to prevent occupational ergonomic health hazards and provides more comfort to the dentist and patient.
Objective
To obtain information regarding dental ergonomics practice of dentists in Indonesia and its related factors.
Methods
A cross‐sectional study was conducted using a purposive sampling method via Google Form to 231 dentists in DKI Jakarta, Indonesia from November to December 2022. The questionnaire consisted of 34 items divided into five sections; socio‐demographic, job characteristics, knowledge of dental ergonomics, attitude towards dental ergonomics and the practice of dentists regarding dental ergonomics. Bivariate analysis was conducted using Pearson Chi‐square Test.
Result
76.2% dentists have poor dental ergonomics practice. There is a significant relationship (p‐value < 0.05) between the practice of dental ergonomics and age group, years of practical experience and level of knowledge.
Conclusion
Most Indonesian dentists (76.2%) still lack of dental ergonomics practice. Age, duration of work experience and ergonomic dental practice knowledge are significantly correlated.
Keywords: dental ergonomics, dentists, Indonesia, work‐related musculoskeletal disorders (WMSDs)
1. Introduction
The term ‘ergonomic’ is derived from the Greek terms ‘Ergon,’ meaning work and ‘Nomos,’ meaning law or natural system [1]. It is an applied science aimed at efficiently and safely designing and arranging items used by individuals [2]. According to the International Ergonomics Association, ergonomics is a scientific discipline focused on understanding the relationships between people, beliefs and workplace design methods to optimise human well‐being and overall system performance [1, 3]. The goal of ergonomics is to establish a safe, healthy and comfortable work environment, thereby preventing health problems and increasing productivity [4]. In dentistry, the application of dental ergonomics can improve work quality and efficiency [5].
Dentistry demands a high level of skill, with dentists working within a confined space, typically the oral cavity, where precise and repetitive application of force is necessary for dental and oral health care. This requirement often necessitates a fixed posture, posing an occupational hazard for dentists [4, 6]. Consequently, they are at increased risk of work‐related musculoskeletal disorders (WMSDs) due to the combination of repetitive movements, poor posture and prolonged working hours [6].
A high prevalence of MSDs among dentists is evident, with 63.5% of young Indonesian dentists experiencing musculoskeletal symptoms [7, 8]. Similar research in different countries also showed that the prevalence of MSDs among dentists was significantly higher compared to the general population [9, 10]. The impact of MSDs on dentists extends beyond compromising productivity and comfort, often leading to lowered job satisfaction, accidents, reduced work capacity, temporary leave and early retirement [11, 12].
Applying ergonomic principles in dentistry can prevent occupational health hazards and enhance comfort for both dentists and patients [1]. However, research indicates that dental students and practicing dentists often struggle to implement ergonomic postures effectively, despite their awareness of musculoskeletal disorders and the importance of workplace health [5, 13, 14]. As one of the important factors of dentists' well‐being, there is a lack of studies assessing Indonesian dentists' attitudes, knowledge and practices regarding dental ergonomics. This study aims to address this gap by examining Indonesian dentists' behaviours and related factors that may be beneficial for curriculum adjustments for dental students and continuing education for practicing dentists in Indonesia.
2. Methods
The reporting of the present study is in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. Ethical approval was granted by the Research Ethics Committee of the Faculty of Dentistry, Universitas Indonesia (No: 115 /Ethical Approval /FKGUI/XI/2022). Conducted in Indonesia's capital city, DKI Jakarta, between November 24th and December 1st, 2022, this cross‐sectional study aimed to obtain a minimum sample size of 192 respondents to achieve a significance level of 0.05 and a power of 95%, based on a previous study's finding that only 11.8% of dentists had ergonomic awareness [1]. Probability proportional to size convenience sampling were conducted representing 5 district in DKI Jakarta and 231 dentists gave their consent to participate in this study.
