Dental students must study in a very challenging setting since the field demands regular patient connection, in-person practice, and both theoretical and clinical expertise. Stress among dental students is a well-documented issue that significantly affects their academic performance, mental health, and overall well-being. They encounter a variety of stressors during their school years, including demanding schedules, high workloads, and the need to balance studying fundamentals with developing technical clinical abilities. Other pressures, such managing patients, taking responsibility for patient care, and having trouble learning manual skills, surface during the clinical period. This review explores the prevalence, sources, and consequences of stress among dental students globally. It also evaluates coping mechanisms and institutional interventions aimed at mitigating stress. A systematic literature search was conducted across PubMed, MEDLINE, PsycINFO, and Cochrane Library for studies published. The findings highlight academic, clinical, and interpersonal stressors, gender differences, and regional variations in stress levels. The review underscores the need for institutional reforms, faculty training, and structured mental health support programs.

Keywords: dental students, mental health, stress

Dental education is widely acknowledged as one of the most demanding academic fields, often leading to high levels of stress among students.^1,2 The rigorous curriculum requires students to develop both theoretical knowledge and practical clinical skills while managing patient care under close supervision.^3,4 As a result, stress has become a major concern within dental schools, impacting students' mental and physical well-being.^5,6

Academic pressure remains one of the primary contributors to stress among dental students.^7,8 Heavy coursework, frequent examinations, and performance expectations can overwhelm students, leading to anxiety and burnout.⁹ The transition from preclinical to clinical training presents additional challenges, as students must apply their theoretical knowledge to real patient care while adhering to strict clinical requirements and competency assessments.^10,11

Furthermore, interpersonal relationships with peers and faculty play a crucial role in stress levels among dental students.^12,13 Peer competition, faculty expectations, and communication challenges can contribute to stress and anxiety.^14,15 Studies indicate that female dental students generally report higher stress levels than their male counterparts, possibly due to gender-specific societal pressures and emotional sensitivity.^16,17

The consequences of chronic stress among dental students are significant. Studies suggest that prolonged stress can lead to burnout, depression, and decreased academic performance.⁴ Additionally, stress has been associated with physical symptoms such as headaches, musculoskeletal pain, and gastrointestinal issues.^5,6 If not managed effectively, stress may also impact professional competence, leading to long-term career dissatisfaction and reduced patient care quality.^10,11

Recognizing the detrimental effects of stress on dental students, many institutions have introduced stress management programs and institutional reforms aimed at alleviating stress.^1,4 These include mindfulness training, faculty mentorship programs, and peer support networks.¹⁸ However, the effectiveness of these interventions remains an area of active research, with mixed findings regarding their long-term benefits.¹⁹

This systematic review aims to comprehensively analyze the sources, effects, and coping mechanisms of stress among dental students, based on existing literature. It also explores institutional interventions that may help reduce stress and promote student well-being.

This review included studies published in peer-reviewed journals from 2010 to 2024. This review included research articles, systematic reviews, and meta-analyses focusing on stress among undergraduate dental students. Studies employing validated stress assessment tools, such as the Dental Environment Stress (DES) questionnaire, Perceived Stress Scale (PSS), General Health Questionnaire (GHQ), and Depression, Anxiety, and Stress Scale (DASS-21). Studies conducted in various geographical regions to ensure diverse representation.

The review excluded studies focusing on practicing professionals, Non-empirical articles (e.g., editorials, commentaries, and opinion pieces) and studies evaluating stress in non-dental health professions.

Search strategy

A systematic literature search was conducted in PubMed, MEDLINE, PsycINFO, and Cochrane Library. The following keywords and Boolean operators were used “Dental students” AND “Stress”, “Dental education” AND “mental health” and “Stress assessment” AND “dental training”.

