Gamifying Dentist Health: A case for gamification against MSD

May 5, 2020 Sonal Chadha

Posture while treating a patient has been the most pressing research of majority of innovations in Dentistry, even then today we are from finding lasting universal solutions for the same. During dentistry procedures, the Dentist ‘s posture is strained, which induces stress injury on the musculoskeletal system. While the prevalence of musculoskeletal conditions varies by age and diagnosis, between 20%–33% of people across the globe live with a painful musculoskeletal condition. The prevalence of MSDs among Indian dentists, from various research studies, is higher. The current study result shows that 92.4% of the dentists reported pain and discomfort in at least one part of their bodies in the past 12 months and 87.1% of the dentists reported joint pain in the past 7 days.

Another study conducted by Indian doctors, reported, in which a total of 206 dentists participated, of which 106 were male, and 100 were female, a prevalence of 81.06% (167 dentists) of which 79 males and 88 females were affected with MSD. 104 dentists were young aged 20–29 years, 41 were 30–39 aged, 11 were above 40–49, and > 50 years suffered from MSDs.

This data suggests that MSD (Musculoskeletal Disease) is the highest prevalent health disorder among dentists.

The main factors associated with any risk assessment are:

Static Positions that may be required (defined as working posture maintained longer than 4 seconds; this applies to slight of non-existent variants around a fixed force level, delivered by muscles and other body structures). It appeared to be the main cause of MSDs described in over 84% of the studies, followed by Repetitive Movements (53.8%)
Duration of the task – A typical treatment in a clinic is for 30 minutes
Awkward postures for dental personnel – To reach difficult parts of the patients’ mouth the doctor is forced to change body posture to suit the treatment needed and this causes new potential areas of concern to occur in the body.
1. Tasks requiring Extended Reach, Bent or twisted Neck and Abducted Arms (drawing out to the side)

TYPES OF MUSCULOSKELETAL DISORDERS

Neck and Shoulder disorders
1. Myofascial Pain Disorder: Pain and tenderness in the neck, shoulders and arm muscles. Painful trigger points upon touch.
2. Cervical Spondylosis: intermittent/chronic neck and shoulder pain or stiffness, headache, arm and neck pain, numbness and tingling.
3. Thoracic outlet syndrome: pain in shoulder, arm of hand, numbness, tingling of fingers, muscle weakness, fatigue, cold arm or hand.
4. Rotary Cuff Tendinitis/Tears: pain and stiffness in the shoulders associated with backward and upward arm movements. Weakness of rotary cuff muscles.
5. Hand and Wrist Disorders:
  - De Quervain’s disease: pain in hand and wrist area when grasping, pinching and twisting.
  - Carpel Tunnel Syndrome: Hand or finger numbness, pain, tingling, burning and clumsiness. Eventual muscle weakness and atrophy. Symptoms often worsen with increased activity.
6. Guyon’s syndrome: feeling of pins and needles in the ring and little finger.
Back Disorders:
1. Herniated Spinal Disc – back and leg numbness, tingling, pain, weakness. Worsens with coughing, sneezing, sitting, driving, being forward.
2. Lower back pain: pain, stiffness in lower spine and surrounding tissues.
3. Sciatica: pain from lower back or hip radiating to buttocks and legs. Leg weakness, numbness or tingling. Possible causes are prolapsed intervertebral disc pressurising the sciatic nerve; worsened with prolonged sitting or excessive bending/lifting.

Control strategies to mitigate the risks associated with such ergonomic hazards include:

ENGINEERING CONTROLS:
1. The better ergonomic design of workstation, chairs, instruments, and equipment to improve efficiency. 61.5% of the studies suggest that the use of modern and ergonomic instrumentation played a key role in preventing MSDs
2. Use support: while sitting and standing, don’t lean forward or stoop in an unsupported posture for prolonged periods. If you are sitting, sit up straight or recline slightly in a chair with good back support and use a good footrest off necessary.
3. Change posture: alternate between sitting and standing to reduce postural fatigue and maximize postural variety, which helps to reduce static muscle fatigue.
4. Safe reaching: Keep the items used more frequently within a distance of about 20inches(50cms). Use assistants to help move equipment into this zone.
5. Normal arm posture: keep elbows and upper arms close to the body and don’t raise and tense the shoulders when working.
6. Use comfortable equipment: use equity at isn’t too heavy, that can be used without awkward upper body posture and that feels comfortable to use. Ergonomically designed equipment helps to minimize stresses on the upper extremities and the back.
7. Use of automatic and ultrasonic instruments/ tools wherever possible.
8. Use of indirect vision when treating maxillary teeth.

ADMINISTRATIVE CONTROLS:
- Adjustment of workstation time the patient each time.
- Proper Scheduling of patients in an effort to reduce risk factors.
- Manage time by avoiding long appointments wherever possible, or intersperse these with frequent short rest breaks in which you can change posture and relax the upper extremities.
- Maintainance of all equipment as per manufacturer’s recommendations.

Wazzan al et al in their study, reported that only 37% of those suffering back and neck pain sought medical treatment. These musculoskeletal disorders end up reducing the efficiency of a dentist thus, in a longer run, leading to reducing years from their active work-life

Many developed countries face scarcity of dentists where demand is high but supply is less. In these countries dentists get serious implications on their health due to negligence during administering a dental treatment. The dentists are stretched in their ability to work with patients and musculoskeletal disorders further hamper in the service delivery.

Dentists are appreciated for their skill, hand work and knowledge, and are expected to work on their patients with utmost precision. And the service delivery is critical as they are in direct contact of their patients. Prevention is definitely the best cure for all Musculoskeletal Disorders.

As most of the MSDs can be prevented to a large extent with regular physical movements specific to pressure points, the only thing that seems to be lacking is the willingness and motivation to continue.

The solution could definitely be an IOT based app gamified to reward and push Dentists for achieving goals on their health.

A FRAMEWORK FOR DESIGNING ON THE PRINCIPLES OF GAMIFICATION

Source: https://yukaichou.com/gamification-examples/octalysis-complete-gamification-framework/

In order to drive self-awareness and resolve for self-help, a mobile application that rewards dentists for maintaining schedules of exercise and specific movements based prevention measures between daily routine can go a long way.

This could be an App that can be configured to a dentist’s daily appointment schedule, and the app designs the daily exercise schedule around it. On the one hand the app helps Dentists to organise exercise schedule and on the other hand gamifies the achievement of specific goals.

By gamification we essentially mean adding games based logics and rewards on achievement of specific goals. In this app, whenever a dentist achieves goals (daily/weekly/monthly) the app rewards them with real life commensurate coupons redeemable for essentials and non-essentials.

The app will take care of a dentist’s physical and mental health to enhance on productivity goals and well-being goals.

This app could also be a paired with other devices of friends and other users to drive willingness to participate via shared goals and bigger rewards for groups.

Reward and Push strategy has the greatest potential to build a habit among a community of dentists.

SOURCES:

Sahu, Deepsikha & Tandon, Shourya & Dhingra, Sonal & Chinmaya, BR & Prasad, Sumanth & Bali, Esha & Ghosh, Abhishek. (2015). Prevalence of musculoskeletal disorders among dentists: A pilot cross-sectional survey. Journal of Indian Association of Public Health Dentistry. 13. 307. 10.4103/2319-5932.165281.

British Dental Association (2004).Health and safety law for dental practice, London:BDA

British Dental Association,(2009).Infection control in dentistry, BDA

Gambhir, RS(2011). Occupational health hazards in current Dental Proffession- A review. The open occupational health and safety journal,B

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