This study assessed the knowledge, attitudes and practices regarding dental ergonomics as outcomes and factors such as age, gender, expertise, workplace setting, duration of work and length of work experience as the potential exposure. Data collection using cross‐culturally adapted and validated questionnaires, with the instrument adapted from previous research by El‐Sallamy et al. [1] We are also ensuring respondent anonymity to reduce potential bias. Initially, the original questionnaires were translated into Indonesian by researchers and sworn translation agencies, followed by a synthesis of the translations and back translation into English. The translated items were evaluated to ensure alignment with the original questionnaire's objectives. Before the main study, pilot testing involved 31 respondents to assess the reliability and validity of the questionnaire was conducted. Cronbach's alpha and intraclass correlation coefficient (ICC) tests indicated that knowledge (α = 0.931; ICC = 0.919), attitude (α = 0.840; ICC = 0.829) and practice (α = 0.737; ICC = 0.876) have good reliability. All items have CITC value of > 0.3. Validity tests included face validity, evaluating subjective assessments regarding the questionnaire's presentation, relevance, clarity and ambiguity [15]. Based on feedback, adjustments were made by paraphrasing or rewording some items while preserving their original meaning.
For knowledge assessment, each correct answer was scored 2, "to some extent" as 1 and incorrect 0, with respondents' knowledge categorised as poor (< 16), moderate (16–23), or good (> 24). Attitude questions were rated on a 5‐point Likert scale, with total scores indicating positive (> 15) or negative (< 15) attitudes. Practice questions were also rated on a 5‐point Likert scale, with total scores indicating good (> 18) or poor (< 18) practices [1]. SPSS 23 software (IBM Corp., Armonk, NY, USA) was used for descriptive analysis to analyse the means and standard deviation (SD) for numerical variables and the prevalence for categorical variables. Pearson Chi‐square statistical tests were performed to see the relationship between variables (significance at p < 0.05).
3. Results
Out of 250 questionnaire distributed, 231 dentists completed this study (response rate = 92.4%). Majority of the dentists was ≥ 41 years old, female and general dentist working in private sector only. They work more than 6 hours on their working days with more than 21 years working experience. Respondents filled out knowledge‐attitude‐practice questionnaire regarding dental ergonomics. Based on this study, it was found that most dentist already know that popular operating posture can cause musculoskeletal disorders (89.2%). However, less of them know about degree of sight‐line and light line, also about stabilisation when doing dental practice. Only few of them know the ideal distance from the floor to the position and know that they need to do stretching between patients. Complete distribution regarding dentists' knowledge shown in Table 1. Scores > 75% (> 24) indicated strong knowledge, 50%–75% (16–23) indicated sufficient knowledge and < 50% (< 16) indicated low knowledge [1]. The results showed that 52.4% of survey participants knew dental ergonomics well (n = 121).
TABLE 1.
Dentists' knowledge related to dental ergonomics (n = 232).
