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A comparison of methods for reducing stress among dental students
Abstract
The University of California at San Francisco School of Dentistry established a wellness program in 1983 with stress management as a primary focus. The results of a comparison of the effectiveness of a newly developed relaxation device with progressive relaxation training is presented. (MLW)
... Five of the selected studies reported intervention programs for stress management and the other two reported prevention programs. 1,5,[18][19][20][21] For six of the seven programs, the authors reported significant effects on stress reduction; however, no significant effect was found in one study. 18 The stress management programs used varied in type, in that there were programs that trained students in specific relaxation strategies or techniques (ie, deep breathing, progressive muscle relaxation, Synchro-Energizer, yoga), 1,18,19,20 other programs that introduced an interpersonal approach to dentistry (ie, faculty advising system, counseling Duplicates excluded 08 ...
... 1,5,[18][19][20][21] For six of the seven programs, the authors reported significant effects on stress reduction; however, no significant effect was found in one study. 18 The stress management programs used varied in type, in that there were programs that trained students in specific relaxation strategies or techniques (ie, deep breathing, progressive muscle relaxation, Synchro-Energizer, yoga), 1,18,19,20 other programs that introduced an interpersonal approach to dentistry (ie, faculty advising system, counseling Duplicates excluded 08 ...
... Full-text articles excluded 07 system, study and test-taking skills program, stress management workshop), 21 and another program using multiple stress management seminars. 7 Outcomes of the stress management programs were measured using multiple measurement tools including the Visual Analog Scale, 18,19 Spielberger State-Trait Anxiety Inventory, 18-20 COPE questionnaire, 18 Dental Environment Stress questionnaire, 1 Expectancy, 7 Stress Knowledge Inventory, 7 Profile of Mood States, 20 Observer Rating Inventory, 20 and Thurstone Temperament Schedule and Stanford Stress questionnaire. 20 The variety of the stress management programs ( Table 1) indicated that there are as yet no gold standards for the duration of such programs or the tools that can be used to assess their outcome. ...
This study compared the effectiveness of stress management programs in dental education by systematic review of the literature. The number of studies concerning stress management programs for dental students is limited compared with studies discussing sources of stress. Several types of programs for stress management have been reported, and differ in their duration, content, and outcomes. Two main strategies have been used to help stressed students, ie, decreasing the number of stressors and increasing the ability to cope with stress. The first strategy includes several components, such as reducing fear of failure and workload pressure due to examinations and requirements. The second strategy includes coping techniques, such as deep breathing exercises. Although positive effects have been reported for most of the programs, these have mainly been evaluated using subjective self-report measures. There is a need for more research to identify the most effective stress management program.
... In the medical literature, few studies have examined stress-management interventions. [16][17][18][19] The objectives of this paper are to evaluate the effect of yoga intervention in reducing medical students' anxiety before and during or immediately or after first internal assessments and improves cognitive performance. ...
... It is established as a sensitive screening test for mild cognitive impairment, dementia, and Alzheimer's disease. The following criteria were considered for scoring appropriate points such as attention and orientation (18), memory (26), fluency (14), language (26), and visuospatial (16). This cognitive questionnaire test was conducted before and after yoga training and the total score achieved by the students were analyzed. ...