Study selection

The study selection included Title and abstract screening by two independent reviewers. This was followed by Full-text review of eligible studies and then Quality assessment using the Newcastle-Ottawa Scale (NOS). Studies scoring 7 or more on NOS were considered high quality, while those scoring 5–6 were rated moderate quality. Studies with scores below 5 were excluded.

The systematic review included studies from diverse geographic regions. The prevalence of stress among dental students ranged from 60% to 90%, with variations based on gender, academic year, and institutional curriculum.

Prevalence of stress

Higher prevalence in final-year students compared to first-year students, likely due to clinical workload and licensing examination pressure. Some studies have shown that female students might have higher stress levels than male students which could be attributed to females being more emotionally sensitive. Students in private institutions exhibited more financial stress than those in public institutions due to higher tuition fees and living expenses.

Primary stressors identified

The Primary Stressors Identified were Academic Stressors: Heavy coursework, frequent exams, lack of study time, and pressure to perform, Clinical Stressors: Managing real patients, meeting competency requirements, and supervisor pressure and Interpersonal Stressors: Peer competition, faculty relationships, and financial burdens.

Psychological and physiological impact

Increased anxiety and depression rates were noted among students with persistent high stress levels, leading to emotional exhaustion and burnout. Physical manifestations of stress included headaches, insomnia, gastrointestinal issues, and musculoskeletal pain, especially in students handling complex clinical cases. Burnout syndrome prevalence was highest in final-year students, significantly impacting their motivation and career aspirations.

Coping strategies among students

Effective coping mechanisms included time management, exercise, meditation, and seeking peer or faculty support. Maladaptive coping strategies such as substance use (caffeine, smoking, alcohol) and avoidance behaviors were noted in some studies, exacerbating stress levels. Institutional Support Initiatives such as peer mentoring, psychological counseling services, and mindfulness-based interventions showed promising results in reducing student stress levels.

Stress among dental students is a multifactorial issue influenced by academic, clinical, and interpersonal stressors.^20,21 Academic workload remains a primary concern, with heavy coursework and frequent exams contributing to heightened stress levels.^22,23 Students often experience performance anxiety, particularly in competitive academic environments where grades significantly impact future career opportunities.²⁴

Dental students' academic performance and the standard of patient care are both impacted by stress and emotional weariness. Furthermore, emotional tiredness and stress can lead to other psychological diseases including depression, which can raise the risk of suicide and cause school dropout.^25-27 Other research on university students' experiences with these kinds of problems has mostly concentrated on confirming the validity of current tools for assessing burnout, emotional weariness, and perceived stress.²⁸

Clinical stressors arise when students transition from preclinical coursework to direct patient care.²⁹ Many students report anxiety over patient interactions, fear of making clinical errors, and pressure from faculty evaluations.^30,31 The demand for technical proficiency, coupled with limited clinical exposure, adds to their stress burden.³²

Interpersonal relationships also play a critical role in student stress levels. Studies indicate that faculty-student interactions can either support or exacerbate stress, depending on the quality of mentorship and feedback.³³

Gender differences have been observed in stress perception, with female students reporting higher stress levels than their male counterparts.³⁴ Female students' propensity and desire to more freely communicate their views and feelings might be the reason for the higher reported stress levels among them. Their reported greater stress levels may be a result of their desire to express oneself, especially when it comes to unpleasant ideas and sentiments.^23,35

As a component of the National Task Force on Mental Health and Well-Being of Medical Students, NMC of India carried out a Pan-India research of medical college students. According to 50.9% of respondents, the family environment is very supportive, 34.6% supportive, and 4.5% unsupportive. Though most students feel supported at home, some students (15.5%) reported feeling academic pressure from their family frequently or regularly, and 30.2% occasionally. Just 1.5% of students think their academic workload is light or very light, but the majority (56.6%) think it is appropriate yet substantial. Twenty-seven percent think it is excessively heavy. 51.6% of undergraduate students agree or strongly agree that their performance is negatively impacted by their fear of failing, making it a significant issue.³⁶

