The precedence and viability of yoga in the lives of D3- Dental Students, Dental Practitioners and Dental Patients

Health desk.  Musculoskeletal disorders are injuries of muscles, ligaments, tendons, nerves, blood vessels, bones and joints, that can result in pain in the neck, shoulder, arm, wrist, hands, upper and lower back, hips, knees and feet. Dentistry is considered to be a high risk profession in terms of acquiring musculoskeletal disorder due to ergonomic factors like uncomfortable and static position with repetitive movements of arms and hands in combination with postural loads of upper back and head , wrong positioning of body, limited body movement, while performing the dental procedures for long duration of time. Moreover, the dental professionals tend to bend their backs, over flex and twist their neck, raise their arms and shoulders in order to gain more visibility and accessibility which can result in overstressing of muscles, ligaments and pressurize the nerve roots, thus resulting in pain. This may dwindle the quality and efficiency of one's practice.

Several studies have reported the incidence of musculoskeletal disorders amongst dental professionals. Hayes M et al reported a prevalence of general musculoskeletal pain ranging between 64%-93% among dentists, dental hygienists and dental students in which back and neck pain were most common for dentists while hand and wrist pain was more prevalent amongst dental hygienist. the prevalence of musculoskeletal pain ranged between 0.5-70%. In a scenario like this, yoga can come to the rescue. Literary evidence indicates the importance of yoga in management of musculoskeletal disorders.

Monson AL et al reported bi-weekly practice of yoga sessions to be beneficial in decreasing musculoskeletal pain in dental hygiene students. Koneru S et al reported prevalence of musculoskeletal pain in dentists to be 34.5%. They also established a significant role of physical activity on the quality and quantity of work-related musculoskeletal disorders, in which yoga was found to be more effective than other modes of physical activities. Deolia SG et al studied the effect of yoga as a therapeutic aid for the treatment of physical hazards among dental interns aged between 21 and 24 years and reported reduction in backaches and headaches, thereby proving its efficacy.  According to a systemic review by McCaffrey et al, yoga intervention was found to be moderately feasible and likely to be equal to or superior to exercise or usual care for reducing pain and pain medication use in various musculoskeletal disorders. Yoga involves asanas (different body postures) and pranayamas (breathing exercises) which helps the mind to focus and achieve relaxation. Yoga improves the body's flexibility, posture, range of motion and function, and also builds muscle strength which reduces strain on the back, neck, shoulders, muscles and joints, thus helping in the management of musculoskeletal disorders.  The varied practised asanas improves blood circulation, increases the spine flexibilty and rejuvenates it, thus reducing the incidence of backache. Thus, practicing yoga on a daily basis can be beneficial for dental professionals and help in maintaining a pain and stress free healthy lifestyle.

Stress and anxiety

Dentistry as a profession is considered to be quite challenging and stressful. Factors like time and scheduling pressure, management of  uncooperative patients, highly technical and intensive nature of work may act as stressors for the dental professionals. Dental education too has been found to be associated with noteworthy amount of stress, wherein stress has been found to increase with the year of study.Various studies have reported factors like gender, year of study, marital status, first choice of admission, financial problems, living arrangement, examinatns and grades, workload, and patients to be the stressors in dental students. This stressful lifestyle could result in a lot of complications in the longer run which would adversely affect one's health. This alarming rise in stress in the dental community needs addressing and timely interventions to maintain the professionals physical, mental and psychological health. The ages old Indian practice of yoga can be effectively used in stress management and boosting the health conditions of an individual. Stress has been found to be inversely proportional to yoga.