Background: The medical students experience a lot of stress, which increase when they appear for internal assessment examination. Yoga as an anxiolytic tool which has been practiced over centuries in India. Aims and Objectives: To assess the efficacy of yoga in increasing the cognitive performance in medical students after practicing it for 6 months. Materials and Methods: A comparative study was conducted in the Department of Physiology, MNR Medical College and Hospital, Sangareddy, Medak District, Telangana, India. A total number of 80 medical students who were ready to undergo their first internal examinations were selected. Students were randomly assigned to four groups and were given a 60-min session on pranayama and suryanamaskar. Group I, Control group, was not underwent any kind of yoga during the study period and were given a lecture on stress reduction, practice of meditation without any yoga instructions, Group II, study Group, who can practice only pranayama, Group III who can practice only suryanamaskar and Group IV practices both pranayama and suryanamaskar. The investigator who was unaware of the groups had taken the Addenbrooke’s Cognitive Examination-Revised questionnaire of the students two times (a) before appearing for internal examination and (b) after immediately appearing for examination and both were compared after 6 months of yoga for their improvement in cognitive functions. Statistical analysis was performed using analyses of variance (ANOVA) by SPSS V.16. Results: The statistical results showed a significant improvement in the Group A compared to Group B (ANOVA; P < 0.001). Conclusions: This study concludes that yogic breathing and yogic postures (suryanamaskar) has a significant effect on the reduction of anxiety level and improvement in cognitive functions of medical students.
... Freeman.R.1985 reported that dental students show difficulty to adhere to these behaviors due to their anxiety[914] which in turns exacerbates patients’ distress during procedures.[15] Schwartz et al.,[16] and Howard et al.,[17] suggested various stress reduction programs for dental students. Malathi and Damodaran[18] studied the effect of yoga on reducing stress in first-year medical students. ...
... Malathi and Damodaran[18] studied the effect of yoga on reducing stress in first-year medical students. In the medical literature, few studies have examined stress-management interventions.[14161719] The objectives of this paper is to evaluate the effect of Yoga intervention in reducing dental students’ anxiety prior to and during a periodontic surgical procedure. ...
The dental students experience a lot of stress, which increase when they perform their first surgical procedure. Yoga as an anxiolytic tool in anxiety reduction has been practiced over centuries in India.
To assess the efficacy of yoga in reducing the state trait anxiety of dental students before their first periodontal surgery performance.
A randomized controlled study using a two-way split plot design (pre-post-test) was conducted in the department of periodontics, Pacific Dental College, Udaipur, India.
One hundred clinical dental students who were ready to perform their first periodontal surgery were selected. Students were randomly assigned to two groups and were given a 60-min session on stress reduction. Group A, yogic intervention group, were instructed to do yoga and their performances were monitored for a period of one week and Group B, control group, were given a lecture on stress reduction without any yoga instructions. The investigator who was unaware of the groups had taken the state trait anxiety score of the students three times a) before assigning them to each group, b) prior to the surgical procedure and c) immediately after the performance of surgery.
Analyses of variance (ANOVA) by SPSS V.16.
The statistical results showed a significant reduction in the VAS and state trait anxiety of Group A compared to Group B (ANOVA; P<0.001).
This study concludes that Yogic breathing has a significant effect on the reduction of state trait anxiety level of dental students.
... Others have found however that final year students show greater anxiety about the future 6,7,21 The reconsideration of the existing educational system towards a more student-centered orientation could facilitate collaborative learning and interpersonal support amongst students, which may have a protective effect against difficulties faced whilst in a dental institution 27 A broad spectrum of intervention studies has evaluated such programmes for dental students, including specific courses, stress-reduction sessions, introduction to behavioural sciences and faculty-incorporated advising systems. Howard 28 et al (1986) stated that although some professionals have viewed stress management interventions as band-aid techniques to the over-whelming problem of faculty-induced stress, such techniques do have a significant impact It can be concluded that the primary sources of stress as perceived by the dental students were examinations, unemployment after graduation, fear of failing the year, lack of time for relaxation and fear of unable to catch up if getting behind the work so there is a need for the establishment of student advisors and counselors combined with a faculty advising system in addition to student-oriented programs in India. Dental schools should adopt strategies for stress management and provide resources to help reduce stress in dental education. ...
... In the Tisdelle study the researchers were targeting general anxiety rather than distress associated with a specific situation, such as the first restorative procedure performed by the student. In another study of dental student stress management, Howard et al. 11 compared two strategies to decrease dental student anxiety: a Synchro-Energizer, goggles with flashing lights and headphones playing rhythmic sounds that reportedly helped the brain relax, and progressive muscle relaxation. Over seven thirty-minute sessions, students in both groups showed decreases in overall anxiety and an increase in overall life satisfaction. ...