Chronic stress leads to both psychological and physiological consequences. High levels of stress are associated with anxiety, depression, and emotional exhaustion.³⁷ Physical symptoms, such as headaches, insomnia, and gastrointestinal distress, are commonly reported among stressed dental students. Without appropriate intervention, prolonged stress can impact academic performance, clinical efficiency, and overall well-being.³⁸

Fourth-year students have noticeably higher rates of depression. These rates might be a reflection of both academic burden and the uncertainty around future employment and career opportunities.³⁹ The material now in publication, however, offers a binary viewpoint about the scholastic years that are most closely linked to elevated levels of these illnesses. While some study provides conflicting results, other studies propose a single stage of academic life.^40-42

Institutional interventions have been introduced to help students manage stress. These include mindfulness training, faculty mentorship, structured stress management workshops, and peer support programs.¹⁰ Studies have shown that structured stress management programs can significantly reduce anxiety levels and improve student well-being. However, further research is required to assess the long-term effectiveness of these interventions.

Qualitative methods aimed at dentistry students are particularly significant as they often enable the gathering of in-depth information and firsthand accounts of people's experiences.⁴³ Long-term research circumstances can be improved with the use of these insights. Twelve final-year dentistry students were asked about their experiences with a mentorship program that had been put in place at the institution in one qualitative research conducted in Denmark.⁴⁴ Numerous studies have also examined the perceived effects of particular interventions from the viewpoint of the students themselves (e.g., yoga sessions,⁴⁵ a risk-oriented prevention educational concept,⁴⁶ the inclusion of self-care techniques in the curriculum,⁴⁷ mind-body wellness training,⁴⁸ or a stress-reduction technique based on cognitive reappraisal.⁴⁹ For medical studies, there are additional thorough studies that include stressors and student-recommended solutions.^50,51

In addition to revealing stressful domains (performance pressure, workload, and clinical training), a recent mixed methods study offered more thorough insights into dental and endodontic-related stress in undergraduate students. It also revealed suggestions for student improvement (e.g., introducing a patient management team, including more laboratory sessions in the curriculum to practice more, more support with administrative work, or first-year and second-year students helping students in higher semesters to provide more assistance for them and teach students from first semesters practical knowledge early on).⁷

Stress among dental students is a global concern, affecting mental health and professional development. Addressing stress requires curricular reforms, faculty training, and student wellness programs. Future research should focus on longitudinal studies and intervention trials to identify effective stress management strategies.

None.

The authors declare that there are no conflicts of interest.

