The deconstruction of chronic orofacial pain and a hiding inhibition pathway of orofacial pain: the trigeminal proprioceptive mesencephalic periaqueductal gray pathway.

Chronic orofacial pain has a significant negative impact that influences individuals' quality of life and our society. The prevalence is around 11.2% to 33.2% and remains high in females. Currently, there are two main diagnostic classification systems that are used internationally for chronic pain: the International Classification of Diseases, 11th Revision (ICD-11), which was published by the World Health Organization (WHO) in 2018, and the International Classification of Orofacial Pain, which was published by the International Association for the Study of Pain (IASP) in 2020. Deficits in ascending and descending pain modulation pathways may be involved in the chronic pain pathophysiology. A newly described "trigeminal proprioceptive mesencephalic periaqueductal gray pathway" is considered to be the mechanism of action of occlusal appliance in managing orofacial pain. The genetic basis of chronic orofacial pain is not yet fully understood, but a genetic susceptibility involving multiple genes among the peripheral nerves, brainstem and higher brain regions to regulate and suppress the transmission of pain signals, thereby modulating the perception of pain, is likely.

Teledentistry from research to practice: a tale of nineteen countries.

Aim: The COVID-19 pandemic has accelerated teledentistry research with great interest reflected in the increasing number of publications. In many countries, teledentistry programs were established although not much is known about the extent of incorporating teledentistry into practice and healthcare systems. This study aimed to report on policies and strategies related to teledentistry practice as well as barriers and facilitators for this implementation in 19 countries. Methods: Data were presented per country about information and communication technology (ICT) infrastructure, income level, policies for health information system (HIS), eHealth and telemedicine. Researchers were selected based on their previous publications in teledentistry and were invited to report on the situation in their respective countries including Bosnia and Herzegovina, Canada, Chile, China, Egypt, Finland, France, Hong Kong SAR, Iran, Italy, Libya, Mexico, New Zealand, Nigeria, Qatar, Saudi Arabia, South Africa, United Kingdom, Zimbabwe. Results: Ten (52.6%) countries were high income, 11 (57.9%) had eHealth policies, 7 (36.8%) had HIS policies and 5 (26.3%) had telehealth policies. Six (31.6%) countries had policies or strategies for teledentistry and no teledentistry programs were reported in two countries. Teledentistry programs were incorporated into the healthcare systems at national (n = 5), intermediate (provincial) (n = 4) and local (n = 8) levels. These programs were established in three countries, piloted in 5 countries and informal in 9 countries. Conclusion: Despite the growth in teledentistry research during the COVID-19 pandemic, the use of teledentistry in daily clinical practice is still limited in most countries. Few countries have instituted teledentistry programs at national level. Laws, funding schemes and training are needed to support the incorporation of teledentistry into healthcare systems to institutionalize the practice of teledentistry. Mapping teledentistry practices in other countries and extending services to under-covered populations increases the benefit of teledentistry.

Patient-centred care attitudes and knowledge: a national study of BDS students in New Zealand.

OBJECTIVE: The aim of this study was to investigate the attitudes and knowledge towards patient-centred care among Bachelor of Dental Surgery (BDS) students in New Zealand. METHOD: The study was a mixed methods cross-sectional national study of the BDS students in New Zealand. All 2021 BDS students at the New Zealand's National Centre for Dentistry, New Zealand, were recruited in the study. The Patient-Practitioner Orientation Scale (PPOS) questionnaire was used to evaluate the dental students' attitudes and knowledge of patient centred care. The students' perspectives on the BDS curriculum regarding patient-centred care were also collected. ANOVA and the Student's T-test were used to compare the difference among the BDS years, gender, and background. RESULTS: A total of N = 277 (277/346; 80% response rate) students completed the study. Female students had higher scores than male students for sharing (difference = 0.19, 95% CI 0.04-0.34, P = 0.01), caring (difference = 0.15, 95% CI 0.01-0.29, P = 0.03) and PPOS (difference = 0.17, 95% CI 0.05-0.30, P < 0.01). Domestic students had higher scores than international students for caring (difference = 0.35, 95% CI 0.21-0.50, P < 0.01) and PPOS (difference = 0.22, 95% CI 0.08-0.35, P < 0.01). Three main themes of patient-centred care were extracted from the qualitative analysis of students' perspectives: (1) Understanding of the concept of patient-centred care, (2) Perception of the importance of patient-centred care in dentistry, and (3) Perspective on the curriculum about patient-centred care. CONCLUSION: Most dental students favoured a patient-centred approach. According to dental students, the patient-centred care component of their education should be increased.