Research has demonstrated that dental students experience considerable stress during their training. Students' anxiety is likely to be especially high when they perform their first pediatric restorative procedure. The aims of this study were to provide a description of dental students' level of anxiety and typical coping strategies and to evaluate the use of a distress management intervention for reducing anxiety around their first pediatric restorative procedure. Dental students were randomly assigned to either an Anxiety Management or an Attention Control group. The management group received training on relaxation strategies (i.e., deep breathing, progressive muscle relaxation). The control group attended a lecture on the relation among stress, anxiety, and health. No significant differences were found between group levels of anxiety related to their first pediatric restorative procedure. Information is provided on students' reported level of anxiety and general coping strategies. Limitations of the current study and suggestions for future research are provided.
... Placement of sensors on the scalp allows the measurement of brainwave patterns that reflect the current state of an individual. The best studied brainwave frequencies range from the slower delta frequencies (1)(2)(3)(4), which are associated with deep sleep; to theta frequencies (4)(5)(6)(7)(8), which are associated with light sleep, creativity, and insight; to alpha frequencies (8)(9)(10)(11)(12), which reflect a calm and peaceful yet alert state; to beta frequencies (13)(14)(15)(16)(17)(18)(19)(20)(21), which are associated with a thinking, focusing state; to high beta frequencies (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32), which are associated with intensity or anxiety." Research shows that presentation of a consistent rhythmic stimulus (usually either a pulsating light or a tone) within 8 to 10 Hz causes brainwaves in the occipital lobe, parietal lobe, or temporal cortex to exhibit a frequency-following response that either resonates with the presenting stimulus or shows a ftequency harmonic or a sub-harmonic of a stimulus.''^" ...
Brainwave entrainment (BWE), which uses rhythmic stimuli to alter brainwave frequency and thus brain states, has been investigated and used since the late 1800s, yet many clinicians and scientists are unaware of its existence. We aim to raise awareness and discuss its potential by presenting a systematic review of the literature from peer-reviewed journals on the psychological effects of BWE.
Terms used to describe BWE and psychological outcomes were used to search English language studies from OVID Medline (1950-2007), PsychInfo (1806-2007), and Scopus.
Twenty studies selected satisfied the following criterion: studies needed to use rhythmic stimuli with the aim ofaffecting psychological outcomes. Peer-reviewed experimental and quasi-experimental studies were accepted. Case studies and review articles were excluded. Psychological outcomes were measured using standard assessment methods or as deemed appropriate by peer review.
Other clinical measurements, including electroencephalogram response, galvanic skin response, and neurotransmitter levels were not included.
Psychological outcomes addressed cognition, stress and anxiety, pain relief, headaches or migraines, mood, behavior, and premenstrual syndrome (PMS). Protocols included the use of single, alternating, ascending, or descending frequencies or were determined by the subject, using auditory and/or photic stimulation. Studies examined single session effects and/or longer-term multiple session effects.
Findings to date suggest that BWE is an effective therapeutic tool. People suffering from cognitive functioning deficits, stress, pain, headache/migraines, PMS, and behavioral problems benefited from BWE. However, more controlled trials are needed to test additional protocols with outcomes.
... A broad spectrum of intervention studies has evaluated such programmes for dental students, including specific courses, stress-reduction sessions, introduction to behavioural sciences and faculty-incorporated advising systems. Howard et al. (30) stated that although some professionals have viewed stress management interventions as 'band-aid' techniques to the overwhelming problem of faculty-induced stress, such techniques do have a significant impact. ...
Dental students have to face the additional stress of their studies in addition to the stresses related to dentistry as a profession. Furthermore, increasing stress may result in declining student performance. The aim of the present study was to assess perceived sources of stress amongst dental undergraduate students at a private dental institution in India.
