Stress management in dental students: a systematic review

Figures & data

Figure 1 Articles screened for review.

Table 1 Summary of selected studies

Reference	Year	Study sample	Study design	Outcomes measurement	Effectiveness
Shankarapillai et al^Citation19	2012	100 students	Controlled trial	VAS, STAI	Significant stress reduction
Alzahem et al^Citation5	2011	49 articles	Systematic review	Data collection form	Not applicable
Ahmad et al^Citation1	2011	291 students	Cross-sectional	DES questionnaire	90.3% stress reduction
Piazza-Waggoner et al^Citation18	2003	26 students	Controlled trial	VAS, STAI, COPE questionnaire	No significant effect
Howard et al^Citation20	1986	23 students	Controlled trial	PMS, STAI, ORI, symptoms questionnaire	Stressed students benefited the most
Schwartz et al^Citation21	1984	Dental students	Case report	Not available	Not available
Tisdelle et al^Citation7	1984	17 students	Controlled trial	Stress Knowledge Inventory, STAI, Symptom Checklist, physiological assessment	Effective in reducing dental students’ physiological and self-reported stress levels

Abbreviations: DES, Dental Environment Stress; VAS, visual analog scale; STAI, Spielberger State-Trait Anxiety Inventory; COPE, Coping Orientation for Problem Experiences; PMS, Profile of Mood States; ORI, Observer Rating Inventory.

Figure S1 Study review form.

Figure S2 Data extraction form.

