Dental Undergraduate Student Stress, Anxiety and Confidence in Endodontic Education: A Narrative Review.

Background: Endodontics is considered a challenging and stressful area by dental practitioners and particularly by dental undergraduate students. Stress or anxiety is prevalent among dental undergraduates, with academic and clinical factors considered the principal sources. In addition, the lowest level of student confidence is generally observed when undertaking complex procedures such as root canal treatment.

Objectives: The aim of this review was to investigate the factors responsible for stress, anxiety and confidence in endodontic education and to identify factors which could potentially moderate undergraduate student stress and enhance confidence, improve well-being before concluding by suggesting potential educational improvements.

Method: A narrative review was performed by searching 3 databases (Pubmed, Web of Science and Scopus). Inclusion criteria were original research reports related to undergraduate dental students' stress, anxiety or confidence in endodontics education. Quantitative, qualitative or mixed-method studies were considered.

Results: This narrative review included 51 studies, which were subdivided into six categories describing factors that have an influence on student stress, anxiety and confidence in endodontics: the patient, the clinical procedure, the academic staff, the teaching methods, the clinical organisation and the student. The management of the endodontic patient's expectations, personality and sometimes acute pain can be stressful for the student. The clinical endodontic procedure, with its complexity and multiple steps, visualisation difficulties and possible complications can also be challenging. Academic staff experienced in endodontics, who are supportive and provide consistent advice, are crucial in managing student stress and anxiety. Educational methods also play an important role in increasing confidence, with a reflective approach, a special focus on hands-on sessions and clinical support with systematic feedback. The clinic should be well-organised and ideally multi-disciplinary, with adequate endodontic equipment and should ensure that the student has sufficient time to practise. Finally, the student's individual stress level is an important factor. The year of training as well as gender should be considered as having an influence on the student stress level.

Conclusions: Undergraduate students find endodontics stressful. Educational improvements in endodontics can contribute to moderating the stress and increasing confidence, while improving endodontic learning and promoting student well-being.