A modified dental environment stress (DES) questionnaire which consisted of 38 questions was used to assess the levels of stress.
The first major stressor for all the students was examination and grades with a mean score of 2.86 (SD 1.06) followed by full working day, receiving criticism from supervisors about academic or clinical work, amount of cheating in dental faculty, rules and regulations of the faculty and fear of unemployment after graduation. Amongst the six highest stressors in each year, at least three were dental faculty related. There was a significant difference in stress perception between genders with a predilection for males. Twelve of the 38 questionnaire items had significant differences across the year groups including clinical DES items.
The primary sources of stress as perceived by nearly 275 students at one private dental school in India were examinations and grades followed by full working day and receiving criticism from supervisors about academic or clinical work. It appears there is a need for the establishment of student advisors and counsellors combined with a faculty advising system in addition to student-oriented programmes.
... In the Tisdelle study the researchers were targeting general anxiety rather than distress associated with a specific situation, such as the first restorative procedure performed by the student. In another study of dental student stress management, Howard et al. 11 compared two strategies to decrease dental student anxiety: a Synchro-Energizer, goggles with flashing lights and headphones playing rhythmic sounds that reportedly helped the brain relax, and progressive muscle relaxation. Over seven thirty-minute sessions, students in both groups showed decreases in overall anxiety and an increase in overall life satisfaction. ...
Relations between general behavior, temperament, and procedure-related behavior and distress were examined in children receiving intramuscular injections before undergoing restorative dental procedures. Younger children are likely to benefit the most from interventions prior to and during dental procedures. Children's anxiety before dental procedures could help identify those at risk of displaying problematic behaviors. General behavior and temperament seem useful at identiying children who may experience greater levels of pain.
... Of the 20 studies reviewed in Huang's article, 9 studies used photic stimulation, 6 studies used auditory stimulation, and only 5 used both auditory and photic stimulation (AVS). Table 1 provides a summary of the five AVS studies (Howard et al. 1986;Joyce and Siever 2000;Morse and Chow 1993;Olmstead 2005;Ossebaard 2000), and two additional AVS studies published after 2007 (Tang et al. 2014;Tang et al. 2015). Among the five studies taken from Huang's review, three aimed to reduce stress in adults and two focused on attention training in children with attention deficit and hyperactivity disorder (ADHD). ...
Audio Visual Stimulation (AVS), a form of neurofeedback, is a non-pharmacological intervention that has been used for both performance enhancement and symptom management. We review the history of AVS, its two sub-types (close- and open-loop), and discuss its clinical implications. We also describe a promising new application of AVS to improve sleep, and potentially decrease pain. AVS research can be traced back to the late 1800s. AVS's efficacy has been demonstrated for both performance enhancement and symptom management. Although AVS is commonly used in clinical settings, there is limited literature evaluating clinical outcomes and mechanisms of action. One of the challenges to AVS research is the lack of standardized terms, which makes systematic review and literature consolidation difficult. Future studies using AVS as an intervention should; (1) use operational definitions that are consistent with the existing literature, such as AVS, Audio-visual Entrainment, or Light and Sound Stimulation, (2) provide a clear rationale for the chosen training frequency modality, (3) use a randomized controlled design, and (4) follow the Consolidated Standards of Reporting Trials and/or related guidelines when disseminating results.
... Procedures for stress reduction consist of different training programs that are intended to reduce stress. Examples hereof are relaxation via Synchro-Energizer, 7 training workshops that include aspects of academic problem solving, 8 deep breathing and Progressive Muscular Relaxation (PMR), 9 and introducing stress-management training over time which is effective in stress reduction and coping. 10 Based on those previous studies we decided to develop a new stress management program for dental students, incorporating elements that have been proved to be useful previously. ...