| Knowledge | N (%) | ||
|---|---|---|---|
| No | To some extent | Yes | |
| Do you know what is meant by ergonomics? | 12 (5.2) | 35 (15.2) | 184 (79.7) |
| Do you know what are the health hazards of your job without ergonomics? | 13 (5.6) | 27 (11.7) | 191 (82.7) |
| Do you know the benefits of ergonomic application? | 23 (10) | 25 (10.8) | 183 (79.2) |
| Do you know the popular operating posture that may cause musculoskeletal disorders? | 4 (1.7) | 21 (9.1) | 206 (89.2) |
| Do you know the best posture of the dentist sitting? | 7 (3) | 47 (20.3) | 177 (76.6) |
| Do you know the best level of the dentist shoulders and site of elbow and upper arms? | 14 (6.1) | 74 (32) | 143 (61.9) |
| Do you know the best site for forearms and operating fingers of the dentist? | 23 (10) | 82 (35.5) | 126 (54.5) |
| Do you know the degree of sight‐line and light‐line? | 36 (15.6) | 95 (41.1) | 100 (43.3) |
| Do you know the points on the body, including fingertips and feet, that come in contact with patients and objects for stable control and sightings of the operating points? | 36 (15.6) | 96 (41.6) | 99 (42.9) |
| Do you know, when designing and equipping the treatment room, what specifics should dentists be looking for? | 23 (10) | 67 (29) | 141 (61) |
| Do you know human supports and material objects that account for body space, paths of motion of body parts and location of instrument supports? | 16 (6.9) | 60 (26) | 155 (67.1) |
| Do you know the orbit range around the patient's head? | 34 (14.7) | 75 (32.5) | 122 (52.8) |
| Do you know the ergonomic head rest and its benefits? | 30 (13) | 70 (30.3) | 131 (56.7) |
| Do you know the ideal distance from the floor to the position? | 66 (28.6) | 87 (37.7) | 78 (33.8) |
| Do you know the moving, exercise and stretch exercise between patient's appointment? | 86 (37.2) | 62 (26.8) | 83 (35.9) |
| Do you know how to maintain a comfortable environment, light and temperature in the treatment room? | 38 (16.5) | 78 (33.8) | 115 (49.8) |
Table 2 showed distribution of dentists' answers regarding attitude towards dental ergonomics. Majority respondends have great attitude towards each item of dental ergonomics. The overall score from this component is 20, re‐classified into negative and positive sentiments. Respondents with scores > 75% (> 15) had good attitudes, while those with scores < 75% (< 15) had negative attitudes. Dental ergonomics was positively viewed by most dentists (n = 200, 86.6%).
TABLE 2.
Dentists' attitude related to dental ergonomics (n = 232).
| Attitude | N (%) | ||||
|---|---|---|---|---|---|
| Definitely no | No | Neutral | Yes | Definitely yes | |
| Do you think ergonomics should be a part of the dental curriculum? | 0 (0) | 0 (0) | 22 (9.5) | 66 (28.6) | 143 (61.9) |
| Do you think dentists should follow the ergonomic principles in routine dental practice? | 0 (0) | 0 (0) | 9 (3.9) | 47 (20.3) | 175 (75.8) |
| Do you think the dental chair and instruments play any role in following ergonomic principles in routine dental practice? | 0 (0) | 0 (0) | 8 (3.5) | 73 (31.6) | 150 (64.9) |
| Do you think dentist should alternate between sitting and standing between patient appointments? | 0 (0) | 6 (2.6) | 29 (12.6) | 66 (28.6) | 130 (56.3) |
| Do you think various dental institutions should conducts continuing dental education? | 1 (0.4) | 3 (1.3) | 50 (21.6) | 78 (33.8) | 99 (42.9) |
Table 3 showed dentists' answer regarding their practice related to dental ergonomics. It showed that among other kind of practice, most dentist always work with legs separated and fee flat on the floor. However, less of them work in the upright position and spine resting on the back of the stool. Also, majority of the dentists did not use dental loupes for magnification purposes. The total score from this domain is 24, divided between good and unsatisfactory practises. Respondents scoring > 75% of the total score (> 18) were classified as good practices, while those scoring < 75% (< 18) were classified as poor practises. Dental ergonomics practices was poor for most dentists (n = 176, 76.2%).
TABLE 3.
Dentists' practice related to dental ergonomics (n = 232).
