Dental Students Stress during Clinical Restorative Procedures: A Saudi-Based Study

1. INTRODUCTION

Dental education is known for its demanding nature, imposing significant psychological burdens on students, and contributing to elevated stress levels [1, 2]. It is well documented that the rigorous demands and intensive curriculum of dental programs adversely impact students, affecting their mental health, well-being, and academic performance [3-5]. Several considerations affect dental students’ stress levels. The change from theoretical to clinical training, an intensive curriculum, competitiveness, performance demands, and student-instructor and student-patient interactions all increase stress levels [6]. These factors not only challenge students' ability to manage time and master technical skills but also require them to apply theoretical knowledge in practical and clinical settings, where the interplay of skills, knowledge, and human interaction further amplifies stress [2, 7].

Students identify restorative dental procedures like endodontics, restorations, caries treatment, and asso- ciated diagnostic procedures as significant stressors [8]. These procedures demand a high level of knowledge, precision, and technical skills, presenting challenges in mastering these skills and managing patient care, which students often find particularly stressful [6, 8, 9].

Assessing student's stresses and subsequently under- standing their causes, especially those related to clinical procedures, can help develop and improve curricula in dental schools [10]. Identifying the most stressful clinical procedures can help develop targeted approaches to manage these challenges in the curriculum [11]. This can ultimately enhance the overall educational experience for dental students [12].

There are a few previous studies that investigated the effect of restorative dental procedures on stress levels among dental students at clinical levels. For example, Mocny-Pachońska et al. examined stress levels among dental students during specific conservative dental treatment procedures [8]. Recently, Alamoush et al. investigated stress levels and their factors among fourth- and fifth-year dental students, which included some restorative clinical procedures [13]. Tavares et al. reported students' perceptions of root canal treatments [14]. Rayyan et al. investigated the self-perceived stress levels of senior dental students in Saudi Arabia during fixed prosthodontic procedures, examining factors that contribute to stress during clinical practice [10]. Given the limited research focusing on stressors related to clinical procedures in restorative dental treatments for clinical levels and both genders, this study was conducted to address part of this gap.

This study aims to assess the stress levels faced by a group of Saudi dental students at clinical levels while performing different restorative dental procedures and to explore variations in these levels of stress among different student year levels, genders, and restorative categories to fill a critical research gap by examining this area. Understanding these stress levels can help improve the curriculum, develop targeted stress management strategies, and improve dental education. This study's findings can help create more resilient and competent dental professionals, which could improve patient care. Additionally, the findings of this study could improve students' preparation and the support of dental students for clinical education, thereby improving dental education and student well-being.

2. METHOD

3. RESULTS

4. DISCUSSION

This study investigated the self-perceived stress levels of dental students at the College of Dentistry, University of Ha’il, Saudi Arabia, during various clinical restorative procedures using a structured questionnaire. The stress levels showed a declining trend from third to fifth-year levels in all categories. Most students reported no or low stress during diagnostic procedures, while approximately half experienced medium or high stress during operative or endodontic procedures. Across all categories, there were no significant gender differences in stress levels, except for fifth-year students, where females reported higher stress than males during the endodontic category. Additionally, no significant differences in stress levels were observed between students' year levels across all categories, except for third-year students, who reported significantly higher stress in the operative category. Comparing the categories, both operative and endodontic procedures significantly increased stress levels in dental students compared to diagnostic procedures. However, there were no significant differences in stress levels between the operative and endodontic categories.

Previous studies have explored the differences in stress levels across students' year levels, reporting diverse findings. Jowkar et al. observed that the highest stress levels occurred among fifth-year students, attributed to their increased clinical responsibilities [15]. Tangade et al. also observed an increase in student stress levels from the first to the final year, with a notable increase between the second and third years, likely due to the shift from pre-clinical to clinical education [16]. Ersan et al. [17] and Alamoush et al. [13] also noted that stress levels tend to increase as students progress to higher levels, reflecting the cumulative effect of ongoing academic and clinical pressures. In contrast, our study found that third-year students reported the highest stress levels, but there was a noticeable reduction in stress by the fifth year across all categories. This reduction may be attributed to improvements in students' clinical skills and educational interventions that aid in managing and adapting to the demands of their training. This is supported by findings from Mocny-Pachońska et al., where third-year students felt a high level of stress during endodontic procedures, which decreased markedly by the fifth year [8]. Furthermore, Tavares et al. highlighted that difficulties in performing specific endodontic techniques decreased significantly as students progressed in their training, pointing out the importance of continuous education and practice in reducing stress [14].

These observations highlight the complex interplay between students' year levels, clinical exposure, and stress perception in dental education. As they progress through their programs, targeted support and structured educa- tional strategies are critical in helping them navigate these challenges effectively. This includes focusing on both the technical aspects of dental procedures and the psychological support needed to manage stress, which can enhance both educational outcomes and students’ well-being.

