SavedAdd your journal

Journals / Medical Records / 2026 / Sayı: 1

Evaluation of Stress, Temporomandibular Disorder Symptoms, and Cortisol Levels in Dentistry Students During Prosthetic Dentistry Internship: A Pilot Study

Diş Hekimliği Öğrencilerinde Protetik Diş Tedavisi Stajı Sırasında Stres, Temporomandibular Bozukluk Belirtileri ve Kortizol Düzeylerinin Değerlendirilmesi: Pilot Çalışma

Meryem Şahin(TOKAT GAZIOSMANPASA UNIVERSITY, FACULTY OF DENTISTRY)0000-0002-9521-5922
Figen Güzelgül(TOKAT GAZIOSMANPASA UNIVERSITY, FACULTY OF PHARMACY, DEPARTMENT OF BASIC PHARMACEUTICAL SCIENCES, DEPARTMENT OF BIOCHEMISTRY)0000-0002-2796-9511
Pages
—
Publication Date
2026-03-24
🏛️Bibliographic metadata and full text access for this article are provided via DergiPark.
DergiPark Record ↗
✨

AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

It is recommended to support these results with larger sample sizes and implement stress management programs during clinical training.

📌 3 Key Takeaways

🎯
Objective & Hypothesis:Aim: Dental education, particularly during the prosthodontic internship, can be a demanding period characterized by high academic and clinical workload.
📊
Key Findings & Data:Material and Methods: Thirty-one students (13 in their 4th year and 18 in their 5th year) participating in their prosthodontic internship at Tokat Gaziosmanpaşa University Faculty of Dentistry were included in this study.
💡
Conclusion & Impact:It is recommended to support these results with larger sample sizes and implement stress management programs during clinical training.
🔬Design:Araştırma Makalesi
📍Scope:Comprehensive Sample
⚙️Variables:Stres düzeyi · kortizol düzeyi · diş hekimliği öğrencileri

Abstract

Aim: Dental education, particularly during the prosthodontic internship, can be a demanding period characterized by high academic and clinical workload. These stressors may influence both psychological and physiological well-being, potentially contributing to the development or exacerbation of temporomandibular disorder (TMD) symptoms. Cortisol, a key biomarker of stress, provides an objective measure of the body’s physiological response to these challenges. This pilot study was designed to explore the variations in stress levels, TMD symptoms, and salivary cortisol concentrations among dentistry students throughout their prosthodontic internship. Material and Methods: Thirty-one students (13 in their 4th year and 18 in their 5th year) participating in their prosthodontic internship at Tokat Gaziosmanpaşa University Faculty of Dentistry were included in this study. The Perceived Stress Scale-10 (PSS-10) was employed for stress assessment and the Fonseca Anamnestic Index (FAI) for TMD assessment. Cortisol levels, a biological stress parameter, were measured at the beginning and end of the internship. Data were analyzed using Mann-Whitney U, Wilcoxon, and Spearman’s rho tests. Results: A significant increase was found in stress levels of 5th-year students at the end of the internship (p=0.033). Although there was a trend towards an increase in 4th-graders, it was not found to be significant (p=0.099). Cortisol levels increased in both groups but were not statistically significant. There was no significant change in FAI scores. However, there was a positive correlation between stress and TMD scores in 5th-graders before and after the internship. Conclusion: Prosthodontic internships may be associated with increased stress levels in students, and a positive association between stress and TMD symptoms was observed. It is recommended to support these results with larger sample sizes and implement stress management programs during clinical training.

Özet

Giriş: Diş hekimliği eğitimi, özellikle protez stajı sırasında, yüksek akademik ve klinik iş yüküyle karakterize zorlu bir dönem olabilir. Bu stres faktörleri hem psikolojik hem de fizyolojik refahı etkileyerek temporomandibular bozukluk (TME) semptomlarının gelişmesine veya şiddetlenmesine katkıda bulunabilir. Stresin temel bir biyobelirteci olan kortizol, vücudun bu zorluklara verdiği fizyolojik tepkinin objektif bir ölçüsüdür. Bu pilot çalışma, diş hekimliği öğrencileri arasında protez stajı boyunca stres seviyelerindeki, TME semptomlarındaki ve tükürük kortizol konsantrasyonlarındaki değişimleri araştırmak üzere tasarlanmıştır. Gereç ve Yöntemler: Tokat Gaziosmanpaşa Üniversitesi Diş Hekimliği Fakültesi'nde protez stajına katılan otuz sekiz öğrenci (13'ü 4. sınıfta ve 18'i 5. sınıfta) bu çalışmaya dahil edildi. Stres değerlendirmesi için Algılanan Stres Ölçeği-10 (PSS-10), TME değerlendirmesi için ise Fonseca Anamnestik İndeksi (FAI) kullanıldı. Biyolojik bir stres parametresi olan kortizol seviyeleri, stajın başında ve sonunda ölçüldü. Veriler Mann-Whitney U, Wilcoxon ve Spearman'ın rho testleri kullanılarak analiz edildi. Sonuçlar: Staj sonunda 5. sınıf öğrencilerinin stres seviyelerinde anlamlı bir artış bulundu (p=0,033). 4. sınıf öğrencilerinde artış eğilimi olmasına rağmen, bu artış anlamlı bulunmadı (p=0,099). Kortizol seviyeleri her iki grupta da arttı, ancak istatistiksel olarak anlamlı değildi. FAI puanlarında anlamlı bir değişiklik görülmedi. Ancak, 5. sınıf öğrencilerinde staj öncesi ve sonrası stres ve TMD puanları arasında pozitif bir korelasyon vardı. Sonuç: Protez stajları öğrencilerin stres seviyelerini artırmakta ve stres ile TMD semptomları arasında olası bir ilişki olduğunu düşündürmektedir. Bu sonuçların daha büyük örneklem büyüklükleriyle desteklenmesi ve klinik eğitim sırasında stres yönetimi programlarının uygulanması önerilmektedir.

