Dental environment stress among international dental students in Tunisia: a national pilot study

Objective This study aimed to evaluate psychological distress among international dental students in Tunisia and to explore its relationship with dental environment stress (DES), acculturative stress, and perceived social support, with potential implications for academic performance and patient care. Materials and methods A cross-sectional pilot study was conducted in 2026 at the only accredited dental faculty in Tunisia. The study included all international dental students ( N = 95), of whom 48 participated (response rate: 50%), representing 8.9% of the total student population ( N = 1,066). International students were defined as non-Tunisian students originating mainly from Middle Eastern countries, with Arabic as their native language and English as a second language. Data were collected using an anonymous, self-administered online questionnaire. Psychological distress was measured using the DASS-21, DES using the Dental Environment Stress questionnaire, acculturative stress using the ASSIS, and perceived social support using the MSPSS. Descriptive, correlation, and multiple linear regression analyses were performed. Results Participants reported moderate levels of dental environment stress and acculturative stress, alongside relatively high perceived social support. No significant gender differences were observed across all variables. Correlation analysis showed a strong association between DES and psychological distress ( r = 0.731, p < 0.001), and a moderate association with acculturative stress. Regression analysis identified DES as the only significant predictor of psychological distress, explaining 55.8% of the variance, while acculturative stress, social support, and gender were not significant predictors. Conclusion International dental students in Tunisia exhibit heightened psychological vulnerability, with stress predominantly driven by academic demands and clinical training pressures. These findings highlight the need for targeted stress-reduction interventions, resilience-building strategies, and mental health support systems to promote well-being and safe clinical competency within this educational context.