Prevalence of Stress-Related Oral Lesions and their Association with Academic Stress among Dental Students: A Multi-Stage Study

Abstract

Background: Dental education is known to be demanding, often exerting psychological pressure on students, which can manifest physically, including in the oral cavity. Stress-related oral lesions such as aphthous ulcers, bruxism-related trauma, burning mouth, and herpetic eruptions are commonly reported in high-stress populations. However, data on their prevalence and association with academic stress among dental students in Pakistan remain scarce

Objective: To determine the prevalence of stress-related oral lesions and explore their association with academic stress among dental students in Pakistan.

Methods: This cross-sectional analytical study was conducted using a multi-stage sampling method involving one dental college from Punjab and one from Khyber Pakhtunkhwa (KP). Stratified random sampling was employed to recruit students from each academic year. Data were collected using a structured questionnaire that included demographic details and the Perceived Stress Scale (PSS-10). Clinical oral examinations were conducted to identify stress-related oral lesions. Statistical analysis included descriptive statistics, Chi-square test, and logistic regression to evaluate associations.

Results: A total of 356 students participated (Punjab: 178, KP: 178). The overall prevalence of stress-related oral lesions was 38.2%. The most common lesions were aphthous ulcers (18.5%), bruxism-related trauma (12.6%), and burning mouth sensation (7.1%). High levels of academic stress were significantly associated with the presence of oral lesions (p < 0.01). Logistic regression identified academic stress (OR = 2.41, 95% CI: 1.45–4.02), female gender (OR = 1.73, 95% CI: 1.02–2.91), and inadequate sleep (OR = 2.19, 95% CI: 1.28–3.74) as significant predictors.

Conclusion: Stress-related oral lesions are prevalent among dental students, with academic stress playing a significant role. Regular mental health support and stress management interventions are recommended to improve students' oral and general well-being.Stress-related oral lesions