Dentistry is a highly stressful program; stress is associated with xerostomia and periodontal disease.

Objective: This study aims to investigate the association of perceived stress, severity of xerostomia, and periodontal status in dental students.

Methods: This was a two-phase cross-sectional study of 245 Universiti Sains Malaysia (USM) undergraduate dental students. Phase 1 involved administration of the Perceived Stress Scale (PSS-10) and Summated Xerostomia Inventory (SXI). In phase 2, the Community Periodontal Index (CPI) was performed on 150 students to determine their periodontal status.

Results: Mean PSS-10 and SXI scores were 19.6 (SD 5.47) and 7.9 (SD 2.04), respectively. Only 7.3% students had healthy periodontium while 17.3% had gingival bleeding, 65.3% had calculus, 6.7% had shallow pockets, and 3.3% had deep pockets. The association of perceived stress, severity of xerostomia, and periodontal status was not significant. Nevertheless, a significant positive correlation was found between PSS-10 and SXI scores (r = 0.318, p < 0.01).

Conclusion: Most USM dental students were affected by some degree of periodontal disease, but it was not associated with perceived stress or severity of xerostomia. Students with higher perceived stress had more severe xerostomia. Information from this study could be utilised by the dental school in planning towards providing a stress-free training environment.


  1. Divaris K, Barlow PJ, Chendea SA, Cheong WS, Dounis A, Dragan IF, Hamlin J, Hosseinzadeh L, Kuin D, Mitrirattanakul S, Mo’nes M, Molnar N, Perryer G, Pickup J, Raval N, Shanahan D, Songpaisan Y, Taneva E, Yaghoub-Zadeh S, West K, Vrazic D. The academic environment: The students’ perspective. Eur J Dent Educ. 2008; 12 Suppl 1:120-30.
  2. Kopp MS, Thege BK, Balog P, Stauder A, Salavecz G, Rózsa S, Purebl G, Adám S. Measures of stress in epidemiological research. J Psychosom Res. 2010; 69(2):211-25.
  3. Cohen S, Kessler RC, Gordon LU, editors. Measuring stress: A guide for health and social scientists. New York: Oxford University Press; 1997.
  4. Al-Sowygh ZH. Academic distress, perceived stress and coping strategies among dental students in Saudi Arabia. Saudi Dent J. 2013; 25(3):97-105.
  5. Saddki N, Sukerman N, Mohamad D. Association between emotional intelligence and perceived stress in undergraduate dental students. Malays J Med Sci. 2017; 24(1):59-68.
  6. Collin V, O’Selmo E, Whitehead P. Stress, psychological distress, burnout and perfectionism in UK dental students. Br Dent J. 2020; 229(9):605- 14.
  7. Foster K, Fethney J, Kozlowski D, Fois R, Reza F, McCloughen A. Emotional intelligence and perceived stress of Australian pre-registration healthcare students: A multi-disciplinary cross-sectional study. Nurse Educ Today. 2018; 66:51-6.
  8. Drachev SN, Stangvaltaite-Mouhat L, Bolstad NL, Johnsen JK, Yushmanova TN, Trovik TA. Perceived stress and associated factors in Russian medical and dental students: A cross-sectional study in North-West Russia. Int J Environ Res Public Health. 2020; 17(15):5390.
  9. Elani HW, Allison PJ, Kumar RA, Mancini L, Lambrou A, Bedos C. A systematic review of stress in dental students. J Dent Educ. 2014; 78(2):226-42.
  10. Botelho J, Machado V, Proença L, Oliveira MJ, Cavacas MA, Amaro L, Águas A, Mendes JJ. Perceived xerostomia, stress and periodontal status impact on elderly oral health-related quality of life: Findings from a cross-sectional survey. BMC Oral Health. 2020; 20(1):199.