| Practice | N (%) | ||||
|---|---|---|---|---|---|
| Never | Rarely | Often | Very often | Always | |
| How frequent do you work with your legs separated and your feet flat on the floor? | 4 (1.7) | 7 (3) | 46 (19.9) | 49 (21.2) | 125 (54.1) |
| How frequent do you work in the upright position and your spine resting on the back of the stool? | 10 (4.3) | 52 (22.5) | 90 (39) | 55 (23.8) | 24 (10.4) |
| How frequent do you orient the operating field to the elbow level of your working hand? | 5 (2.2) | 22 (9.5) | 93 (40.3) | 68 (29.4) | 43 (18.6) |
| How frequently do you made an effort to maintain neutral posture while working? | 0 (0) | 20 (8.7) | 75 (32.5) | 85 (36.8) | 51 (22.1) |
| How frequent do you orient beam of light perpendicular to the observational direction? | 1 (0.4) | 10 (4.3) | 63 (27.3) | 80 (34.6) | 77 (33.3) |
| How frequently do you use dental loupes for magnification purposes? | 133 (57.6) | 30 (13) | 26 (11.3) | 16 (6.9) | 26 (11.3) |
A Pearson Chi‐square tests was performed to assess the relationship between multiplie dentists characteristics and their dental ergonomics practices. The findings of this test were showed in Table 4 along with the distribution of dentists' characteristic participate in this study. The results showed significant associations between dentists' characteristics and their dental ergonomic practices. Specifically, different age group (p = 0.042) and work experience (p = 0.029), showed statistically significant difference with ergonomic practices. However, gender (p = 0.488), qualification (p = 0.576), workplace (p = 0.369) and work duration (p = 0.173) did not show significant relationship. Knowledge level significantly influenced ergonomic practices (p < 0.001), with dentists exhibiting poor knowledge more likely to have poor practices. However, attitude did not show a significant difference (p = 0.079).
TABLE 4.
Dentists' characteristic and comparison to their dental ergonomic practices.
| Dentists' characteristic | n (%) | Dental ergonomics practice | ||
|---|---|---|---|---|
| Poor (n = 176) | Good (n = 55) | p | ||
| n (%) | n (%) | |||
| Age | ||||
| 20–25 years | 16 (6.9) | 11 (68.8) | 5 (31.3) | 0.042* |
| 26–30 years | 42 (18.2) | 36 (85.7) | 6 (14.3) | |
| 31–35 years old | 35 (15.2) | 27 (77.1) | 8 (22.9) | |
| 36–40 years | 33 (14.3) | 30 (90.9) | 3 (9.1) | |
| ≥ 41 years old | 105 (45.5) | 72 (68.6) | 33 (31.4) | |
| Gender | ||||
| Female | 182 (78.8) | 141 (77.5) | 41 (22.5) | 0.488 |
| Male | 49 (21.2) | 35 (71.4) | 14 (28.6) | |
| Qualification | ||||
| General dentist | 148 (64.1) | 115 (77.7) | 33 (22.3) | 0.576 |
| Specialist | 83 (35.9) | 61 (73.5) | 22 (26.5) | |
| Workplace | ||||
| Government | 37 (16) | 26 (70.3) | 11 (29.7) | 0.369 |
| Private | 172 (74.5) | 135 (78.5) | 37 (21.5) | |
| Both | 22 (9.5) | 15 (68.2) | 7 (31.8) | |
| Work duration | ||||
| < 6 h | 113 (48.9) | 91 (80.5) | 22 (26.9) | 0.173 |
| ≥ 6 h | 118 (51.1) | 85 (72) | 33 (28) | |
| Length of work experience | ||||
| ≤ 5 years | 56 (24.2) | 46 (82.1) | 10 (17.9) | 0.029* |
| 6–10 years | 35 (15.2) | 27 (77.1) | 8 (22.9) | |
| 11–15 years | 41 (17.7) | 37 (90.2) | 4 (9.8) | |
| 16–20 years | 30 (13) | 21 (70) | 9 (30) | |
| ≥ 21 years old | 69 (29.9) | 45 (65.2) | 24 (34.8) | |
| Knowledge | ||||
| Poor | 27 (11.7) | 26 (96.3) | 1 (3.7) | < 0.001* |
| Moderate | 83 (35.9) | 76 (91.6) | 7 (8.4) | |
| Good | 121 (52.4) | 74 (61.2) | 47 (38.8) | |
| Attitude | ||||
| Negative | 31 (13.4) | 28 (90.3) | 3 (9.7) | 0.079 |
| Positive | 200 (86.6) | 148 (74) | 52 (26) | |
Note: Bivariate test: Pearson Chi Square.
p‐value < 0.05.