🔖

Cite This Article

Şahin, M., Güzelgül, F. (2026). Evaluation of Stress, Temporomandibular Disorder Symptoms, and Cortisol Levels in Dentistry Students During Prosthetic Dentistry Internship: A Pilot Study. Medical Records, Sayı: 1. https://doi.org/10.37990/medr.1819288

📄 Full Text PDF Viewer

📄

PDF görüntüleyici hazırlanıyor...

References (40)

  1. Stormon N, Ford PJ, Kisely S, Bartle E, Eley DS. Depression, anxiety and stress in a cohort of Australian dentistry students. Eur J Dent Educ. 2019;23(4):507-514.
  2. Jowkar Z, Masoumi M, Mahmoodian H. Psychological stress and stressors among clinical dental students at Shiraz School of Dentistry, Iran. Adv Med Educ Pract. 2020;11:113-120.
  3. Shehada MR, Alfakhry G, Jamous I, Aljoujou A, Abdul-hak M. Major stress sources amongst dental students at Damascus University, Syria. Int Dent J. 2023;73:205-211.
  4. Al Salieti H, Kassab M, Alnayfeh D, Hadi A, Alatoom R. Evaluation of self-reported stress and provoking factors of conservative dentistry clinic procedures for clinical dental students: a prospective study. Jordan J Dent. 2025;2(2).
  5. Luo F, Jiang J, Cao Y, Tang X. Role-playing training method for intern impression-taking training. J Dent Educ. 2023;87:879-881.
  6. Reissmann D. Dental patient-reported outcome measures are essential for evidence-based prosthetic dentistry. J Evid Based Dent Pract. 2019;19(1):1-6.
  7. Altan B, Cinar S. Evaluation of the prosthodontic clinical internship experiences of 4th and 5th grade dentistry students: a cross-sectional study. Turkiye Klin J Dent Sci. 2023;29(1):147-158.
  8. Iqbal S, Howse J, Banu S, Lateef A, Khan S, Barlas Z, Shah AA. The effects of stress on health. Psychiatr Ann. 2024;54(10):e272-e276.
  9. O’Connor DB, Thayer JF, Vedhara K. Stress and health: a review of psychobiological processes. Annu Rev Psychol. 2021;72:663-688.
  10. Vaccarino V, Shah AJ, Mehta P, et al. Brain-heart connections in stress and cardiovascular disease: implications for the cardiac patient. Atherosclerosis. 2021;328:74-82.
  11. James K, Stromin J, Steenkamp N, Combrinck M. Understanding the relationships between physiological and psychosocial stress, cortisol and cognition. Front Endocrinol (Lausanne). 2023;14.
  12. Eskin M, Harlak H, Demirkiran F, Dereboy C. The adaptation of the perceived stress scale into Turkish: reliability and validity analysis. New Symp J. 2013;51:132-140.
  13. Yilmaz Kogar E, Kogar H. A systematic review and meta-analytic confirmatory factor analysis of the perceived stress scale (PSS-10 and PSS-14). Stress Health. 2024;40(1):e3285.
  14. Kuć J, Szarejko KD, Maciejczyk M, et al. Oxidative imbalance as a co-player in jaw functional limitations and biopsychosocial profile in patients with temporomandibular disorder—myofascial pain with referral. Front Neurol. 2025;15:1509845.
  15. Florjański W, Orzeszek S. Role of mental state in temporomandibular disorders: a review of the literature. Dent Med Probl. 2021;58(1):127-133.
  16. Kmeid E, Nacouzi M, Hallit S, Rohayem Z. Prevalence of temporomandibular joint disorder in the Lebanese population, and its association with depression, anxiety, and stress. Head Face Med. 2020;16(1):19.
  17. Arikan H, Citaker S, Ucok C. Psychometric properties of the Fonseca anamnestic index (FAI) for temporomandibular disorders: Turkish version, responsiveness, reliability, and validity study. Disabil Rehabil. 2024;46(7):1408-1415.
  18. de Souza Ferreira F, Barros I, da Costa Neves T, Pazos JM, Garcia PPNS. Stress amongst dental students in the transition from preclinical training to clinical training: a qualitative study. Eur J Dent Educ. 2023;27(3):568-574.
  19. Lugassy D, Ben-Izhack G, Zissu S, et al. Anxiety, stress, and depression levels among dental students: gender, age, and stage of dental education related. Psychol Health Med. 2025:1-15.
