What question did this study set out to answer?

The study aims to evaluate the relationship between stress, TMD symptoms, and cortisol levels in dentistry students during their prosthodontic internship.

March 26, 2026Open Access

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

Key Points

The study aims to evaluate the relationship between stress, TMD symptoms, and cortisol levels in dentistry students during their prosthodontic internship.
Participants included 31 dental students in their 4th and 5th years during the internship.
Stress was assessed using the Perceived Stress Scale-10 (PSS-10).
Temporomandibular disorders were assessed with the Fonseca Anamnestic Index (FAI).
Cortisol levels were measured in saliva before and after the internship.
Data analysis was performed using Mann-Whitney U, Wilcoxon, and Spearman’s rho tests.
Stress levels significantly increased in 5th-year students after the internship (p=0.033).
4th-year students showed a trend towards increased stress, but it was not statistically significant (p=0.099).
Cortisol levels increased in both groups without statistical significance.
No significant change was found in FAI scores.
A positive correlation between stress and TMD scores was noted in 5th-year students before and after the internship.

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.

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