The dental education stress effects and sources were explored thoroughly in the literature, but the effectiveness of stress management programs received less attention. This study introduced a new stress management program, named Dental Education Stress Management (DESM) program. It showed its effectiveness in a quasi-experimental pretest-posttest-follow-up-control group design. The new program was based on the principle of psychoeducation and consisted of three 90-min sessions, to teach dental students how to better deal with their stress symptoms and to reduce their general stress level. Two instruments were used to assess the level of stress of the dental students, namely the Dental Environment Stress questionnaire (DES), and the Psychological Stress Measure (PSM-9). Results show that the DESM program has the desired effect of decreasing the stress levels of its participants, and these effects lasted for at least two weeks. Because of several methodological limitations of the study more research is needed to draw more generalizable conclusions.
... Others have found however that final year students show greater anxiety about the future 6,7,21 The reconsideration of the existing educational system towards a more student-centered orientation could facilitate collaborative learning and interpersonal support amongst students, which may have a protective effect against difficulties faced whilst in a dental institution 27 A broad spectrum of intervention studies has evaluated such programmes for dental students, including specific courses, stress-reduction sessions, introduction to behavioural sciences and faculty-incorporated advising systems. Howard 28 et al (1986) stated that although some professionals have viewed stress management interventions as band-aid techniques to the over-whelming problem of faculty-induced stress, such techniques do have a significant impact It can be concluded that the primary sources of stress as perceived by the dental students were examinations, unemployment after graduation, fear of failing the year, lack of time for relaxation and fear of unable to catch up if getting behind the work so there is a need for the establishment of student advisors and counselors combined with a faculty advising system in addition to student-oriented programs in India. Dental schools should adopt strategies for stress management and provide resources to help reduce stress in dental education. ...
Introduction:Stress in dental students may be multifactorial, arising from both the academic and socio-cultural environment, and attributable to social support issues. The intensity of the bachelor of dental surgery curriculum requires enormous commitment and hard work by students which may produce stress on them. This study was conducted with an aim to investigate perceived sources of stress among dental students in South India. Methods: A modified version of the Dental Environment Stress questionnaire was used to measure sources of stress. Results: A total of 343 of the 369 registered undergraduate students participated in the study with an overall response rate of 92.9%. Among them, 167 (48.6%) were males and 176 (51.3%) were females. Mean age of the total sample was 20.19 (1.5) years. Examinations were perceived to be the highest sources of stress followed by fear of unemployment after graduation and fear of failing the year. Conclusion: Stress levels were slight to moderate and were higher amongst senior students. Students during clinical training period exhibited higher levels of stress. Overall third years were the most stressed followed by fourth years, second years and first years.
... These were recommended as these are easy to implement, liked by students and can achieve high outcomes with least time consumption and effort. 37,[39][40][41] Alzahem et al introduced a new program named Dental Education Stress Management program (DESM program) to reduce stress among dental students. This program was based on psychoeducation principle and it included three 90-minute sessions. ...
Stress is a response to pressure or threat. Under stress one may feel tense, nervous or on edge. It also creates physical response as it triggers secretion of a hormone called adrenaline that temporarily affects the nervous system. The students of professional courses are more prone to stress because of various stress factors. In this article we will discuss about stressors and management of stress among dental students.
The causes and levels of stress vary. The study of Information Technology is basically a rigorous one as it is designed to prepare students for the actual demands in the world of work. This study sought to determine the causes of stress, the effects of stress, and the stress coping mechanisms of Bachelor of Science in Information Technology students in the Leyte Normal University, Tacloban City. It tested some assumptions using the descriptive survey method with 51 respondents. Thesis writing/research and school requirements/projects were the most common causes of stress. Sleepless nights and irritable/moody feeling were the common effects of stress. There was disparity on the causes and effects of stress between the male and female respondents. The use of computer and praying to God were the common stress coping mechanisms. There was an observed disparity between the male and female responses.