  20. Alamoush R, Al-Sawaeir S, Baker DA, et al. Stress experienced by dental students performing clinical training in different dental disciplines: a cross-sectional study. J Occup Health. 2024;66(1):uiae006.
  21. Inglehart M, Marti K, LeBlanc MJ, Bak SY, Boynton J. Pediatric dentistry, prosthodontics, and oral and maxillofacial surgery residents’ stress, career satisfaction, and gender-based discrimination/harassment. J Dent Educ. 2024;88(Suppl 1):713-726.
  22. Maskey B, Shrestha K, Mathema S. The perception of stress among the final year students in prosthodontics. J Nepal Prosthodont Soc. 2019;2:1-5.
  23. Guthardt L, Niedworok C, Muth T, Loerbroks A. Stress, psychosocial resources and possible interventions: a qualitative study among dental students. BMC Med Educ. 2024;24(1):1479.
  24. Amirkhan J. A brief stress diagnostic tool: the short stress overload scale. Assessment. 2018;25:1001-1013.
  25. Alqarni A, Hosmani J, Alassiri S, et al. Association between psychosocial stressors and temporomandibular disorders in clinical dental students: a cross-sectional study. PeerJ. 2025;13:e19066.
  26. Larkin N, Fricton V, Sangalli L, Prodoehl J, Fricton J. Prevalence and impact of signs and symptoms of temporomandibular disorders in dental students and faculty. J Dent Educ. 2024;88(12):1696-1708.
  27. Zhang MJ, Yap AUJ, Lei J, Fu KY. Psychometric evaluation of the Chinese version of the Fonseca anamnestic index for temporomandibular disorders. J Oral Rehabil. 2020;47(3):313-318.
  28. Sancar E, Akbasak Sungur AO, Alici S, et al. Prevalence and awareness level of temporomandibular joint dysfunction among undergraduate and graduate dentistry students. J Dent Sci Educ. 2024;2(4):85-90.
  29. Sharfuddin M, Muralidharan A, Shetty P, Nandan A, Jain A. Stress-related temporomandibular joint disorders: a comparative study between preclinical and clinical undergraduate students of dentistry. Indian J Forensic Med Toxicol. 2020;14(4):4306-4310.
  30. Knezevic E, Nenic K, Milanovic V, Knezevic NN. The role of cortisol in chronic stress, neurodegenerative diseases, and psychological disorders. Cells. 2023;12(23):2726.
  31. Russell G, Lightman S. The human stress response. Nat Rev Endocrinol. 2019;15(9):525-534.
  32. Vives AH, Angel VD, Papadopoulos A, et al. The relationship between cortisol, stress and psychiatric illness: new insights using hair analysis. J Psychiatr Res. 2015;70:38-49.
  33. O’Brien KM, Tronick EZ, Moore CL. Relationship between hair cortisol and perceived chronic stress in a diverse sample. Stress Health. 2013;29(4):337-344.
  34. Joseph NT, Jiang Y, Zilioli S. Momentary emotions and salivary cortisol: a systematic review and meta-analysis of ecological momentary assessment studies. Neurosci Biobehav Rev. 2021;125:365-379.
  35. AlSarhan M, AlJasser R, AlOraini S, et al. Relationship of self-perceived stress and expression of salivary cortisol in relation to gender and academic levels among dental students. Open Dent J. 2024;18(1).
  36. Zenthofer A, Graf A, Rammelsberg P, Klotz A. The impact of the SARS-CoV-2 pandemic on stress and anxiety of dental students. Eur J Dent. 2023;17:1221-1228.
  37. Botelho M, Gao X, Bhuyan SY. An analysis of clinical transition stresses experienced by dental students: a qualitative methods approach. Eur J Dent Educ. 2018;22(3):e564-e572.
  38. Chan CCK, Fok EHW, Botelho M. An analysis of students’ perceptions of strategies to improve well-being in dentistry. Eur J Dent Educ. 2025;29:249-265.
  39. Felszeghy S, Kurki P, Liukkonen M, Suominen AL, Huhtela O. The combination of listening to background music and deep breathing as a stress reduction strategy during dental preclinical study. J Dent Educ. 2024;88(3):342-347.
  40. Lopez-Valverde N, Lopez-Valverde A, Macedo de Sousa B, Blanco Rueda JA. Efficacy of music therapy on stress and anxiety prior to dental treatment: a systematic review and meta-analysis of randomized clinical trials. Front Psychiatry. 2024;15:1352817.