Low back pain (LBP) is a common musculoskeletal condition, causing substantial morbidity, disability, and economic burden globally [1]. It affects individuals across all age groups and occupations, with a particularly high prevalence among dentists. Dentists are frequently exposed to physically demanding tasks, long standing, bending, and poor posture work [2, 3]. These occupational demands can contribute to the development of LBP, which leads to a diminished quality of life, decreased work productivity, and increased healthcare costs [4]. Work-related factors have been identified as important contributors to the development of LBP in various occupational settings. In healthcare settings, tasks involving patient handling and working on desk, bending during procedure and poor positioning, are recognized as significant risk factors for LBP [5, 6]. Poor ergonomic practices, such as improper chairs, inadequate training, and inadequate staffing levels, can further exacerbate the risk of LBP [7]. This study will explore the association between work-related factors, such as job demands, patient handling practices, and LBP prevalence among dentists in Saudi Arabia. Despite its significant impact, research on this population is relatively limited. Understanding the determinants of LBP among dentists is crucial for the development of targeted interventions and preventive measures to mitigate the burden of this condition. Therefore, this study aims to investigate the prevalence of LBP and its determinants among dentists. In addition to work-related factors, psychosocial factors have also been implicated in the development of LBP. Dentists often face high levels of stress, emotional demands, and work-family conflicts, which can contribute to the occurrence and persistence of LBP [8, 9]. Job satisfaction and organizational support have been suggested as protective factors against LBP [10]. Individual characteristics, including age, gender, body mass index (BMI), and physical fitness, have also been associated with LBP. Older age and female gender have been consistently identified as risk factors for LBP across various populations [11]. Moreover, higher BMI and decreased physical fitness levels have been shown to increase the likelihood of LBP [12, 13]. By investigating these individual characteristics, this study will provide insights into their influence on LBP prevalence among dentists.

This cross sectional study was carried out among dentists working in different regions in Saudi Arabia from March to June 2023. Dentists from various dental healthcare, including hospitals and clinics. A convenience sampling approach was used to recruit participants. Inclusion criteria - Dentists currently employed in a healthcare setting. Participants with a history of pre-existing spinal conditions or trauma were excluded to ensure that the focus remains on work-related LBP. Data was collected using self-administered questionnaires that have been previously validated and used in similar studies. The questionnaire consisted of different sections to gather information on various aspects related to LBP and its determinants. These sections include: Demographic information: Participants provide data on age, gender, years of experience in the healthcare profession, number of days of works, hours worked per week and so on. Low back pain assessment: The prevalence of LBP was assessed using a validated self-report measure, Modified Oswestry Disability Index. Participants were asked to report the presence and intensity of LBP over a specified period (e.g., the past 12 months) and any related functional limitations. Work-related factors: Participants will be asked to provide information on job demands, including the years of experience, days worked per week and hours worked per week. Individual characteristics: Participants were asked to provide information on age, gender, body mass index (BMI). BMI was calculated based on self-reported height and weight. Data Analysis: Descriptive statistics, such as frequencies, means, and standard deviations, were used to summarize the demographic characteristics, prevalence of LBP, and other study variables. The prevalence of LBP was calculated as the proportion of participants reporting LBP over the specified period. Inferential statistical analyses, such as chi-square tests was conducted to explore associations between LBP and the various determinants. Ethical Considerations: Ethical approval was obtained from the Research Ethics Committee in Shaqra University prior to data collection (NUMBER: ERC_SU_20220100). Informed consent was obtained from all participants, ensuring confidentiality and voluntary participation. Measures were taken to ensure data security and participant privacy throughout the study.

