Introduction
Stress is a reaction to adapt the individuals to factors and conditions that cause mental and physical pressure. 1 Anxiety is defined as the "fear of unknown".2 A specific phobia is regarded as the frequently encountered anxiety disorders. Dentistry is a stressful career. This stress associated with dentistry is due to the nature of clinical work, working environment and personality traits of individuals who choose this career as well as the small area to work with. Of all dental treatments, endodontic treatments often cause occupational stress among dentists, dental students, and even endodontists. 3
There are several reasons for occupational stress and anxiety in endodontic treatments including lack of a direct vision to the working area, as well anatomical variability and complexity of the root canal system. 4 Stressful conditions and anxiety can negatively affect the occupation and wellbeing of dentists. One important group of people is dental students, who are future frontline health care providers. 5 It is necessary for a dental student to learn about the techniques that can help them to overcome their own anxiety.4 A decrease in their anxiety levels would make them confident practitioners, who could in turn treat their patients well. 6, 7
A questionnaire study was conducted among undergraduate internship students to evaluation the stress and anxiety during the endodontic treatment.
Materials and Methods
The study was conducted among undergraduate dental students of three different colleges. Sample size was calculated to be 100 numbers and a questionnaire consisting of 15 questions were prepared. The questions were based on the procedures of root canal treatment. To assess the stress and anxiety level, workload and loss of control during endodontic treatment, a questionnaire was circulated among undergraduate interns and then collected. It was ensured that the questionnaire was understandable for the dental students and had optimal internal validity.
Result
This study was to assess the stress and difficulty experienced by the dental students during endodontic treatment. The result was represented using bar chart (Figure 1). 70% of students reported that canal location is the reason for the fear of endodontic treatment, but their anxiety starts before the treatment begins. Around 60% of students have moderate level of anxiety before starting the treatment and 70% manifest sweating during the process of the endodontic treatment.
Access cavity preparation of the posterior teeth and oral fluid control were considered as the factors to feel stressed during the procedure among 51% and 29% of the undergraduates respectively.(Figure 2) According the result the following factors cleaning and shaping of the canal is the time consuming procedure and 50% of students occasionally experience difficulty in handling endodontic files. On an average of 46% -47% of the dental students get anxious about post-operative pain and RCT failure after the treatment.
Discussion
In the present study, generally anxiety and stress during endodontic treatment is common among undergraduate dental students. This primarily refers to difficulty in canal location, more during access cavity preparation of posterior teeth, although the anxiety and stress starts before the treatment.
According to Saqib Ali, et al in 2015 revealed that dental students can suffer from phobia related to different dental procedures, with the limitations which included a small sample size and date a represent from only one dental college. 8 M. Zare Jahromi, et al in 2012 reported that stress among the undergraduate dental students was more than those of professionals and postgraduate dental students. 9
SH. Emamikhah Abarghooii, et al in 2016 revealed that the coping strategies had a direct correlation with the level of stress among the dental students, such that effective coping strategies decrease the stress level of students. Stress decreases the efficiency and efficacy of work and increases the risk of procedural errors. 10 Anxiety negatively affects the wellbeing of the dentist.
Anxiety and stress may be due to lack of knowledge of the anatomy of root canal and improper instrumentation skills. To overcome this, proper guidance and supervision should be done by endodontists. Well-designed access preparation is essential for good endodontic results, the clinician should know about the guidelines for access cavity preparation, thus it will eradicate the fear before starting the endodontic treatment and canal location. 11
Frequent practice in extracted tooth will help to overcome the fear of access cavity preparation and canal location. As per the results, time consuming is also a factors to be considered for stress during endodontic treatment. On average of 70 students reported that shaping and cleaning the canal during treatment makes them to feel stressed and patient handling is also challenging during procedure (i.e.) patient cooperation, oral fluid control can also make to get fear. Informing about the procedures to patients prior to the treatment will and proper instrumentation decreases the risk of procedural errors. .make patient relax and cooperative. Proper isolation will provide clean operative area to work
Conclusion
According to this study, higher level of anxiety were seen among the undergraduates and therefore, the stress control must be focused before starting the procedure, access cavity preparation and while handling endodontic instruments. For dental undergraduate students, stress controlling training and techniques should be recommended through dental workshop.