4. Discussion
Practicing ergonomics behaviour involves applying transdisciplinary knowledge to organise job‐related labour activities. With the goal of providing a safe, healthy and comfortable workplace, ergonomics aims to mitigate health issues and enhance productivity [4]. In dental settings, integrating ergonomic principles not only improves productivity and efficiency but also enhances the comfort of both dentists and patients [1, 5]. As global awareness of oral health grows and demand for dental services increases, oral health care providers face higher workloads, potentially exposing them to workplace hazards arising from improper posture and long working hours during patient care [4]. Despite the benefits, many dentists still facing challenges in implementing ergonomic principles into their daily practice [14].
This study indicated that 52.4% of respondents knew dental ergonomics well, with most answering ‘Yes’ to almost every question. Higher positive score showed in attitude domain, which 86.6% of dentists have positive attitude towards it. Findings from this study similar to Salah et al., where the majority of dentists in the study also had a positive attitude towards dental ergonomics [14]. However, it is important to consider the potential influence of social desirability bias, where respondents may provide answers they believe will be viewed favourably by others [16, 17]. Nevertheless, these findings surpass those of studies conducted in Egypt and India, suggesting potential disparities in knowledge levels attributable to factors like socioeconomic status, cultural background and historical context within geographical differences [14, 18].
Despite the considerably high knowledge and attitude, this study found that 76.2% of dentists had poor dental ergonomics practices. This trend aligns with observations from various countries where dental students and practitioners encounter challenges in applying ergonomic principles in their daily routines. For instance, studies by Salah et al. and El‐Salamy et al. in Egypt reported that 92% and 95.4% of dentists, respectively, having poor dental ergonomics practices [1, 14]. Similarly, research among Brazilian dental students found that 62.1% struggled to adopt ergonomic concepts effectively [5]. Study by Karibasappa et al. [4] among Indian dentists revealed that while they possessed knowledge and positive attitudes, these did not consistently translate into corresponding behaviours or practices.
This study also highlighted a statistically significant relationship between age and dental ergonomics, where the previous findings indicating a decline in practices with increasing age, likeliy attributed to age‐relate declines in cognitive functions [14, 18, 19]. In this study, the majority of dentists in all age groups had poor dental ergonomic practices, with the highest rates shown in the 36–40 age group (90.9%). However, similar to other study, this study showed no relationship between gender and dental ergonomics [1, 14, 20]. This study observed no statistically significant correlation between dentist expertise and dental ergonomics practices; however, in contrast, numerous previous studies have demonstrated a statistically significant association, indicating that dental ergonomics proficiency tends to improve with higher scientific degrees, with specialists exhibiting superior ergonomic practices compared to general dentists, emphasising the critical role of ongoing education, motivation and training in dental ergonomics during and after graduation [14, 21, 22].
In this study, the duration of a dentist's work did not demonstrate a significant impact on dental ergonomics practices; nonetheless, previous research has highlighted that prolonged work hours can contribute to WMSD stemming from poor oral ergonomics [6]. Implementing breaks during extended work periods may prevent musculoskeletal issues, while intervals between patient sessions have been shown to reduce the incidence of these problems [23, 24, 25]. On the other hand, dentists' experience also a statistically significant factor influencing dental ergonomics, aligning with findings from prior studies indicating that practitioners with greater expertise tend to exhibit fewer ergonomic issues, showing the importance of professional experience in promoting ergonomic practices [14, 26].