This systematic review is dedicated to deepening the study of two phenomena: binaural beats and isochronic tones. Data from the scientific literature suggest the existence of a promising therapeutic potential in neurology and psychophysiology due to their influence on specific frequencies of brain waves and their implications for mental health and homeostasis of brain neurotransmitters. Prolonged audio stimuli in repetitive and synchronized manner may induce changes in brain waves patterns and, consequently, modulating neurophysiological, and behavioral responses. The literature review was conducted using PUBMED, MEDLINE, LILLACS, and SCIENCE DIRECT online platforms using the search words: “audio brain entrainment,” “auditory beat stimulation, “ “binaural beats,” “brainwave entrainment (BWE),” and “isochronic tones.” The search yielded 674 studies, of which 49 were in duplicate, and 592 were out of the scope of this review, and, therefore, were excluded from the study. The remaining studies were analyzed according to the Cochrane Handbook for Systematic Reviews, resulting in 33 randomized, controlled clinical trials that were then evaluated by the Jadad scale. From that, 17 studies obtained a score of three points or more on the Jadad scale. These studies were fully read and critically analyzed. Binaural beats were used in 15 studies (88.25%), whereas isochronic tones were used only in two studies (11.76%). Although most of the studies reviewed here indicated audio BWE effectiveness, some positive outcomes may require further investigation, with more refined and appropriate evaluation tools, better suited for each specific type of intervention and/or therapeutic target. Considering these limitations, the performance of additional studies with more adequate experimental design and data analysis is recommended, particularly focusing on the neurophysiological and behavioral effects of brain wave entrainment on mental states.
The present study was conducted to provide future researchers and dental educators with an overview of stress amongst undergraduate dental students reported in the literature. This overview is needed for the development of a new questionnaire measuring the level of stressors including students, staff and process of dental education. In addition, the review can be used to modify dental curricula to decrease such stress and produce better dentists. Our study consisted of a systematic review of 49 peer-reviewed articles published between 1966 till October 2008 in English, discussing different aspects of stress amongst undergraduate dental students. These aspects are demographic variables of stress, sources of stress, impact of stress, indicators of stress, instruments measuring stress level and management of stress. Major sources of reported stress were related to examinations, clinical requirements and dental supervisors. Studies suggest using signs and symptoms for early detection of stress and proper intervention.
Dental students deal with various stressors while in dental school. While some develop adaptive coping skills, others may suffer from damaging effects of constant and increasing levels of stress. This study evaluated a peer mentoring program at a dental school in the Midwest to determine student perceptions of its benefits and to identify areas for improvement. Data were collected through a survey sent out to all dental classes online. The twenty-five-item survey was based on student responses during two focus groups held to elicit student assessment of the peer mentoring program. Sixty-six percent of the student body participated with representation from all four classes. Students find their peer mentoring program an effective tool in helping them deal with stress especially during transition phases of their curriculum, first into dental school and later from preclinic to the clinics. Having a mentor means easy access to an available person who can help students relieve anxieties about dental school. Experiencing dental school enables a student to serve as a mentor, so a non-dental student is seen as not effective. Peer mentoring needs to be loosely structured and flexible and should cover all years in the dental curriculum.
