Sir, I read with interest the article by Vijay and Ide1 which highlights how the well-recognised issues with musculoskeletal disorders (MSDs) in dentists are also demonstrated in dental students.

As a practising dentist for over 20 years, I understand that dentistry is a uniquely challenging profession.

When I retrained as an osteopath in the 1990s, there was a clear understanding that good working habits should be instilled from the beginning of the course. These principles were emphasised by every member of staff from day one in order to reduce physical stress when treating patients and to reduce the risk of MSDs both in the short and in the long term.

Indeed 25% of the marks at every clinical technique assessment were allocated to the category of 'care of self'. This meant there was an inducement to keeping your own back, shoulders, wrists etc in the best possible position, rather than focussing solely on the end point of the clinical technique. I wonder if this concept could be applied to dental students?

However, the stresses involved in dentistry are not purely physical. Good posture cannot be the sole focus.

The modern approach to back pain in any population is to take a biopsychosocial approach, with attention paid to understanding and managing stress. This is essential in dentistry where the emotional demands are high. It is noted in the title of Myers' paper on stress and health in the general dental practitioner, 'It's difficult being a dentist'.2

Another important factor is physical conditioning. Evidence is accumulating about the positive benefits of exercise and physical activity on many aspects of health, including mental health.

The specific benefits of exercise in reducing back pain have been shown by many studies, including the one cited by Peros et al.3 which showed that dental students who exercised more regularly had significantly less back pain.

In conclusion, may I suggest a positive, proactive and holistic approach is adopted with the emphasis on the health and wellbeing of the individual, from the early stages of dental school and continued throughout working life? The aim would be to help to enjoy long and fulfilling careers.