Despite some inconsistencies with previous study, this study also showed that there was a statistically significant relationship between knowledge and dental ergonomic practice, similar with previous ones [1, 14]. Understanding an issue and possessing the skills to address it can influence individuals behaviour or practice [27, 28]. Generally, individuals with higher knowledge levels are more likely to modify their behaviour accordingly [29]. However, this study found no statistically significant association between the attitude and dental ergonomics practice similar with other studies where most respondents having favourable attitudes yet still inadequate practice [30, 31].
The study has several limitations, such as skewed gender and age ratios, potential reporting/recall bias and the possibility of dishonest responses due to social desirability when using self‐reporting questionnaires. Additionally, due to the cross‐sectional nature of the study, it is not possible to establish causation between the independent and dependent variables. Morover, the use of a non‐probability sampling method limits the generalizability of the findings to the entire population. However, despite these limitations, this study highlight Indonesian dentists' behaviour regarding dental ergonomics, which is crucial as improper practices can lead to illnesses, less productivity, even early retirement. Therefore, providing comprehensive academic training about ergonomics both as dental students and practicing professionals through in continuing education is necessary.
5. Conclusion
A majority of Indonesian dentists (76.2%) show inadequate dental ergonomics practices, with significant correlations observed with age, duration of work experience and knowledge of ergonomic dental practices. Comprehensive education on dental ergonomics is essential for both dentists and dental students to mitigate these risks and promote occupational well‐being.
6. Clinical Relevance
Scientific Rationale for Study: Research shows that dental students and practicing dentists often struggle to effectively implement ergonomic postures, highlighting a gap in studies assessing Indonesian dentists' attitudes, knowledge and practices regarding dental ergonomics.
Principal Findings: Most of Indonesian dentists still lack of ergonomic practices despite their awareness of musculoskeletal disorders and the importance of workplace health.
Practical Implication: Integrating comprehensive training into dental curriculums and continuing education programs will be beneficial both current and future professionals to adopt ergonomic principles effectively to the prevalence of musculoskeletal disorders and enhance overall work satisfaction and productivity within the dental community.
Author Contributions
F.S., H.N., M.A. and R.R.D. supervised the study and contributed to the conception of the study. E.M.H. contributed to the acquisition of data. F.S., E.M.H., S.K. and R.R.D. contributed to the statistical analysis and data interpretation. F.S., E.M.H. and R.R.D. drafted the manuscript. S.K. revised the manuscript critically for important intellectual content and contributed to the drafting and finalising of the manuscript. All authors give final approval of the article.
Ethics Statement
Ethical approval was granted by the Research Ethics Committee of the Faculty of Dentistry, Universitas Indonesia (No: 115 /Ethical Approval /FKGUI/XI/2022). This research was conducted in full accordance with the World Medical Association Declaration of Helsinki. The principal investigator is responsible for ensuring the confidentiality of the study documents and the privacy of all the participants.
Consent
Informed consent was obtained from all participants to participate in this study.
Conflicts of Interest
The authors declare no conflicts of interest.
Acknowledgements
The authors have nothing to report.
Funding: This work was supported by Faculty of Dentistry, Universitas Indonesia.
Data Availability Statement
The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.