The aim of this study was to identify dental students' self-reported sources of stress and to explore the role of specific curricular and institutional differences in the variation of perceived stressors among dental students in Greece, Ireland, Slovenia, Sweden, Spain, and Croatia. A thirty-item modified version of the Dental Environment Stress (DES) questionnaire was administered to all undergraduate students enrolled at six European dental schools selected to reflect geographical, curricular, and professional environment diversity: Athens, Greece; Dublin, Ireland; Ljubljana, Slovenia; Malmö, Sweden; Santiago de Compostela, Spain; and Zagreb, Croatia. Participation varied from 93 percent in Athens to 65 percent in Dublin. A total of 1,492 questionnaires were available for analysis. Univariate analysis and multivariate modelling were used for data analysis. Performance pressure, workload, and self-efficacy beliefs constituted the students' main concerns. In the univariate analysis, student responses differed by country: Swedish students provided the lowestst scores in five out of six DES factors, Spanish students were the most concerned about "clinical training" and "performance pressure," whereas Greek students were the most concerned about "patient treatment." Multivariate modelling revealed that problem-based learning (PBL) was inversely associated with perceived stress for "self-efficacy beliefs" OR (95% CI): 0.66 (0.52, 0.84), "workload" OR (95% CI): 0.58 (0.41, 0.80); and "clinical training" OR (95% CI): 0.69 (0.50, 0.95) when compared to traditional curricula. Students' perceived stressors differed greatly among the six institutions and were associated with both individual (gender, study level) and educational/institutional (curriculum type, class size, educational costs) parameters.
Objectives
The practice of dentistry has long been associated with high levels of occupational stress and anxiety and music has been shown as a method of reducing stress. Considering the reportedly high level of stress among dental students and its consequences and also considering the positive effect of music therapy, the aim of this study was to evaluate the relationship between music practice and level of stress in dental students.
Materials and Methods
In this analytical, cross-sectional study, 88 students, including 44 with a history of music practice and 44 matched controls without music practice who met the defined inclusion criteria, participated. Upon obtaining written informed consent, all volunteers filled the Beck anxiety inventory (BAI) and Beck depression inventory (BDI) questionnaires. Data were analyzed using the Kolmogorov-Smirnov test, and multiple linear regression test with backward method was used to evaluate the effect of demographic factors on anxiety and depression scores.
Results
The level of anxiety was higher in students who did not have music practice and this difference was significant (P<0.001). The same was observed for depression (P=0.027). Other factors including age, gender, and being far from family had no significant effect on depression and anxiety (P>0.05). But level of anxiety and depression was higher in students of universities with tuition fee compared to free public institutes (P<0.05).
Conclusions
It may be concluded that music practice can reduce anxiety and depression of dental students.
The goals of this study were to identify sources of stress in dental education and to explore the role of year of study and gender on perceived stressors. Five hundred and seventy-one undergraduates, officially registered at the University of Athens School of Dentistry, participated in the survey by completing a thirty-item modified version of the Dental Environment Stress Questionnaire. Assigned workload, performance pressure, and self-efficacy beliefs constituted the most stress-provoking factors. Gender differences were found in most of the perceived stressors, whereas stress intensity greatly differed by year of study. Multivariate analysis suggested that, irrespective of gender, fourth-year and graduating students were less concerned about class work overload, clinical training difficulties, and course failing, but were significantly more insecure about their professional future. Entry-level students appeared to be the most concerned about the lack of time for relaxation. However, they were the least stressed about completing graduation requirements compared with the rest of their peers. Possible strategies for reducing stress in Greek dental education are considered in the light of these findings.
The aim of this study was to systematically review the available literature on the levels, causes, and impact of stress among dental students. The investigators searched eight electronic databases: Medline, Medline in process, Psychinfo, ERIC, Embase, Cochrane Library, Web of Science, and SCOPUS. Two independent reviewers conducted the selection, data extraction, and quality appraisal for included studies. The investigators then coded both quantitative and qualitative studies using similar codes and pooled results from studies that used the Dental Environment Stress questionnaire to demonstrate dental students' stress levels. The search initially identified 4,720 studies, of which 124 studies were included in the final qualitative synthesis and twenty-one were included in the meta-analysis. Evidence from this research showed that dental students experience considerable amounts of stress during their training. This stress is mainly due to the demanding nature of the training. In addition, studies suggest adverse effects of elevated stress on students' health and well-being. Most of the available literature is based on cross-sectional studies; thus, future longitudinal studies are needed to follow students throughout their curriculum. In addition, further research needs to explore and test stress management interventions.
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