الفهرس 
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Abstract
Stress is the biological reaction to any adverse internal or external stimuli. Prolonged stress can lower the human performance and lead to negative health consequences and burnout. The dental school, with its strict academic and clinical requirements, is regarded as a highly pressurized environment for students. Thus, the aim of the study was to evaluate the perceived sources of stress among dental students and coping mechanisms to overcome those stressors.
A cross-sectional study was carried out using a self- administered questionnaire among third and fifth undergraduate dental students, at both faculties of dentistry, in Alexandria University and Pharos University, during spring 2019 academic semesters.The total number of students, who responded to the questionnaire of this study, was 358 students, representing a response rate nearly 95%. The participants assessed the stressors on a 4-points Likert scale (not stressful, slightly stressful, moderately stressful and severely stressful) that was converted into a quantifiable estimation using mean and standard deviation. The internal consistency of the questionnaire was calculated using chronbach’s alpha and was acceptable for all domains (more than 0.6).The questionnaire comprised two main sections. The first section dealt with socio-demographic information regarding the students’ gender, age, nationality and academic year of undergraduate study. The second section investigated the possible sources of stress that were included in seven main domains.
In Alexandria University, the students’ mean age was 21.94 ± 1.17, with females representing about three quarter of the study participants (73.3%), and 65.2% were in their clinical years compared to Pharos University where the mean age was 21.74 ± 1.37 and males accounted for 57.4%, with 49.2% being in their clinical years. Excellent grade was the most frequent among students in Alexandria University (38.5%) compared to good grade (62.1%) in Pharos University.
All seven domains of stress exhibited significantly higher mean scores (p <0.001) among students in Alexandria University (72.74 ± 12.64) than Pharos University (62.48 ± 14.46). Faculty and administration as well as workload domains showed the highest mean values of stress among both Alexandria students ( 18.73± 4.37 and 19.52 ± 3.46, respectively) and Pharos students ( 15±4.98 and 16.83 ± 4.31, respectively), whereas performance pressure was the lowest in both faculties (2.73 ± 0.98 and 2.40 ± 1.04, respectively). Social stressors were nearly the same among both university students (p=0.80).
Comfort in religion (88.3%) as well as praying and meditation (88%) were the most common coping strategies adopted by students, in both universities. Meanwhile, smoking tobacco and behavioral disengagement were the least used mechanisms.
The multivariable regression analysis showed that males were almost 5 times less stressed than females and students of the governmental Alexandria University were 6.65 times more stressed than those enrolled in private Pharos University. Moreover, students of preclinical years were 11.41 times less stressed than those in the clinical years, with those having good grade in previous year being the least stressed among all participating students. Tobacco and drug use decreased stress more than twice any other mechanism, whereas behavioral disengagement was the least effective.
The present findings; therefore, emphasize the pressing need to reduce such stressors during the academic dental education and to encourage constructive coping mechanisms.
Finally the total stress score was significantly higher among Alexandria University students, which is the expected outcome of all the stress factors, documenting that Alexandria dental students are leading through their study years witha higher level of stress than that encountered by Pharos students, indicating some differences due to the study and educational environment of public and private dental schools.