/home/opencode/cpanel/stomaeduj_hacked/uploads/2017/06/SEJ_2-2017_Articol_Bojinov.pdf DENTAL PUBLIC HEALTH PRACTISING SPORTS AMONG DENTISTS IN BULGARIA Original Articles Peter Georgiev Bojinov1a, Krassimira Borissova Yaneva-Ribagina1b*, Yulian Emilov Borisov2c ¹Department of Dental Public Health, Faculty of Dental Medicine, Medical University - Sofia, Sofia, Bulgaria ²DSK Bank PLC, Sofia, Bulgaria a PhD, Assistant Professor b PhD, Professor, Head of Department, Vice-Dean of Academic Affairs c Sociologist, Market Research Analyst Received: May 04, 2016 Revised: May 30, 2016 Accepted: March 25, 2017 Published: April 01, 2017 Academic Editor: Jacques Vanobbergen, MDS, PhD, Professor Em., Professor and Chairman, Gent University, Gent, Belgium Cite this article: Bojinov PG, Yaneva-Ribagina KB, Borisov YE. Sport activity among dentists in Bulgaria. Stoma Edu J. 2017;4(2):140-145. ABSTRACT DOI: 10.25241/stomaeduj.2017.4(2).art.7 Introduction: Musculoskeletal disorders (MSD) are one of the main occupational risk factors for dentists. They are associated with factors such as gender, age, length of service, lifestyle, working ergonomic conditions, sport activity etc. The aim of this study is to determine the spread of practicing sports among dentists in Bulgaria and the impact of some factors (gender, length of service, weekly and daily workload, and health self- assessment) on it. Methodology: The study was conducted by an anonymous survey of 1300 dentists in Bulgaria. The response rate of the survey was 53.84% - 700 questionnaire forms were returned back. The results are processed using statistical analyses – descriptive, graphical, alternative and Ӽ2. Results: The results of our study reveal that a tiny fraction of dentists practiced some sport regularly (12,63%), the most active being those having 11-20 years length of service, while males are a bit more active than females. Practicing sports increases with the increase of the weekly and daily workload and drops with the decrease in own health self-assessment. With the increase of pain, caused by Work Related Musculoskeletal Disorders (WRMSD), practicing sports goes down, the most active remaining those presenting the most recent episodes of pain (for weeks) – 85.7% and moderate intensity. Conclusion: A very small number of dentists practice sports regularly (12.63%). The most active is the group of 11-20 years length of service, men being a bit more active than women. Practicing sports drops down with the decrease in health self-assessment. Practicing sports decreases with the pain intensity increase, the most active being those presenting the most recent episodes of pain (for weeks) – 85.7% and moderate intensity. Keywords: musculoskeletal disorders (MSD), sport activity, health self-assessment, daily and weekly workload. 1. Introduction Another study by S. Sunnel et al. from British The importance of practising sports for the general Columbia reported that 88% of dental hygienists health of each individual is beyond doubt. Even and 61% of the dentists tested different therapies back in the ancient world Aristotle noted „Nothing and approaches for relieving the WRMSD exhausts and destroys the human body more symptoms. The strategies, providing for continued than continued physical inactivity“. The continued relief were: physical exercises (13%); changing state of good general health is a guarantee and their work habits/postures (6%); fewer work days prerequisite for a long professional career. (6%).3 Data from the study of M.D. DeCarvalho et al. A study by Basset dating back to 1983 among 465 among Brazilian dental students showed that 52% Canadian dentists established that 50% exercised practised sports regularly – bodybuilding (20.3%) as prevention of WRMSD and felt its effects.4 and walking/jogging/running (16.7%).1 A study conducted in Poland by J. Szymanska Pursuant to a study conducted in Nepal by B.P in 2002 revealed that 64.6% of the dentists Shrestha et al. about prevalence of WRMSD among undertook some treatment because of MSD. The dentists, only 16.7% asked for medical care, while most popular methods were: physical exercises 36,8% self-treated themselves with medicines, for the back – 41.55%; morning stretch exercising – while 30.9% had regular physical exercises as back 39.27%; flexor-extensor exercises for the backbone pain prevention.2 – 36.99%; swimming – 35.62%; abdominal muscles *Corresponding author: Professor Krassimira Borissova Yaneva-Ribagina, PhD, Head of