References
- 1. El‐sallamy R. M., Atlam S. A., Kabbash I., El‐fatah S. A., and El‐flaky A., “Knowledge, Attitude, and Practice Towards Ergonomics Among Undergraduates of Faculty of Dentistry, Tanta University, Egypt,” Environmental Science and Pollution Research 25, no. 31 (2018): 30793–30801. [DOI] [PubMed] [Google Scholar]
- 2. Gupta G., Gupta A., Mohammed T., and Bansal N., “Ergonomics in Dentistry,” International Journal of Clinical Pediatric Dentistry 7, no. 1 (2014): 30–34. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3. Jahanimoghadam F., Horri A., Hasheminejad N., Hashemi Nejad N., and Baneshi M. R., “Ergonomic Evaluation of Dental Professionals as Determined by Rapid Entire Body Assessment Method in 2014,” Journal of Dentistry 19, no. 2 (2018): 155–158. [PMC free article] [PubMed] [Google Scholar]
- 4. G. N. K. and Rajeshwari K., “Dentists' Knowledge, Attitude and Behavior Towards Dental Ergonomics,” IOSR Journal of Dental and Medical Sciences 13, no. 5 (2014): 86–89. [Google Scholar]
- 5. Garcia P. P. N. S., Gottardello A. C. A., Wajngarten D., Presoto C. D., and Campos J. A. D. B., “Ergonomics in Dentistry: Experiences of the Practice by Dental Students,” European Journal of Dental Education 21, no. 3 (2017): 175–179. [DOI] [PubMed] [Google Scholar]
- 6. Kamal A. M., Ahmed D. R. M., Habib S. F. K., and Al‐Mohareb R. A., “Ergonomics of Preclinical Dental Students and Potential Musculoskeletal Disorders,” Journal of Dental Education 84 (2020): 1438–1446. [DOI] [PubMed] [Google Scholar]
- 7. Lietz J., Ulusoy N., and Nienhaus A., “Prevention of Musculoskeletal Diseases and Pain Among Dental Professionals Through Ergonomic Interventions: A Systematic Literature Review,” International Journal of Environmental Research and Public Health 17, no. 10 (2020): 3482, 10.3390/ijerph17103482. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8. Phedy P. and Gatam L., “Prevalence and Associated Factors of Musculoskeletal Disorders Among Young Dentists in Indonesia,” Malaysian Orthopaedic Journal 10, no. 2 (2016): 1–5. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9. Ohlendorf D., Naser A., Haas Y., et al., “Prevalence of Musculoskeletal Disorders Among Dentists and Dental Students in Germany,” International Journal of Environmental Research and Public Health 17, no. 23 (2020): 1–19. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10. Simmer‐Beck M. and Branson B. G., “An Evidence‐Based Review of Ergonomic Features of Dental Hygiene Instruments,” Work 35, no. 4 (2010): 477–485. [DOI] [PubMed] [Google Scholar]
- 11. de Santana Sampaio Castilho A. V., Michel Crosato E., de Carvalho Sales‐Peres S. H., et al., “Effectiveness of Ergonomic Training to Decrease Awkward Postures During Dental Scaling Procedures: A Randomized Clinical Trial,” International Journal of Environmental Research and Public Health 18, no. 21 (2021): 1–20. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12. Lietz J., Kozak A., and Nienhaus A., “Prevalence and Occupational Risk Factors of Musculoskeletal Diseases and Pain Among Dental Professionals in Western Countries: A Systematic Literature Review and Meta‐Analysis,” PLoS One 13, no. 12 (2018): 1–26. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13. Anu V., Babu A. M. S., and Kumar P. D. M., “Insights About Dental Ergonomics Among Dental Students: The Need of the Hour to Recommend Dental Ergonomics in Academic Curriculum,” Journal of Advanced Oral Research 9, no. 1–2 (2018): 49–54. [Google Scholar]
- 14. Salah D., Khattab N., and Ahmed W., “Dental Ergonomics Knowledge, Practice, and Attitude Assessment of Dentists in Upper Egypt: A Cross‐Sectional Study,” Egyptian Dental Journal 67, no. 2 (2021): 1009–1016. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15. Taherdoost H., “Validity and Reliability of the Research Instrument; How to Test the Validation of a Questionnaire/Survey in a Research,” International Journal of Academic Research in Management (IJARM) 5, no. 3 (2016): 28–36. [Google Scholar]