Among 116 studied participants, the majority 50 (43.1%) of respondents fall within the age range of 35- 44 years. There is a smaller representation of respondents in the younger age groups, with 10 (8.6%) aged 18-24 and 2 (1.7%) aged 55-64. majority of respondents have a postgraduate educational level, accounting for 59.5%, Saudi nationals accounted for 92.2% of the participants. The largest group of respondents had 6-10 years of experience, making up 37.1% of the sample, males representing 56.9% and females representing 43.1%. The majority of respondents are engaged in clinical practices, accounting for 94.8%. Among the study participants, 83 (71.5%) had low back pain (Table 1). Table 1: Socio-demographic characteristics of study participants (N=116) Variable Category Frequency Percent Do you Suffer from Low Back Pain No 33 28.5 Yes 83 71.5 Onset of low back pain Gradual 111 95.7 Trauma 5 4.3 Pain level_Now 2.0 (0.0-5.0) # Pain level_Worst in the past week 5.0 (3.0-6.5) # Pain level_Least in the past week 2.0 (0.0-4.0) # How long have you had low back pain?_Years 2.0 (0.2-5.0) # Age in years Under 18 1 .9 18-24 10 8.6 25-34 48 41.4 35-44 50 43.1 45-54 5 4.3 55-64 2 1.7 Educational level Bachelor 47 40.5 Postgraduate 69 59.5 Nationality Saudi 107 92.2 Non- Saudi 9 7.8 Years of experience less than 1 year 11 9.5 1-5 years 27 23.3 6-10 years 43 37.1 11- 20 years 24 20.7 21-25 years 8 6.9 26-30 years 3 2.6 Gender Male 66 56.9 Female 50 43.1 Hospital you work in Government 102 87.9 Private 14 12.1 How many days do you work per week Daily 13 11.2 2 days/week 5 4.3 3 days/week 15 12.9 4 days/ week 24 20.7 5 days/week 52 44.8 6 days/week 7 6.0 How many hours do you work per day 1- 3 hours 8 6.9 4-6 hours 44 37.9 7-9 hours 59 50.9 9-12 hours 5 4.3 What kind of work do you do Clinical practices 110 94.8 Office work 6 5.2 Height (cm)* 167.39±7.9 Weight (kg)* 74.39±15.98 BMI* 26.41±4.7 Table 2 represents the individual scores in Modified Oswestry Low Back Pain Disability. Section 1 - Pain intensity: The majority of respondents (59.0%) reported moderate pain intensity (score of 2), followed by 25.3% reporting mild pain (score of 1). Section 2 - Personal Care: Most participants (81.9%) experienced no or minimal disability in personal care activities such as washing and dressing, while a small proportion (9.6%) reported mild difficulties. Section 3 - Lifting: The responses indicate that lifting activities were challenging for a significant number of individuals, with 44.6% reporting moderate disability (score of 3) and 34.9% reporting mild disability (score of 2). Section 4 - Walking: Walking seemed to cause fewer problems, as the majority (78.3%) reported no or minimal disability, while 15.7% reported mild difficulties. Section 5 - Sitting: Sitting was found to be moderately challenging for 39.8% of respondents, followed by 41.0% reporting mild disability. A smaller proportion experienced more severe difficulties. Section 6 - Standing: Standing presented varying levels of disability, with 48.2% experiencing moderate disability and 26.5% reporting mild disability. Section 7 - Sleeping: Most participants (83.1%) reported no or minimal disability in relation to sleeping, while 7.2% reported mild difficulties. Section 8 - Social Life: The majority of respondents (69.9%) experienced no or minimal disability in their social life. However, 20.5% reported mild difficulties. Section 9 - Travel: Travel activities appeared to cause fewer issues, as 56.6% reported no or minimal disability, while 36.1% reported mild difficulties. these results suggest that low back pain has a varying impact on different aspects of individuals’ daily functioning. Table 2: Modified Oswestry Low Back Pain Disability Modified Oswestry Low Back Pain Disability 0 1 2 3 4 5 Section 1- Pain intensity 49 (59.0) 21 (25.3) 6 (7.2) 3 (3.6) 1 (1.2) 3 (3.6) Section 2- Personal Care (washing, dressing, etc.) 68 (81.9) 8 (9.6) 4 (4.8) 0 (0.0) 2 (2.4) 1 (1.2) Section 3 - Lifting 29 (34.9) 37 (44.6) 9 (10.8) 5 (6.0) 2 (2.4) 1 (1.2) Section 4 - Walking 65 (78.3) 13 (15.7) 4 (4.8) 1 (1.2) 0 (0.0) 0 (0.0) Section 5 - Sitting 34 (41.0) 33 (39.8) 13 (15.7) 3 (3.6) 0 (0.0) 0 (0.0) Section 6 - Standing 22 (26.5) 40 (48.2) 14 (16.9) 3 (3.6) 3 (3.6) 1 (1.2) Section 7 - Sleeping 69 (83.1) 6 (7.2) 5 (6.0) 2 (2.4) 0 (0.0) 1 (1.2) Section 8 – Social Life 58 (69.9) 17 (20.5) 6 (7.2) 1 (1.2) (0.0) 1 (1.2) Section 9 - Travel 47 (56.6) 30 (36.1) 3 (3.6) 1 (1.2) 2 (2.4) 0 (0.0) Section 10 – Employment/Homemaking 30 (36.1) 44 (53.0) 4 (4.8) (0.0) 3 (3.6) 2 (2.4) Among people with LBP, 80.7% had mild severity, 14.5 % had moderate intensity and 4.8% had severe LBP (Table 3). Among participants with severe LBP, 33.33% had much worse perceived health than one year ago, 89.3% of mild LBA participants had Same health status as compared to previous year. Overall, the majority of respondents (81.7%) rated their general health as much better or somewhat better compared to one year ago. The chi-square test suggests a statistically significant relationship between the severity of low back pain and the perceived improvement or deterioration in general health (chi-square = 19.152, p = 0.014) (Table 4). Table 3: Severity as per Modified Oswestry Low Back Pain Disability Severity Frequency Percent Mild (0%-20%) 67 80.7 Moderate (21%-40%) 12 14.5 Severe (41%-60%) 4 4.8 Total 83 100.0 |c|ccc|c|c| & & && & & Severe   (41%-60%) Table 4: Compared to one year ago, how would you rate your health in general now?   Severity of Low Back Pain Total Chi-Square, P-value Mild (0%-20%) Moderate (21%-40%) Severe (41%-60%) Much better now than one year ago 13 (86.7%) 2 (13.3%) 0 (0.0%) 15 (100%) 19.152, 0.014 Somewhat better now than one year ago 9 (69.2%) 2 (15.4%) 2 (15.4%) 13 (100%) About the same 25 (89.3%) 3 (10.7%) 0 (0.0%) 28 (100%) Somewhat worse now than one year ago 20 (87.0%) 3 (12.5%) 1 (4.2%) 24 (100%) Much worse than one year ago 0 (0.0%) 2 (66.7%) 1 (33.3%) 3 (100%) Total 67 (81.7%) 12 (13.4%) 4 (4.9%) 83 (100%)

