Background <p>Understanding the relationship between clinical anxiety and self-confidence in dental education is crucial for enhancing students’ perceptions of professional competence and improving educational processes. This study aimed to examine the association between clinical anxiety and self-confidence experienced by dental students during clinical training.</p> Methods <p>A cross-sectional, multi-center survey was conducted among 4th- and 5th-year undergraduate dentistry students (<i>n</i> = 548) enrolled in faculties across Türkiye. Data were collected online using a structured three-part questionnaire comprising demographics, 10 Likert-type items assessing clinical anxiety, and 10 Likert-type items evaluating clinical self-confidence. Each item was rated on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). Statistical analyses, including descriptive statistics and Kendall’s Tau correlation, were employed to examine the associations between clinical anxiety and self-confidence variables, with significance set at <i>p</i> &lt; 0.05.</p> Results <p>A total of 548 students participated (57.7% [<i>n</i> = 316] 4th-year, 42.3% [<i>n</i> = 232] 5th-year), with 64.4% (<i>n</i> = 353) female. Clinical anxiety was most pronounced regarding fear of making mistakes (37.8%, <i>n</i> = 207), difficult cases (45.3%, <i>n</i> = 248), time pressure during treatment (43.8%, <i>n</i> = 240), and complex procedures such as endodontics, prosthodontics, and surgery (39.1%, <i>n</i> = 214). In contrast, self-confidence was higher in areas such as professional competence (50.9%, <i>n</i> = 279), patient management (52.6%, <i>n</i> = 288), rapid decision-making (51.3%, <i>n</i> = 281), and skill development through faculty feedback (56.4%, <i>n</i> = 309). Correlation analyses demonstrated a weak but statistically significant negative relationship between clinical anxiety and self-confidence (τ = −0.07 to − 0.34, <i>p</i> &lt; 0.05), indicating that higher anxiety levels were associated with lower self-confidence across multiple domains.</p> Conclusions <p>This study indicates that clinical anxiety is associated with lower levels of self-confidence among dental students; however, self-confidence tends to increase with greater experience and constructive feedback. The findings suggest that teaching technical skills alone is insufficient in clinical education programs; curricula should also incorporate interventions aimed at enhancing students’ psychological resilience, including stress management, mentorship, and psychosocial support.</p>