Stress related oral health condition

Literary evidence suggests that stressed individuals report poorer oral health. Shankardass K hypothesized two pathways via which chronic stress could result in long term oral disease development. Firstly, stressed individuals tend to cope in unhealthy ways like substance abuse, poor diet which can nurture oral diseases. Secondly, chronic stress could result in dysfunctional physiological systems which in turn would affect the underlying mechanism of disease progression.  Various stress related conditions can affect the oral cavity including aphthous ulcers, myofacial pain dysfunction syndrome (MPDS), oral lichen planus, xerostomia, burning mouth syndrome, bruxism.  Moreover, irregular eating habits could result in gastric refluxes which ultimately would result in dental erosion.  Xerostomia would culminate in halitosis, dental caries and periodontal diseases, all of which affect the quality of life.

Practicing Yoga has been effectively proven to reduce stress levels and induce the sense of calmness in individuals, which could help in management of several stress induced oral conditions. Sharan D et al conducted a pilot study to assess the benefits of yoga in physiotherapists diagnosed with cervical MPDS and reported significant improvement in the quality of health, physical capacity, cervical range of motion and decrease in  the disability and pain.Moreover, breathing techniques of yoga prevent drying of mouth  and throat, which in turn would reduce the incidence of halitosis and dental caries. In addition, yoga asanas like forward bends, twists and  inverted poses have been proven to increase salivary secretion. Singh K et al studied the effect of rhythmic breathing exercises of yoga in maintenance of oral health and gingival bleeding and reported significant reduction in debris, calculus value, oral hygiene and gingival index.

Inflammatory condition

Inflammation can act as a crucial contributing factor for the progression of several diseases like diabetes mellitus, hypertension, insulin resistance syndrome, coronary artery disease, Alzheimers disease, periodontal diseases via pro-inflammatory cytokines like IL-1, 1L-6, IL-8, TNF α, CRP.Moreover, literary evidence suggests chronic inflammation to  influence tumor promotion, survival, proliferation, invasion, angiogenesis, and metastases, and is thus considered a risk factor for most of the cancers including oral cancer.

Shete SU et al studied the effect of yoga training on inflammatory cytokines and C reactive proteins in healthy adults exposed to occupational hazards and reported significant changes in cholesterol, LDL. Yoga can reduce the oxidative stress, pro inflammatory cytokine level and also enhance immunity, which would aid in reduction of chronic gingival and periodontal inflammation, and hence improve the periodontal health.

Orofacial development

Myofunctional therapy, an adjunct used in interceptive orthodontics includes facial and tongue exercises in order to promote proper tongue position, improved breathing, chewing and swallowing. These when used in early formative years can aid in reducing the severity of  malocclusion. Moreover, these exercises can also be used in interception of deleterious habits like thumb sucking, mouth breathing, tongue thrusting, bruxism which could result in or worsen malocclusion. In addition to these, myofunctional therapy also improves proprioception, tone and mobility. Various components of yoga including postures, breathing exercises can be effectively used in myofunctional therapies which would aid in proper orofacial development.

Others

Yoga can also be helpful in management of substance abuse like tobacco, alcohol which can result in morbidity and mortality. Breathing exercises, meditation can help an individual to relax, and thus help in control the urges.According to a review published by Jha RK et al, alternate nostril breathing can result in immediate reduction in strength of urges to smoke. Moreover, it also increases the mental and physical strength, both of which are required to manage the withdrawal symptoms.   

Yoga helps in relaxation, which will help in reducing the anxiety of patients, and thus make them more co operative. Kakodhar PV et al reported reduction in anxiety levels of the patients after a 10 minute chair side yoga session before extraction. Similarly, a study by Lovas et al stated that rapid relaxation by focussing on breathing for a period of 2-3 minutes before administering local anaesthesia helped to reduce anxiety and also diminished the amount of anaesthesia required.

Conclusion

Yoga can be an effective alternative to combat the various occupational hazards associated with the profession of dentistry and it also has been proven to be beneficial for a variety of oral health related conditions. Moreover, it also has a positive effect on psychological stress. An added advantage of practicing yoga is the fact that it is not meticulous and painstaking, and can be easily done in small sessions. Hence, practicing yoga everyday for a small period of time would undo the damage caused by the strenuous lifestyle, rejuvenate an individual and hence provide a holistic approach to life.