CC BY 4.0 · Eur J Dent
DOI: 10.1055/s-0042-1760299
Original Article

The Impact of the SARS-CoV-2 Pandemic on Stress and Anxiety of Dental Students

Andreas Zenthöfer
1   Department of Prosthodontics, Dental School, University of Heidelberg, Heidelberg, Germany
Andreas Graf
1   Department of Prosthodontics, Dental School, University of Heidelberg, Heidelberg, Germany
Peter Rammelsberg
1   Department of Prosthodontics, Dental School, University of Heidelberg, Heidelberg, Germany
Anna-Luisa Klotz
1   Department of Prosthodontics, Dental School, University of Heidelberg, Heidelberg, Germany
› Author Affiliations
Funding None.


Objectives To investigate the impact of the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) pandemic on stress and anxiety of preclinical and clinical dental students.

Materials and Methods Dental students (participants) in their clinical course (CC; n = 64) or preclinical course (PCC; n = 53) were included in the study. The subjective perceived levels of stress and anxiety were evaluated using the Dental Environment Stress (DES) questionnaire and the Depression, Anxiety and Stress Scales (DASS) questionnaire. Cortisol levels were measured in saliva samples collected from participants. Knowledge of the pandemic was evaluated using a 100-mm visual analog scale. All data were collected twice: once during the university holidays and once during term time.

Statistical Analysis Results from DES, DASS, and salivary cortisol tests were compared between baseline and follow-up using descriptive and bivariate statistics. Multivariate linear regression models were computed with DES, DASS, and cortisol values as dependent variables to analyze possible influencing factors.

Results Participants showed medium levels of stress and anxiety at baseline and follow-up. The DASS score in the “anxiety” subdomain was significantly higher in the PCC group than in the CC group at baseline (p < 0.001) and increased during term time. DASS scores in the “stress” subdomain also increased during term time. However, both subdomain scores were lower than the cutoff value for a psychological disorder. The mean total DES scores were 615.9 ± 97.7 in the CC group and 580.40 ± 98.9 in the PCC group. These scores indicated medium stress levels and were not significantly different between the groups, nor did they change during the study period. Mean saliva cortisol levels were higher in the CC group (9.2 ± 5.2) than in the PCC group (4.9 ± 2.2) at baseline (p < 0.001) but converged by follow-up. Multivariate regression models showed that intraindividual perception of stress at baseline was consistently the most important aspect for changes in stress and anxiety levels during term time. The SARS-CoV-2 pandemic affected stress and anxiety levels in some participants, but this was not ubiquitous.

Conclusion Intraindividual differences in stress perception seem to be more relevant than course affiliation (preclinical or clinical) or the SARS-CoV-2 pandemic to stress and anxiety levels in dental students.

Authors' Contribution

A.Z. conceived the idea, performed statistical analysis and was involved in writing the manuscript. P.R. conceived the idea and reviewed the manuscript. A.G. assessed data and reviewed the manuscript. A.-L.K. conceived the idea, supervised data assessment and was involved in writing the manuscript.

Ethics and Consent to Participate

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Informed consent was obtained from all participants included in the study.

Publication History

Article published online:
05 June 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (

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