1. Alzahem AM, van der Molen HT, Alaujan AH, et al. Stress amongst dental students: a systematic review. Eur J Dent Educ. 2011;15(1):8–18.
2. Humphris G, Blinkhorn A, Freeman R, et al. Psychological stress in undergraduate dental students: baseline results from seven European dental schools. Eur J Dent Educ. 2002;6(1):22–29.
3. Khanagar SB, Al–Ehaideb A, Jamleh A, et al. Psychological distress among undergraduate dental students in Saudi Arabia and its coping strategies–a systematic review. Healthcare (Basel). 2021;9(4):429.
4. Peker I, Alkurt MT, Usta MG, et al. The evaluation of perceived sources of stress and stress levels among Turkish dental students. Int Dent J. 2009;59(2):103–111.
5. Silverstein ST, Kritz–Silverstein D. A longitudinal study of stress in first–year dental students. J Dent Educ. 2010;74(8):836–848.
6. Elani HW, Allison PJ, Kumar RA, et al. A systematic review of stress in dental students. J Dent Educ. 2014;78(2):226–242.
7. Rajab LD. Perceived sources of stress among dental students at the University of Jordan. J Dent Educ. 2001;65(3):232–241.
8. Acharya S. Factors affecting stress among Indian dental students. J Dent Educ. 2003;67(10):1140–1148.
9. Veeraboina N, Doshi D, Kulkarni S, et al. Perceived stress and coping strategies among undergraduate dental students- an institutional–based study. Int J Adolesc Med Health. 2020;34(1).
10. Kumar S, Dagli RJ, Mathur A, et al. Perceived sources of stress amongst Indian dental students. Eur J Dent Educ. 2009;13(1):39–45.
11. Polychronopoulou A, Divaris K. Dental students' perceived sources of stress: a multi–country study. J Dent Educ. 2009;73(5):631–639.
12. Turner J, Bartlett D, Andiappan M, et al. Students' perceived stress and perception of barriers to effective study: impact on academic performance in examinations. Br Dent J. 2015;219(9):453–458.
13. Pöhlmann K, Jonas I, Ruf S, et al. Stress, burnout and health in the clinical period of dental education. Eur J Dent Educ. 2005;9(2):78–84.
14. Crego A, Diaz MC, Armfield JM, et al. Stress and academic performance in dental students: the role of coping strategies and examination–related self–efficacy. J Dent Educ. 2016;80(2):165–172.
15. Al–Sowygh ZH. Academic distress, perceived stress and coping strategies among dental students in Saudi Arabia. Saudi Dent J. 2013;25(3):97–105.
16. AlJameel AH, Talakey AA, AlFarhan G, et al. Perceived stress among dental students and the role of parental influence in career decision–making. J Dent Educ. 2024;88(7):910–916.
17. Alhajj MN, Khader Y, Murad AH, et al. Perceived sources of stress amongst dental students: a multicountry study. Eur J Dent Educ. 2018;22(4):258–271.
18. Westerman GH, Grandy TG, Ocanto RA, et al. Perceived sources of stress in the dental school environment. J Dent Educ. 1993;57(3):225–231.
19. Khanal S, Shrestha S. Perceived stress among undergraduate students in a dental college: a descriptive cross–sectional study. JNMA J Nepal Med Assoc. 2021;59(241):892–896.
20. Ravichandra KS, Ravi GR, Kandregula CR, et al. Emotional intelligence among dental undergraduate students: an indispensable and ignored aspect in dentistry. J Int Oral Health. 2015;7(4):69–72.
21. Abu–Ghazaleh SB, Rajab LD, Sonbol HN. Psychological stress among dental students at the University of Jordan. J Dent Educ. 2011;75(8):1107–1114.
22. Gorter R, Freeman R, Hammen S, et al. Psychological stress and health in undergraduate dental students: fifth year outcomes compared with first year baseline results from five European dental schools. Eur J Dent Educ. 2008;12(2):61–68.
23. Mahesh S, Hemalata K, Gupta A. Factors affecting psychological well–being, depression, anxiety, and stress among dental students in Delhi and the national capital region: a cross–sectional study. Cureus. 2024;16(9):e70474.
24. Morse Z, Dravo U. Stress levels of dental students at the Fiji school of medicine. Eur J Dent Educ. 2007;11(2):99–103.
25. Parra PP. Relationship between the level of engagement and theoretical/practical academic performance. J Health Sci Educ. 2010;7(1):57–63.
26. Rosiek A, Kryszewska AR, Leksowski Ł, et al. Chronic stress and suicidal thinking among medical students. Int J Environ Res Public Health. 2016;13(2):212.
