Associations between psychological distress, nutritional attitudes, and oral hygiene behaviors in dental students

Abstract

Abstract Background This study aimed to investigate the interrelationships between psychological distress, nutritional attitudes, and oral health status among dental students and to evaluate the associations of sociodemographic and lifestyle factors on these parameters. Methods In this analytical cross-sectional study, 322 dental students (121 males, 201 females) from Gülhane Faculty of Dentistry were recruited between April and December 2025. Psychological distress was assessed using the Depression, Anxiety, and Stress Scale (DASS-21), nutritional attitudes were evaluated using the Nutritional Attitude Scale (NAS), and oral health status was determined using the Decayed, Missing, and Filled Teeth (DMFT) index based on clinical examination. Results The mean age of participants was 21.45 ± 1.58 years, and 62.4% were female. DMFT was not significantly associated with depression, anxiety, stress, or nutritional attitudes ( p > 0.05). In multiple linear regression analyses, depression was positively predicted by stress (β = 0.510, p < 0.001) and anxiety (β = 0.332, p < 0.001). Anxiety was strongly predicted by stress (β = 0.757, p < 0.001), while father’s education level, income source, and nutritional attitude were significant negative predictors. Stress was positively associated with smoking (β = 0.182, p = 0.001) and negatively associated with sex, living condition, and nutritional attitude (all p < 0.05). Nutritional attitude was positively predicted by toothbrushing frequency (β = 0.185, p = 0.001) and negatively associated with father’s education level (β = -0.160, p = 0.021), dental visit frequency (β = -0.117, p = 0.032), and alcohol use (β = -0.140, p = 0.016). DMFT showed no significant associations with depression, anxiety, or stress ( p > 0.05), although dental visit frequency was a significant negative predictor of DMFT (β = -0.208, p < 0.001). Conclusions Psychological well-being and nutritional attitudes were associated with oral hygiene behaviors and sociodemographic factors among dental students. Psychological distress components were strongly interrelated, with stress as a central factor linked to anxiety and depression. Nutritional attitudes were associated with both psychological and behavioral factors. DMFT showed no association with psychological or nutritional variables. These findings support integrating mental health, nutrition, and oral health promotion in preventive strategies. Findings should be interpreted as associations due to the cross-sectional design.

The authors' abstract, as published at the source. BMC Oral Health, 2026 · DOI ↗