  11. Sabbah W, Gomaa N, Gireesh A. Stress, allostatic load, and periodontal diseases. Periodontol 2000.
  12. 2018; 78(1):154-61.
  13. Bulthuis MS, Jan Jager DH, Brand HS. Relationship among perceived stress, xerostomia, and salivary flow rate in patients visiting a saliva clinic. Clin Oral Investig. 2018; 22(9):3121-7.
  14. Mao W, Chen Y, Wu B, Ge S, Yang W, Chi I, Dong X. perceived stress, social support, and dry mouth among US older Chinese adults. J Am Geriatr Soc. 2019; 67(S3):S551-6.
  15. Tanasiewicz M, Hildebrandt T, Obersztyn I. Xerostomia of various etiologies: A review of the literature. Adv Clin Exp Med. 2016; 25(1):199-206.
  16. Mizutani S, Ekuni D, Tomofuji T, Azuma T, Kataoka K, Yamane M, Iwasaki Y, Morita M. Relationship between xerostomia and gingival condition in young adults. J Periodontal Res. 2015; 50(1):74-9.
  17. GBD 2016 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017; 390(10100):1211-59.
  18. Oral Health Division, Ministry of Health Malaysia. National Oral Health Survey of Adults 2010 (NOHSA 2010). Putrajaya, Malaysia: Oral Health Division, Ministry of Health Malaysia; 2013.
  19. Tonetti MS, Jepsen S, Jin L, Otomo-Corgel J. Impact of the global burden of periodontal diseases on health, nutrition and wellbeing of mankind: A call for global action. J Clin Periodontol. 2017; 44(5):456-62.
  20. Atif S, Syed SA, Sherazi UR, Rana S. Determining the relationship among stress, xerostomia, salivary flow rate, and the quality of life of undergraduate dental students. J Taibah Univ Med Sci. 2021; 16(1):9-15.
  21. Evirgen S, Kamburoglu K. Effects of tongue coating and oral health on halitosis among dental students. Oral Health Prev Dent. 2013; 11(2):169- 73.
  22. Dhaifullah E, Al-Maweri SA, Al-Motareb F, Halboub E, Elkhatat E, Baroudi K, Tarakji B. Periodontal health condition and associated factors among university students, Yemen. J Clin Diagn Res. 2015; 9(12):ZC30-3.
  23. Dhaifullah E, Al-Maweri SA, Koppolu P, Elkhtat E, Mostafa D, Mahgoub M. Body mass index and periodontal health status among young Saudi adults: A cross-sectional study. Ann Saudi Med. 2019; 39(6):433-40.
  24. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983; 24(4):385-96.
  25. Thomson WM, van der Putten GJ, de Baat C, Ikebe K, Matsuda K, Enoki K, Hopcraft MS, Ling GY. Shortening the xerostomia inventory. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011; 112(3):322-7.
  26. Wang Z, Li W, Hong X, Su JZ, Hua H, Peng X, Lv L, Yu GY. Minor salivary glands function is decreased in hyposalivation-related diseases. Arch Oral Biol. 2016; 69:63-70.
  27. World Health Organization. Oral health surveys: Basic methods. 4th ed. Geneva: World Health Organization; 1997.
  28. Lin XJ, Zhang CY, Yang S, Hsu ML, Cheng H, Chen J, Yu H. Stress and its association with academic performance among dental undergraduate students in Fujian, China: A cross-sectional online questionnaire survey. BMC Med Educ. 2020; 20(1):181.
  29. Nguyen TTT, Seki N, Morio I. Stress predictors in two Asian dental schools with an integrated curriculum and traditional curriculum. Eur J Dent Educ. 2018; 22(3):e594-601.
  30. Anbumalar C, Dorathy A, Jaswanti V, Priya D, Reniangelin D. Gender differences in perceived stress levels and coping strategies among college students. Int J Indian Psychol. 2017; 4(4):22-33.
  31. Loos BG, Van Dyke TE. The role of inflammation and genetics in periodontal disease. Periodontol 2000. 2020; 83(1):26-39



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