Effect of the Rho-Kinase/ROCK Signaling Pathway on Cytoskeleton Components.

The mechanical properties of cells are important in tissue homeostasis and enable cell growth, division, migration and the epithelial-mesenchymal transition. Mechanical properties are determined to a large extent by the cytoskeleton. The cytoskeleton is a complex and dynamic network composed of microfilaments, intermediate filaments and microtubules. These cellular structures confer both cell shape and mechanical properties. The architecture of the networks formed by the cytoskeleton is regulated by several pathways, a key one being the Rho-kinase/ROCK signaling pathway. This review describes the role of ROCK (Rho-associated coiled-coil forming kinase) and how it mediates effects on the key components of the cytoskeleton that are critical for cell behaviour.

Prevalence of halitosis among young adults in Dunedin, New Zealand.

OBJECTIVES: To investigate the prevalence of halitosis in young adults. METHODS: Young adults (n = 372; mean age = 21.0 ± 2.6 years old, range = 18-30 years) in Dunedin, New Zealand, were recruited into the cross sectional study after providing informed consent. The prevalence of halitosis was determined using both objective measurements (parts per billion [ppb] volatile sulphur compounds [VSCs] in the exhaled air) and subjective measurements (self-reported halitosis questionnaire, tongue coating index, and organoleptic assessment). RESULTS: Volatile sulphur compounds measurements indicated that the prevalence of halitosis (values ≥140 ppb) was 31.2%; 25.6% of participants self-reported halitosis. The organoleptic assessment revealed that 14.3% of the participants had a score of ≥2. A positive correlation was found between the VSC measurements and organoleptic assessment (p < 0.05). No significant relationship was found between self-reported halitosis and either organoleptic assessment or VSC measurements. Self-reported dry mouth, smoking, oral hygiene index, DMFT index, and tongue coating score were significantly associated with the organoleptic assessment (p < 0.05). The self-reported dry mouth, mouth breathing and tongue coating score were significantly associated with the VSC scores (p < 0.05). CONCLUSION: Halitosis, as represented by VSC, was found in 31.2% of the participants. VSC scores and organoleptic assessment were positively correlated. There was no significant relationship between self-reported halitosis and either organoleptic assessment or VSC measurements.

Review of taste and taste disturbance in COVID-19 patients.

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is responsible for the coronavirus disease 2019 (COVID-19) pandemic that has become a significant global public health concern. The virus gains entry to cells via angiotensin-converting enzyme-2 (ACE2) receptors, which have been found to be the functional receptor for SARS-CoV-2 infection. High expression of ACE2 is found in type II alveolar cells, macrophages, bronchial and tracheal epithelial cells and in the oral cavity, particularly on the tongue. Taste disturbance is one of the early symptoms of COVID-19, suggesting that taste cells in taste buds are vulnerable to SARS-CoV-2 infection. Taste is modulated by hormones that are regulated in the renin-angiotensin-aldosterone system. Hypothetical causes of taste disturbance by SARS-CoV-2 may be due to direct cell and/or neuronal injuries, inflammatory responses and dysregulation of ACE2.

Pathological mechanism of chondrocytes and the surrounding environment during osteoarthritis of temporomandibular joint.

Temporomandibular joint (TMJ) osteoarthritis is a common chronic degenerative disease of the TMJ. In order to explore its aetiology and pathological mechanism, many animal models and cell models have been constructed to simulate the pathological process of TMJ osteoarthritis. The main pathological features of TMJ osteoarthritis include chondrocyte death, extracellular matrix (ECM) degradation and subchondral bone remodelling. Chondrocyte apoptosis accelerates the destruction of cartilage. However, autophagy has a protective effect on condylar chondrocytes. Degradation of ECM not only changes the properties of cartilage but also affects the phenotype of chondrocytes. The loss of subchondral bone in the early stages of TMJ osteoarthritis plays an aetiological role in the onset of osteoarthritis. In recent years, increasing evidence has suggested that chondrocyte hypertrophy and endochondral angiogenesis promote TMJ osteoarthritis. Hypertrophic chondrocytes secrete many factors that promote cartilage degeneration. These chondrocytes can further differentiate into osteoblasts and osteocytes and accelerate cartilage ossification. Intrachondral angiogenesis and neoneurogenesis are considered to be important triggers of arthralgia in TMJ osteoarthritis. Many molecular signalling pathways in endochondral osteogenesis are responsible for TMJ osteoarthritis. These latest discoveries in TMJ osteoarthritis have further enhanced the understanding of this disease and contributed to the development of molecular therapies. This paper summarizes recent cognition on the pathogenesis of TMJ osteoarthritis, focusing on the role of chondrocyte hypertrophy degeneration and cartilage angiogenesis.