- 16. Grimm P., “Social Desirability Bias,” in Wiley International Encyclopedia of Marketing, eds. Sheth J. and Malhotra N. (Hoboken, NJ: John Wiley & Sons, 2010). [Google Scholar]
- 17. Althubaiti A., “Information Bias in Health Research: Definition, Pitfalls, and Adjustment Methods,” Journal of Multidisciplinary Healthcare 9 (2016): 211–217. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18. Kalghatgi S., Prasad K. V., Chhabra K. G., Deolia S., and Chhabra C., “Insights Into Ergonomics Among Dental Professionals of a Dental Institute and Private Practitioners in Hubli‐Dharwad Twin Cities, India,” Safety and Health at Work 5, no. 4 (2014): 181–185. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19. Murman D. L., “The Impact of Age on Cognition,” Seminars in Hearing 36, no. 3 (2015): 111–121. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20. De Sio S., Traversini V., Rinaldo F., et al., “Ergonomic Risk and Preventive Measures of Musculoskeletal Disorders in the Dentistry Environment: An Umbrella Review,” PeerJ 6 (2018): e4154. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21. Alyahya F., Algarzaie K., Alsubeh Y., and Khounganian R., “Awareness of Ergonomics & Work‐Related Musculoskeletal Disorders Among Dental Professionals and Students in Riyadh, Saudi Arabia,” Journal of Physical Therapy Science 30, no. 6 (2018): 770–776. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22. Galla A., Chowdhry A., Bagga A., et al., “Dental practitioners' Knowledge, Attitudes, and Practices of Ergonomics – A Cross‐Sectional Web‐Based Survey,” Acta Bio‐Medica 93, no. 1 (2022): 1–7. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23. Bakhsh H. R., Bakhsh H. H., Alotaibi S. M., Abuzaid M. A., Aloumi L. A., and Alorf S. F., “Musculoskeletal Disorder Symptoms in Saudi Allied Dental Professionals: Is There an Underestimation of Related Occupational Risk Factors?,” International Journal of Environmental Research and Public Health 18, no. 19 (2021): 10167. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24. Chaikumarn M., “Working Conditions and Dentists' Attitude Towards Proprioceptive Derivation,” International Journal of Occupational Safety and Ergonomics 10, no. 2 (2004): 137–146. [DOI] [PubMed] [Google Scholar]
- 25. Al Wazzan K. A., Almas K., Al Qahtani M. Q., Al Shethri S. E., and Khan N., “Prevalence of Ocular Injuries, Conjunctivitis and Use of Eye Protection Among Dental Personnel in Riyadh, Saudi Arabia,” International Dental Journal 51, no. 2 (2001): 89–94. [DOI] [PubMed] [Google Scholar]
- 26. Choudhry N. K., Fletcher R. H., and Soumerai S. B., “Systematic Review: The Relationship Between Clinical Experience and Quality of Health Care,” Annals of Internal Medicine 142, no. 4 (2005): 260–273. [DOI] [PubMed] [Google Scholar]
- 27. Liao X., Nguyen T., and Sasaki N., “Use of the Knowledge, Attitude, and Practice (KAP) Model to Examine Sustainable Agriculture in Thailand,” Regional Sustainability 3 (2022): 41–52. [Google Scholar]
- 28. Ibrahim G. B., “Knowledge, Attitude and Practice – The Three Pillars of Excellence and Wisdom: A Place in the Medical Profession,” Eastern Mediterranean Health Journal 1 (1995): 8–16. [Google Scholar]
- 29. Muslih M., Susanti H. D., Rias Y. A., and Chung M. H., “Knowledge, Attitude, and Practice of Indonesian Residents Toward COVID‐19: A Cross‐Sectional Survey,” International Journal of Environmental Research and Public Health 18, no. 9 (2021): 4473. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 30. Kasemy Z. A., Bahbah W. A., Zewain S. K., et al., “Knowledge, Attitude and Practice Toward COVID‐19 Among Egyptians,” Journal of Epidemiology and Global Health 10, no. 4 (2020): 378–385. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 31. Fuady A., Khoe L. C., Azzahra T. B., et al., “Good Knowledge but Poor Practice Toward COVID‐19 Among Indonesian Youth,” Asia‐Pacific Journal of Public Health 33, no. 5 (2021): 605–607. [DOI] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.