27. Montes NS, Subieta LBD. Estre´s acade´mico, desercion y estrategias de retencion de estudiantes en la educacion superior. Rev Salud Publica. 2015;17(2):300–313.
28. Gonzalez RMT, Landero HR. Emotional tiredness scale (ECE) for university students: psychometric properties in a sample from Mexico. Ann Psychol. 2007;23(2):133–140.
29. Sanders AE, Lushington K. Effect of perceived stress on student performance in dental school. J Dent Educ. 2002;66(1):75–81.
30. Divaris K, Mafla AC, Villa–Torres L, et al. Psychological distress and its correlates among dental students: a survey of 17 Colombian dental schools. BMC Med Educ. 2013;13:91.
31. Al–Saleh SA, Al–Madi EM, Al–Angari NS, et al. Survey of perceived stress–inducing problems among dental students, Saudi Arabia. Saudi Dent J. 2010;22(2):83–88.
32. Murphy RJ, Gray SA, Sterling G, et al. A comparative study of professional student stress. J Dent Educ. 2009;73(3):328–337.
33. Thomas M, Bigatti S. Perfectionism, impostor phenomenon, and mental health in medicine: a literature review. Int J Med Educ. 2020;11:201–213.
34. Tangade PS, Mathur A, Gupta R, et al. Assessment of stress level among dental school students: an Indian outlook. Dent Res J (Isfahan). 2011;8(2):95–101.
35. Deng Y, Chang L, Yang M, et al. Gender differences in emotional response: inconsistency between experience and expressivity. PLoS One. 2016;11(6):e0158666.
36. Report of the national task force on mental health and well–being of medical students. 2024.
37. Saeed MHB, Raja UB, Khan Y, et al. Interplay between leadership and patient safety in dentistry: a dental hospital–based cross–sectional study. BMJ Open Qual. 2024;13(Suppl 2):e002376.
38. Deeb GR, Braun S, Carrico C, et al. Burnout, depression and suicidal ideation in dental and dental hygiene students. Eur J Dent Educ. 2018;22(1):e70–e74.
39. Chi T, Cheng L, Zhang Z. Global prevalence and trend of anxiety among graduate students: a systematic review and meta–analysis. Brain Behav. 2023;13(4):e2909.
40. McLean L, Gaul D, Penco R. Perceived social support and stress: a study of 1st year students in Ireland. Int J Ment Health Addict. 2022:1–21.
41. Siripongpan A, Phattaramarut K, Namvichaisirikul N, et al. Prevalence of depression and stress among the first year students in Suranaree university of technology, Thailand. Health Psychol Res. 2022;10(3):35464.
42. Mirza AA, Baig M, Beyari GM, et al. Depression and anxiety among medical students: a brief overview. Adv Med Educ Pract. 2021;12:393–398.
43. Moser A, Korstjens I, Series: practical guidance to qualitative research. Part 1: introduction. Eur J Gen Pract. 2017;23(1):271–273.
44. Moore R, Molsing S, Meyer N, et al. Early clinical experience and mentoring of young dental students–a qualitative study. Dent J (Basel). 2021;9(8):91.
45. Braun SE, Deeb G, Carrico C, et al. Brief yoga intervention for dental and dental hygiene students: a feasibility and acceptability study. J Evid Based Integr Med. 2019;24:2515690X19855303.
46. Schmalz G, Krause F, Grzelkowski M, et al. Evaluation of an educational concept for risk–oriented prevention in undergraduate dental education. BMC Med Educ. 2020;20(1):298.
47. Ehsan F, Iqbal S, Younis MA, et al. An educational intervention to enhance self–care practices among 1st year dental students– a mixed method study design. BMC Med Educ. 2024;24(1):1304.
48. Pastan CD, Matthews H, Monderer L, et al. Mind–body wellness training for clinical predoctoral dental students. J Dent Educ. 2024;88(Suppl 3):1994–1995.
49. Smith A, Scott I, Ratnayake J, et al. An intervention study: does a cognitive reappraisal technique reduce the perceived stress in fourth–year dental students in New Zealand? Int J Dent. 2019;2019:5864591.
50. Kötter T, Pohontsch NJ, Voltmer E. Stressors and starting points for health–promoting interventions in medical school from the students’ perspective: a qualitative study. Perspect Med Educ. 2015;4(3):128–135.
51. Weber J, Skodda S, Muth T, et al. Stressors and resources related to academic studies and improvements suggested by medical students: a qualitative study. BMC Med Educ. 2019;19(1):312.