Association Between Perceived Stress and Periodontal Health Among University Students in Pakistan: A Cross-Sectional Study

Abstract

Background: Stress perception is a common psychological problem among college/university students that may negatively impact their physical and oral well-being. Psychological stress has been linked to behavior modification, reduced immunity, poor oral hygiene habits, and ultimately, periodontal disease. Although there is growing appreciation for the role of psychological factors in oral health, there are very few reports on the link between stress perception and periodontal health among university students in Pakistan.

Objective: For the study of relationship between stress and periodontal health amongst the university students at universities in Lahore, Pakistan.

Methodology: The current descriptive cross-sectional study was conducted among 300 university students during the months of December 2025 through April 2026. Students were selected by means of convenience sampling method from different academic departments. Perception of stress among the participants was measured by using the PSS-10, whereas their periodontal condition was measured by CPI. Socio-demographic characteristics along with oral hygiene behaviors were also obtained. Data analysis was done by using SPSS software version 26. Chi square test and logistic regression were done for associations between stress and periodontal conditions.

Results: Participants' mean age was 21.8 ± 2.4 years. Participants with high perceived stress were 41.3%, moderate stress was 46.0% and low stress 12.7%. Participants having periodontal disease were 38.7%. High perceived stress showed significant association with prevalence of gingival bleeding, calculus formation and periodontal pockets among students with high perceived stress than students who had low stress levels (p<0.001). High perceived stress was an independent predictor of poor periodontal status even when adjusting for oral hygiene behaviors and demographics (Adj. OR =2.54; 95% CI: 1.48 – 4.36).

Conclusion: Perceived stress is positively correlated with periodontal disease among university students. Effective stress reduction strategies and dental health awareness campaigns could play a role in better periodontal outcomes among this group.