Association among physical activity, stress and oral health among university students: A cross-sectional study

This study aims to comprehensively examine the interrelationships among physical activity, stress, and oral health status in university students to provide empirical evidence for targeted oral health promotion strategies. A survey was conducted among current university students in mainland China. Physical activity was evaluated via the International Physical Activity Questionnaire Short Form, and stress was measured through the 14-item Perceived Stress Scale. Oral health status was evaluated through self-reported indicators, including gingival bleeding, toothache, and oral ulcer. Data were analyzed using multivariable logistic regression and structural equation modeling. A P value < .05 was considered statistically significant. A total of 1578 participants were included. Findings revealed that 47.7% of students had insufficient physical activity, while 38.7% reported high or excessive stress. Multivariable logistic regression showed that insufficient physical activity and elevated stress levels were associated with an increased risk of gingival bleeding and oral ulcers (P < .05). Structural equation modeling showed that physical activity was negatively associated with perceived stress (standardized coefficient = -0.360, P < .05), and perceived stress was positively associated with self‑reported oral symptoms (standardized coefficient = 0.411, P < .05). However, the direct association between physical activity and oral symptoms was not statistically significant (standardized coefficient = -0.009, P = .765). Physical activity, stress, and oral health are closely intertwined. Insufficient activity and high stress are critical determinants of poor oral health among university students. The observed association between physical activity and oral symptoms was mediated primarily through perceived stress rather than a direct effect. Universities should implement integrated interventions that encourage regular exercise and provide mental health support to enhance the holistic and oral well-being of the student population.