Department of Dental Public Health, Vice-Dean of Academic Affairs, Faculty of Dental Medicine, Medical University - Sofia Blvd. G. Sofia no. 1,1431 Sofia, Bulgaria, Tel/Fax: (+3592) 954 2730, e-mail: ribagina@hotmail.com 140 Stoma Edu J. 2017;4(2): 140-145 http://www.stomaeduj.com PRACTISING SPORTS AMONG DENTISTS IN BULGARIA exercises – 35.16%; shoulder area exercises – specific factors, causing MSD. The major share of Original Articles 31.05%; relaxing practices – 17.81%; jogging – dentists, participating in the study, is as follows: 10.05%; fitness – 7.76%.5 general practitioners (58.03%), followed by the A study conducted in Yemen among dentists with group, practicing mostly conservative dentistry musculoskeletal disorders identified that only (12.49%) and prosthetic dentistry (10.29%). 16.7% asked for medical care. As to the physical Comparatively lower is the share of those exercises in case of back pains 30.9% reported practicing specific narrow specialties such as: that they practice regularly, 51.5% didn’t have any oral surgery (7.40%), pediatric dentistry (6.47%), exercising, while 17.6% did not give an answer.6 periodontology (3.12%) and the smallest share is The study by P. Dajpratham found out that key that of orthodontics (2.20%). methods of pain management were traditional massages (51.9%), drug therapy (28.5%), 3. Results physiotherapy (15.8%), acupuncture (7.6%) and 3.1. Dependency between gender, length of alternative medicine (4.4%).7 service and practicing sports The cross-sectional study among 1808 healthcare Just a small fraction of 12.63% (88 individuals) workers in Belo Horizonte, Minas Gerais State, responded to exercise regularly. The bulk group Brazil showed the high prevalence of WRMSD exercises occasionally (not regularly) – 52.80% (49.9%) and their association with many factors, (368), while another large group does not exercise including practising sports less than twice a week.8 at all – 34.57% (Fig. 1). A questionnaire survey about musculoskeletal discomfort, completed by 329 employees in the Public Dental Services of Hordaland proved that practising sports was negatively associated with discomfort in the lower back.9 The aim of this study is to establish the spread of practicing sports among dentists in Bulgaria and the impact of some factors, such as gender, length of service, weekly and daily workload, health self- assessment on it. 2. Methodology 2.1. Study objectives include: Figure 1. Practicing sports among dentists. 1. Outlining the spread of practicing sports among dentists in Bulgaria. 2. Determining the dependence of practicing We explored the relationship between gender and sports on some socio-demographic factors (age practicing sports (Fig.2). and gender) and factors, characterizing the Most of the respondents reported to go practising, dentists’ activity (weekly, daily workload), intensity but not on daily basis. of MSD pain as well as health self-assessment. Generally practicing sports among males is 2.2. Study material and methods higher compared to females. 14.69% of the male The information needed for the purposes of the respondents exercised every day, while 57.96% - study was gathered by distributing and collecting occasionally. filled in questionnaires between October 11.46% of all female respondents practiced on a 2012-April 2013. We developed the survey daily basis, and 50.34% - occasionally. questionnaire specifically for this study. The survey was conducted with the support of the Bulgarian Dental Association (BDA) and the regional bodies in Sofia, Pleven, Shumen, Varna, and Vratza. A total of 1300 questionnaires were prepared and disseminated, out of which we got back 700 (return rate – 53.84%). They comprised 27 close questions (fixed answers) on paper, each having a unique entry code. The age groups covered by the study are almost equally represented, except for the 66+ age group: 25-35 age group – 163 participants (23.35%), 36-45 - 171 individuals (24.50%), the 46-55 age group is the most numerous - 196 individuals (28.08%), 56-65 age group - 139 (19.91%), and Figure 2. Gender relevant practicing sports breakdown. the least represented age group of 66+ - only 29 (4.15%) i.e. all age groups were included. The The results indicate statistically significant relative share of dentists having +20-years length dependency between practicing sports and of service is distinctly high (54.33%). It suggests gender. We also focused on length of service more representative data on