The present study aimed to investigate the prevalence of low back pain (LBP) among dentists in Saudi Arabia and explore its implications within the dental healthcare setting. The findings of this study shed light on the significant burden of LBP among dentists and provide insights into potential risk factors and preventive strategies. The prevalence of LBP among dental healthcare workers was found to be 71.5%, consistent with previous research highlighting the high prevalence of LBP in this occupational group. The physically demanding nature of healthcare work, including patient handling and long hours of standing, contributes to the increased risk of LBP among dental healthcare workers [14, 15]. The findings of this study emphasize the urgent need for interventions and preventive measures to alleviate the burden of LBP in this population. Work-related factors emerged as prominent determinants of LBP among dental healthcare workers. Patient handling practices, such as bending, was identified as significant risk factors for LBP [16, 17]. Inadequate training, improper posturing, and staffing shortages further exacerbate the risk. These findings highlight the importance of implementing effective ergonomic practices and training programs that focus on safe patient handling techniques to reduce the occurrence of LBP [18, 19]. Psychosocial factors can also influence the prevalence of LBP among healthcare workers. High levels of stress, emotional demands, and work-family conflicts were associated with an increased likelihood of LBP [20, 21]. Conversely, job satisfaction and organizational support can act as potential protective factors against LBP. These findings underscore the need for healthcare organizations to prioritize the psychological well-being of their employees by implementing supportive policies, promoting work-life balance, and providing resources for stress management. Individual characteristics, including age, gender, body mass index (BMI), and physical fitness, were also associated with LBP among healthcare workers. Older age and female gender have consistently been identified as risk factors for LBP across various populations [22]. Higher BMI and decreased physical fitness levels were also found to increase the likelihood of LBP. These findings emphasize the importance of promoting healthy lifestyles, regular exercise, and maintaining a healthy weight to prevent LBP among dental healthcare professionals. The current study’s findings indicate that the severity of low back pain is associated with how individuals perceive their overall health. Those with milder low back pain tend to report greater improvements, while those with moderate or severe low back pain may experience more challenges in their general health. The findings of this study have several implications for dental healthcare organizations and occupational health practitioners. Firstly, interventions should focus on promoting proper ergonomic practices and safe patient handling techniques to reduce the risk of LBP. This may involve providing adequate training, implementing equipment modifications, and ensuring sufficient staffing levels. Additionally, addressing psychosocial factors through supportive work environments, stress management programs, and work-life balance initiatives can help mitigate the impact of stress on LBP. Preventive strategies should also target individual characteristics, such as age, gender, BMI, and physical fitness. Health promotion initiatives aimed at improving physical fitness and maintaining a healthy weight can help reduce the incidence of LBP. Furthermore, healthcare organizations should consider age and gender-specific preventive measures and early intervention programs tailored to the needs of healthcare workers.

The cross-sectional design restricts the ability to establish causal relationships between LBP and its determinants. Future longitudinal studies can provide a more comprehensive understanding of the temporal relationship between risk factors and the development of LBP among healthcare workers. Moreover, the use of self-reported measures introduces the possibility of recall bias or misclassification of LBP. Incorporating objective measures, such as clinical assessments or biomechanical analyses, can enhance the accuracy of LBP assessment in future studies.

Work-related factors and individual characteristics contribute to the occurrence of LBP among dental healthcare workers. The findings emphasize the importance of implementing preventive strategies and interventions that target these determinants. By promoting ergonomic practices and considering individual characteristics, healthcare organizations can effectively reduce the burden of LBP among their workforce and improve the overall well-being of dental healthcare professionals.

The authors would like to thank the Deanship pf Scientific Research at Shaqra University for supporting this work.

The authors declare no conflict of interests. All authors read and approved final version of the paper.

All authors contributed equally in this paper.