# Education-Related Stress and Its Behavioral and Somatic Manifestations Among Dental Students: A Cross-Sectional Analysis of Bruxism and Temporomandibular Symptoms

## TL;DR

Dental students experience high stress from their education, which is linked to bruxism and jaw-related symptoms, suggesting a need for better support systems.

## Contribution

This study identifies specific stressors in dental education that correlate with bruxism and temporomandibular symptoms, emphasizing the nature of stressors beyond overall stress levels.

## Key findings

- 76% of dental students reported bruxism, with higher rates among females.
- Bruxism was associated with higher stress and temporomandibular disorder symptom scores.
- Inconsistent academic feedback was a key stressor linked to bruxism.

## Abstract

Background/Objectives: Dental training is known for its demanding academic pace, early clinical exposure, and constant performance pressure. These stressors may contribute to behavioral and physical manifestations, including bruxism and temporomandibular disorder (TMD). This study aimed to better understand the multidimensional burden experienced in this educational setting by investigating the relationship between education-related stress, bruxism patterns, and temporomandibular symptoms (TMD-related symptoms) in dental students. Methods: A cross-sectional survey was conducted at the Ankara University Faculty of Dentistry in 2025 and completed by 287 undergraduate dental students. The questionnaire collected sociodemographic information, self-reported bruxism status, TMD-related symptoms via the Fonseca Anamnestic Index (FAI), and education-related stressors using the Dental Environment Stress (DES) scale. Descriptive statistics, group comparisons, and Spearman correlation analyses were conducted. Results: Bruxism was reported by 76% of students and was significantly more common among females (p < 0.05). Students with bruxism demonstrated higher DES (3.34 ± 0.84) and FAI (41.81 ± 20.32) scores compared with those without bruxism (p < 0.001). DES and FAI scores showed a significant positive correlation (r = 0.229, p < 0.001). Stressors related to workload, examinations, limited rest time, clinical uncertainty, patient responsibility, and financial concerns were strongly associated with bruxism, while inconsistent academic feedback emerged as a key distinguishing factor. Conclusions: Education-related stress is closely linked to bruxism and TMD-related symptoms among dental students. Beyond overall stress intensity, the nature of experienced stressors plays a critical role. These findings highlight the importance of supportive learning structures, targeted stress-management strategies, and curriculum-level improvements to promote student wellbeing and resilience.