the impact of dental- impact on practicing sports (Table 1). Stomatology Edu Journal 141 PRACTISING SPORTS AMONG DENTISTS IN BULGARIA Original Articles Table 1. Dependency between length of service and practicing sports among dentists. N=689 p<0,05 The results indicate a statistically significant 3.2. Dependency between weekly, daily workload dependency between length of service and and practicing sports practicing sports by the respondents. We also focused on the dentists weekly and daily With the increase of length of service the relative workload related to practicing sports (Tables 2, 3). share of those actively exercising drops. The Among the respondents having up to a 3-day highest level of practicing sports is reported weekly workload practicing sports goes up to among the age group 36-45 having 11-20 years 54.84%, while for those with a 5-day workload length of service (77.92%) (Fig. 3). the figure is 65.16%, while for those with a +5-day weekly workload group this figure is 68.42%. In all the three groups of daily and hourly workload practicing sports exceeds 50%. In case of a daily workload of less than 4 hours this activity is 55.74%, 4-8 hours of workload reports 66.35%, while this figure for those having over 8 hours of workload the figure goes to 66.70%. The results indicate a lack of a statistically significant dependency between weekly and daily workload and practicing sports by the dentists. 3.3. Dependency between health self-assessment and practising sports The relationship between health self-assessment and practicing sports is also of interest (Table 4, Fig. 4). In case of poorer health self-assess- Figure 3. Practicing sports trend based on length of service ment practicing sports decreases. 78.44% Table 2. Dependency between the dentists weekly workload (in workdays) and practicing sports. N=695 p>0,05 Table 3. Dependency between the dentists daily workload (in hours) and practicing sports. N=695 p>0,05 142 Stoma Edu J. 2017;4(2): 140-145 http://www.stomaeduj.com PRACTISING SPORTS AMONG DENTISTS IN BULGARIA of respondents, self-assessing their health The data in Table 5 reveal that out of about 2/3 Original Articles as “excellent” practice sports regularly and (567) of the surveyed dentists, reporting the occasionally, as 54.03% of these self-assessing presence of MSD provoked pain, 11.29% practice their health as “satisfactory” practice sports. 66.8% sports on daily basis, and 54.67% - occasionally (a of respondents, self-assessing their health as “very total of 65.96%). good” and “good” practice sports. This makes It gives us grounds to assume that the presence us assume that practicing sports by the dentists of pain motivates dentists to engage in practicing depends on their good health self-assessment. sports. The results indicate a statistically significant The results indicate a lack of a statistically significant dependency between health self-assessment and dependency between the presence of MSD type practicing sports by the dentists. pain and practicing sports by the dentists. 3.4. Dependency between practicing sports and To support this statement we focused on the muscle-skeletal pain dependency between practicing sports and the We also explored the association between pain intensity self-assessment (Table 6). Our data practicing sports and the presence of MSD-pain reveal that those who most actively practice some (Table 5.) The largest groups, having provided sport are those experiencing moderate (64.06%) answers to both questions, covers 310 respondents and mild pain intensity (34.37%). In the group (from a total of 692), who experience pain due to exercising “occasionally“ once again the most MSD but also practice sports “occasionally“. active are those experiencing moderate (69.25%) Table 4. Dependency between health self-assessment and practicing sports by dentists. N=693 p<0,05 Figure 4. Trends in practicing sports referenced to dentistv health self-assessment Table 5. Dependency between practicing sports and the presence of MSD type of pain. N=692 p>0,05 Stomatology Edu Journal 143 PRACTISING SPORTS AMONG DENTISTS IN BULGARIA Original Articles Table 6. Dependency between practicing sports and the dentists’ pain intensity self-assessment. N=567 Note: Sum total of all percentages may exceed 100, as some of the respondents have marked more than one response; the total number is based of the number of respondents. Table 7. Dependency between the dentists’ practicing sports and the duration of MSD provoked pain. N=562 p>0,05 and mild pain (23.62%). 