Table S1 Reference checklist

		Title	Abstract	Full-text	Exclusion reason
1.	Shankarapillai R, Nair MA, George R. The effect of yoga in stress reduction for dental students performing their first periodontal surgery: a randomized controlled study. Int J Yoga. 2012;5(1):48–51.
2.	Divaris K, Polychronopoulou A, Taoufik K, Katsaros C, Eliades T. Stress and burnout in postgraduate dental education. Eur J Dent Educ. 2012;16(1):35–42.	X			Not on undergraduate students
3.	Ahmad MS, Md Yusoff MM, Abdul Razak I. Stress and its relief among undergraduate dental students in Malaysia. Southeast Asian J Trop Med Public Health. 2012;42(4):996–1004.
4.	Tangade PS, Mathur A, Gupta R, Chaudhary S. Assessment of stress level among dental school students: an Indian outlook. Dent Res J (Isfahan). 2011;8(2):95–101.	X			No management program
5.	Pani SC, Al Askar AM, Al Mohrij SI, Al Ohali TA. Evaluation of stress in final-year Saudi dental students using salivary cortisol as a biomarker. J Dent Educ. 2011;75(3):377–384.	X			No management program
6.	Jurkat H, Hofer S, Richter L, Cramer M, Vetter A. [Quality of life, stress management and health promotion in medical and dental students. A comparative study]. Dtsch Med Wochenschr. 2011;136(23):1245–1250. German.		X		No management program
7.	Huth KC, Chen HY, Mehl A, Hickel R, Manhart J. Clinical study of indirect composite resin inlays in posterior stress-bearing cavities placed by dental students: results after 4 years. J Dent. 2011;39(7):478–488.	X			Not related to students stress management
8.	Alzahem AM, van der Molen HT, Alaujan AH, Schmidt HG, Zamakhshary MH. Stress amongst dental students: a systematic review. Eur J Dent Educ. 2011;15(1):8–18.
9.	Abu-Ghazaleh SB, Rajab LD, Sonbol HN. Psychological stress among dental students at the University of Jordan. J Dent Educ. 2011;75(8):1107–1114.		X		No management program
10.	Silverstein ST, Kritz-Silverstein D. A longitudinal study of stress in first-year dental students. J Dent Educ. 2010;74(8):836–848.		X		No management program
11.	Polychronopoulou A, Divaris K. A longitudinal study of Greek dental students’ perceived sources of stress. J Dent Educ. 2010;74(5):524–530.	X			No management program
12.	Manhart J, Chen HY, Mehl A, Hickel R. Clinical study of indirect composite resin inlays in posterior stress-bearing preparations placed by dental students: results after 6 months and 1, 2, and 3 years. Quintessence Int. 2010;41(5):399–410.	X			Not related to students’ stress management
13.	Hinshaw KJ, Richter LT, Kramer GA. Stress, burnout, and renewal activities of dental hygiene education administrators in six US Midwestern States. J Dent Educ. 2010;74(3):235–250.	X			Not related to dental students
14.	Dahan H, Bedos C. A typology of dental students according to their experience of stress: a qualitative study. J Dent Educ. 2010;74(2):95–103.			X	No management. Former students
15.	Polychronopoulou A, Divaris K. Dental students’ perceived sources of stress: a multi-country study. J Dent Educ. 2009;73(5):631–639.	X			No management program
16.	Peker I, Alkurt MT, Usta MG, Turkbay T. The evaluation of perceived sources of stress and stress levels among Turkish dental students. Int Dent J. 2009;59(2):103–111.	X			No management program
17.	Laurence B, Williams C, Eiland D. Depressive symptoms, stress, and social support among dental students at a historically black college and university. J Am Coll Health. 2009;58(1):56–63.	X			No management program
18.	Kumar S, Dagli RJ, Mathur A, Jain M, Prabu D, Kulkarni S. Perceived sources of stress amongst Indian dental students. Eur J Dent Educ. 2009;13(1):39–45.	X			No management program
19.	Schmitter M, Liedl M, Beck J, Rammelsberg P. Chronic stress in medical and dental education. Med Teach. 2008;30(1):97–99.		X		No management program
20.	Muirhead V, Locker D. Canadian dental students’ perceptions of stress and social support. Eur J Dent Educ. 2008;12(3):144–148.		X		No management program
21.	Gorter R, Freeman R, Hammen S, Murtomaa H, Blinkhorn A, Humphris G. Psychological stress and health in undergraduate dental students: fifth year outcomes compared with first year baseline results from five European dental schools. Eur J Dent Educ. 2008;12(2):61–68.	X			No management program
22.	Muirhead V, Locker D. Canadian dental students’ perceptions of stress. J Can Dent Assoc. 2007;73(4):323.	X			No management program
23.	Morse Z, Dravo U. Stress levels of dental students at the Fiji School of Medicine. Eur J Dent Educ. 2007;11(2):99–103.	X			No management program
24.	Sofola OO, Jeboda SO. Perceived sources of stress in Nigerian dental students. Eur J Dent Educ. 2006;10(1):20–23.	X			No management program
25.	Sugiura G, Shinada K, Kawaguchi Y. Psychological well-being and perceptions of stress amongst Japanese dental students. Eur J Dent Educ. 2005;9(1):17–25.	X			No management program
26.	Rosli TI, Abdul Rahman R, Abdul Rahman SR, Ramli R. A survey of perceived stress among undergraduate dental students in Universiti Kebangsaan Malaysia. Singapore Dent J. 2005;27(1):17–22.	X			No management program
27.	Rasmussen JK, Frederiksen JA, Hallonsten AL, Poulsen S. Danish dentists’ knowledge, attitudes and management of procedural dental pain in children: association with demographic characteristics, structural factors, perceived stress during the administration of local analgesia and their tolerance towards pain. Int J Paediatr Dent. 2005;15(3):159–168.	X			Not related to dental students’ stress management
28.	Polychronopoulou A, Divaris K. Perceived sources of stress among Greek dental students. J Dent Educ. 2005;69(6):687–692.	X			No management program
29.	Pohlmann K, Jonas I, Ruf S, Harzer W. Stress, burnout and health in the clinical period of dental education. Eur J Dent Educ. 2005;9(2):78–84.		X		No management program
30.	Friedlander AH, Friedlander IK, Marder SR. Posttraumatic stress disorder: psychopathology, medical management, and dental implications. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004;97(1):5–11.	X
31.	Cardoso CL, Loureiro SR, Nelson-Filho P. Pediatric dental treatment: manifestations of stress in patients, mothers and dental school students. Braz Oral Res. 2004;18(2):150–155.	X
32.	Piazza-Waggoner CA, Cohen LL, Kohli K, Taylor BK. Stress management for dental students performing their first pediatric restorative procedure. J Dent Educ. 2003;67(5):542–548.