Examining gender differences in stress perception reveals a complex landscape where gender influences the stress dental students encounter in various contexts. Contrary to the findings by Jowkar et al. [15], which indicated no significant gender-related differences in depression, anxiety, or stress among students, findings from Tangade et al. [16] and Ersan et al. [17] suggested a more nuanced picture. Tangade et al. [16] found that men experienced higher stress levels than women, while Ersan et al. [17] noted that female students generally suffered from more stress. Similarly, Alamoush et al. [13] observed that female dental students reported higher stress levels than their male counterparts, a trend also supported by Mocny-Pachońska et al. [8], particularly during procedures related to caries treatment. However, our findings complicate this narrative by showing no significant gender differences across most clinical categories and students' year levels, except for fifth-year students, where female participants exhibited significantly higher stress levels during endodontic procedures compared to their male counterparts. This suggests that while there may be a general trend towards higher stress levels in female students, such differences are not universal and may depend on a variety of factors beyond simple psychological or physiological differences between genders. These factors could include the specific educational environ- ment, the nature of clinical tasks, or even the level of support and mentoring available to students. It is important for dental education programs that want to target interventions that effectively address gender-specific stress disparities to recognize these complexities. One way to do this could be to provide specialized support systems and stress management training for high-stress clinical procedures [2, 18].

There are significant variations in how students perceive stress depending on the type of procedure they are performing. Consistent with findings by Frese et al., our study indicates that diagnostic procedures generally cause the lowest stress levels among students [6]. Frese et al. recommended that students begin their clinical training with a focus on diagnostics, preventive dentistry, and initial periodontal treatment before advancing to more complex procedures such as endodontics, which are known to be highly stressful [6]. Consistent with our results, Mocny-Pachońska et al. found that dental students viewed endodontic treatment procedures as particularly stressful [8]. This view is supported by Tanalp et al., who observed that senior students rated endodontics as the most challenging dental specialty [19]. This indicates that while endodontic procedures are stressful, the complexity and perceived risk involved in such treatments, such as managing complications and using specialized equipment like rubber dams, might contribute to the high-stress levels experienced by students [19].

Furthermore, Alrahabi et al. [11] and Tavares et al. [14] discussed the specific aspects of endodontic procedures that challenge students, such as endodontic radiology and root canal obturation evaluation. These findings suggest that targeted training in these areas might alleviate some of the stress associated with endodontic treatments. Tavares et al. pointed out that while basic endodontic procedures like chamber access and working length determination did not pose significant difficulty, areas requiring high precision, such as radiographic examination and the choice of intracanal medication, were more problematic [14].

Overall, these insights underline the importance of curriculum design that considers the varying stress levels induced by different clinical procedures. Introducing high-stress procedures like endodontics later in the curriculum and ensuring adequate preparatory training and support can help reduce stress and improve educational outcomes. This approach not only aligns with the goals of dental education but also with the practical realities faced by students in their clinical training.

Research on students' clinical stress revealed a variety of methodologies. This study, along with other studies by Jowkar et al. [15], Ersan et al. [17], Alrahabi et al. [11], Tavares et al. [14], Alamoush et al. [13], and Mocny-Pachońska et al. [8], demonstrated a variety of methods and tools used to assess stress. For example, the Dental Environment Stress questionnaire was employed by Jowkar et al. [15] and Alamoush et al. [13], while Ersan et al. [17] employed the Perceived Stress Scale and the General Self-Efficacy Scale. This study used a structured questionnaire focusing on three restorative categories: diagnosis, operative, and endodontic dental procedures, across third, fourth-, and fifth-year students. Similarly, Mocny-Pachońska et al. employed a similar methodology, using a structured questionnaire, including caries treatment [8]. However, there are variations in focus, such as Alrahabi et al., who studied endodontic procedures solely [11]. Tanalp et al. emphasized the significance of confidence in performing endodontic treatments [19]. Future research should aim to standardize methods by developing a standardized questionnaire. Furthermore, conducting qualitative methods might deepen understanding and enhance the applicability of findings across educational settings.

Managing stress in dental education requires addressing both environmental factors and individual coping strategies to create a supportive educational atmosphere. Frese et al. [6] and Ersan et al. [17] advocated for a thorough examination of dental curricula to identify and alleviate sources of overload, thereby minimizing unnecessary stressors. Moreover, specific adjustments to endodontics education were recommended by Alrahabi et al., including increasing both preclinical and clinical sessions and incorporating new teaching methods [11]. This approach aligns with findings by Kashbour et al., which highlight the benefits of early clinical exposure to bridge the gap between simulated environments and real clinical settings [9]. Furthermore, stress management strategies should focus early in the curriculum on reducing stressors and enhancing coping mechanisms, including stress reduction techniques, as outlined by Alzahem et al. [20] and Colley et al. [21].

This study has limitations because of its cross-sectional design, which prevents establishing cause-and-effect relationships or tracking changes in student stress over time. Furthermore, because the research took place at the University of Ha’il, its findings might not be applicable to other dental schools operating in different contexts. Furthermore, while this study focused on restorative procedures that are central to the daily practice of general practitioners, the focus on restorative procedures limits a broader, more comprehensive understanding of stress in different disciplines such as prosthodontics, oral surgery, and pedodontics.

CONCLUSION

This study demonstrated the varying stress levels experienced by dental students across different student year levels and different restorative clinical procedures. While diagnostic procedures were generally considered less stressful, operative, and endodontic procedures were more challenging. As students advance across students' year levels, stress tends to decrease, with no generally significant gender-based differences. These findings highlight the necessity of adapting the curriculum and implementing targeted support interventions, particularly in the early stages of training and addressing gender-specific needs. This study lays a base for future research, highlighting the importance of longitudinal studies to track stress progression and evaluate the effectiveness of interventions.

AUTHORS' CONTRIBUTION

The author confirms sole responsibility for the following: study conception and design, data collection, analysis and interpretation of results, and manuscript preparation.

REFERENCES