50.2% practiced sports regularly (20.3% body Gradually, with the increase of the pain intensity building and 16.7% jogging). Our data also show practicing sports is reduced, which means that more active practicing of sports among younger probably strong pain is a barrier to sporting or dentists – with 11-20 years of length of service. We namely due to reduced sports practicing the pains think that pain due to MSD serves as a motivation intensify. to go sporting, yet with the pain intensity increase Our data show no statistically significant practicing sports is reduced, most active being dependence between practicing sports and the those experiencing recent pain (for weeks – pain duration period (Table 7). 85.72%). Practicing sports influenced positively What is interesting in our findings is that the most the health of dentists, decreasing the pain of the active dentists prove to be those experiencing lower back.9 Physical activities less than twice a more recent pain (for weeks - 85,72%). Practicing week were associated with the higher prevalence sports is lower in the groups experiencing the MSD of MSD.8 type of pain for months and years (respectively 68.25% and 63.07%). It indicates that despite 5. Conclusions the lack of statistical significance, it is likely that 1. A very small fraction of the respondent dentists continued chronic pain is a hindrance to practicing practice sports regularly (12.63%). sports by the dentists. 2. The most active is the group of 11-20 years length of service, men being a bit more active than 4. Discussion women. Our study revealed that a small percentage of 3. Practicing sports drops down with the decrease dentists practiced sports regularly (12.6%). The in health self-assessment. more active were the younger dentists (length 4. Despite the lack of statistical significance, the of service group 11–20 years), men being more results showed that practicing sports decreased active than women. Practicing sports dropped with the decrease in health self-assessment. Officially with the pain intensity increase, the most active published data are similar to our findings. The being those with most recent pain (for weeks) – study by J. Szymanska5 conducted in Poland also 85.7% and moderate intensity. indicated a low level of practicing sports– fitness 7.76% and jogging – 10.05%. A significantly higher Acknowledgments level of practicing sports was observed however The authors declare no conflict of interest related among the dental medicine students in Brazil per to this study. There are no conflicts of interest and data reported by M. 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[PubMed] Google Scholar(174) Scopus(72) [PubMed] Google Scholar(44) Scopus(17) Peter Georgiev BOJINOV DMD, PhD, Assistant Professor Department of Dental Public Health Faculty of Dental Medicine Medical University - Sofia Sofia, Bulgaria CV Dr Peter Georgiev Bojinov was born on June 20, 1976 in Sofia. He graduated from the Faculty of Dental Medicine, Medical University - Sofia, Bulgaria in 2000. In 2002 he became an Assistant at the Department of “Social Medicine and Dental Public Health” in the Sofia Faculty of Dental Medicine. In 2005 he obtained a new specialty, namely “Social Medicine and organization of dental health”, and in 2007, another specialty, namely “General Dentistry”. In 2011 he was promoted Assistant Professor. In 2014 he defended his doctoral thesis on the topic: “Musculoskeletal disorders among dentists, associated with dental practice” and was awarded his PhD degree. Questions Work related musculoskeletal disorders among dentists are associated with: qa. Microorganisms in the mouth of patients; qb. Sport activity of dentist; qc. Mercury, monomers of dental plastics and other chemical risk factors of dental practice; qd. Marital status of dentists. Underlain the correct answer: qa. Men are more active than women with sport activities; qb. Older dentists are more active with sport activities than younger; qc. There is no statistical significance between sport activity and length of service; qd. There is statistical dependency between sport activity and daily and weekly workload. In our study the regular sport activity among dentists is: qa. 100%; qb. 12.6%; qc. 77.9%; qd. 50%. The sport activity increases with: qa. Increase of pain intensity; qb. Age; qc. Decrease of pain intensity; qd. Decrease of health self-assessment. Stomatology Edu Journal 145