33.	Acharya S. Factors affecting stress among Indian dental students. J Dent Educ. 2003;67(10):1140–1148.	X
34.	Newbury-Birch D, Lowry RJ, Kamali F. The changing patterns of drinking, illicit drug use, stress, anxiety and depression in dental students in a UK dental school: a longitudinal study. Br Dent J. 2002;192(11):646–649.		X
35.	Naidu RS, Adams JS, Simeon D, Persad S. Sources of stress and psychological disturbance among dental students in the West Indies. J Dent Educ. 2002;66(9):1021–1030.	X
36.	Humphris G, Blinkhorn A, Freeman R, et al. Psychological stress in undergraduate dental students: baseline results from seven European dental schools. Eur J Dent Educ. 2002;6(1):22–29.		X
37.	Rajab LD. Perceived sources of stress among dental students at the University of Jordan. J Dent Educ. 2001;65(3):232–241.	X
38.	Sanders AE, Lushington K. Sources of stress for Australian dental students. J Dent Educ. 1999;63(9):688–697.	X
39.	Heath JR, MacFarlane TV, Umar MS. Perceived sources of stress in dental students. Dent Update. 1999;26(3):94–98, 100.	X
40.	Peretz B, Rosenblum A, Zadik D. Stress levels and related variables among dental students in Jerusalem, Israel. Eur J Dent Educ. 1997;1(4):162–166.	X
41.	Newton JT, Baghaienaini F, Goodwin SR, Invest J, Lubbock M, Marouf Saghakhaneh N. Stress in dental school: a survey of students. Dent Update. 1994;21(4):162–164.	X
42.	Hendricks SJ, Joshi A, Crombie K, Moola MH. Perceived sources of stress among black dental students in South Africa. J Dent Educ. 1994;58(6):406–410.	X
43.	Reyes RE. Stress management in pediatric dentistry. N Y State Dent J. 1993;59(2):22–23.		X
44.	Lopez Rendon JM, Ochoa Garcia JD, Velez Betancur JC. [Diagnosis and proposed solutions to causes of stress in students in the clinic of the CES Health Science Institute Dental School]. CES Odontol. 1990;3(2):83–94. Spanish.		NA	X
45.	Sgan-Cohen HD. Stress among Israeli dental students: a two-year longitudinal study. Int J Psychosom. 1989;36(1–4):69–71.	X
46.	Rubenstein LK, May TM, Sonn MB, Batts VA. Physical health and stress in entering dental students. J Dent Educ. 1989;53(9):545–547.			X	No management program
47.	Grandy TG, Westerman GH, Combs CE, Turner CH. Perceptions of stress among third-year dental students. J Dent Educ. 1989;53(12):718–721.	X
48.	Sgan-Cohen HD, Lowental U. Sources of stress among Israeli dental students. J Am Coll Health. 1988;36(6):317–321.	X
49.	Grandy TG, Westerman GH, Lupo JV, Combs CG. Stress symptoms among third-year dental students. J Dent Educ. 1988;52(5):245–249.	X
50.	Friedlander AH, Mills MJ, Wittlin BJ. Dental management considerations for the patient with post-traumatic stress disorder. Oral Surg Oral Med Oral Pathol. 1987;63(6):669–673.	X
51.	Cecchini JJ, Friedman N. First-year dental students: relationship between stress and performance. Int J Psychosom. 1987;34(3):17–19.	X
52.	Westerman GH, Grandy TG, Lupo JV, Mitchell RE. Relationship of stress and performance among first-year dental students. J Dent Educ. 1986;50(5):264–267.	X
53.	Register J. Dental students today. Feeling pressure/stress. Fla Dent J. 1986;57(2):6–7,58–59.			X	No management program
54.	Howard CE, Graham LE 2nd, Wycoff SJ. A comparison of methods for reducing stress among dental students. J Dent Educ. 1986;50(9):542–544.
55.	[No authors listed]. Management of stress in the dental practitioner. Dent Clin North Am. 1986;30(Suppl 4):S1–S146.	X			Not on students
56.	Musser LA, Lloyd C. The relationship of marital status and living arrangement to stress among dental students. J Dent Educ. 1985;49(8):573–578.	X
57.	Lloyd C, Musser LA. Stress in dental students. J Am Coll Dent. 1985;52(2):11–19.			X	No management program
58.	Tisdelle DA, Hansen DJ, St Lawrence JS, Brown JC. Stress management training for dental students. J Dent Educ. 1984;48(4):196–202.
59.	Sebor RJ. Stress: inherent to dentists or taught to dental students? Dent Stud. 1984;63(1):14–20.			X	No management program
60.	Schwartz RM, Eigenbrode CR, Cantor O. A comprehensive stress-reduction program for dental students. J Dent Educ. 1984;48(4):203–207.
61.	Ravins H. Dental orthopedics – stress management. Basal Facts. 1984;6(1):30–31.			X	Not study (note)
62.	Grandy TG, Westerman GH, Mitchell RE, Lupo JV. Stress among first-year dental students. J Dent Educ. 1984;48(10):560–562.			X	No management program
63.	Cohen H, Hurwitz M, Lanesman B, Myburg N, Prinsloo B. The perception and response to stress by dental students of the University of Witwatersrand. Diastema. 1982;10:16–21.	X
64.	Garbee WH Jr, Zucker SB, Selby GR. Perceived sources of stress among dental students. J Am Dent Assoc. 1980;100(6):853–857.	X
65.	Goldstein MB. Sources of stress and interpersonal support among first-year dental students. J Dent Educ. 1979;43(12):625–629.			X	No management program
66.	Jackson E, Mealiea WL Jr. Stress management and personal satisfaction in dental practice. Dent Clin North Am. 1977;21(3):559–576.		X
67.	Lobene RR, Fredericks M, Mundy P. The relationship between social class stress – anxiety responses, achievement, and professional attitudes of dental hygiene students. J Am Dent Hyg Assoc. 1972;46(2):113–117.	X
68.	Lobene RR, Fredricks MA, Mundy P. The relationship between social class, stress anxiety responses, academic achievement and professional attitudes of students of dental assisting. Dent Assist. 1971;40(8):11–15.	X
69.	Fredericks MA, Mundy P. Relations between social class, stress-anxiety responses, academic achievement, and professional attitudes of dental students. J Dent Educ. 1969;33(3):377–384.	X
70.	Fredericks MA, Mundy P. Dental students: relationship between social class, stress, achievement, and attitudes. J Am Coll Dent. 1967;34(4):218–228.	X

ShankarapillaiRNairMAGeorgeRThe effect of yoga in stress reduction for dental students performing their first periodontal surgery: a randomized controlled studyInt J Yoga201251485122346066

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AlzahemAMvan der MolenHTAlaujanAHSchmidtHGZamakhsharyMHStress amongst dental students: a systematic reviewEur J Dent Educ201115181821226800

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TisdelleDAHansenDJSt LawrenceJSBrownJCStress management training for dental studentsJ Dent Educ19844841962026371085

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