Naringenin promotes SDF-1/CXCR4 signaling pathway in BMSCs osteogenic differentiation.

INTRODUCTION: Naringenin, a dihydro-flavonoid compound that shows chemotactic activity, may have a good application prospect in repairing bone tissue, but its specific mechanism in bone regeneration, especially the osteogenic differentiation of stem cells, needs for a further study. The aim of this study was to investigate the effect of naringenin on the osteogenic differentiation and its roles in the C-X-C chemokine receptor type 4/stromal cell-derived factor 1 (SDF-1/CXCR4) signal pathway of bone marrow-derived mesenchymal stem cells (BMSCs). MATERIAL AND METHODS: BMSCs were harvested from the femurs and tibias of 4-to-6-week-old male Sprague-Dawley rats. Cell Counting kit-8 assay was used to determine cytotoxicity of naringenin. Alkaline phosphatase (ALP) activity was measured in cell's precipitates and alizarin-red staining was performed to determine the osteogenic differentiation capacity of the BMSCs. Real-time polymerase chain reaction, enzyme-linked immunosorbent assay and western blotting were adopted to determine the expression of genes and proteins. RESULTS: The cellular morphology was spindle-shaped, and arranged in radial and whorled patterns. The flow cytometric analysis have confirmed the presence of characteristic surface proteins in the harvested BMSCs. Different concentrations (0-200 µg/ml) of naringenin have no influence on the viability and proliferation rate of the BMSCs. The highest ALP activity was found at culture day 7 and 9 when the concentration of naringenin was 75 and 100 µg/ml. Positive red or dark red stained cells with mineralized nodules can be observed on day 14. The expression of ALP, Runt-related transcription factor 2, CXCR4 and SDF-1a at the gene and protein levels in naringenin-treated cells were significantly higher than those in the control cells. Moreover, AMD3100, an inhibitor of CXCR4, suppressed the expression of the studied genes and proteins. CONCLUSIONS: Naringenin does not show toxic effect on BMSCs. Naringenin promotes the expression of the SDF-1a gene and protein via the SDF-1/CXCR4 signaling pathway. A better understanding of the mechanisms of naringenin action would be helpful for developing specific therapeutic strategies to improve bone regeneration after injuries.

Management of oral medicine emergencies during COVID-19: A study to develop practise guidelines.

Coronavirus disease (COVID-19) pandemic has become a significant global public health concern. Since the announcement of the Public Health Emergency of International Concern, many countries have implemented lockdown and restrictive quarantines; therefore, routine dentistry, as well as oral medicine practise, have been suspended in several countries. However, urgent oral cares and emergencies are still operated and delivered by on-call dental practitioners. The objective of this study was to investigate the management of oral medicine emergency during a viral pandemic such as COVID-19. During the lockdown period, digital technologies, such as video conferencing with Zoom, Google Meeting or WhatsApp, are useful and efficient tools that oral medicine practitioners could consider to use for patient triage, managing emergencies, reassure, and follow patients remotely. Oral medicine emergencies can be carefully evaluated and triaged via video conferencing and sometimes phone contact, to avoid life-threatening risks while realising the limitations by both patient and clinician.

A multicenter study of dental curricula in Asia/Pacific nations: The views and experiences of final-year dental students.

OBJECTIVES: The objective of this qualitative study was to gain greater understanding of final-year dental students' views on and experience of their dental curricula in 4 universities from different Asia/Pacific countries, including New Zealand, Australia, and Hong Kong (China). METHODS: A qualitative study approach was used, with semistructured interviews conducted with final-year students from each of the 4 universities. RESULTS: Interviews were conducted with 60 final-year dental students, and 5 main themes were extracted from the interviews: (1) the definition of an "ideal" dental curriculum, (2) theoretical teaching, (3) transitional tools, (4) assessment, and (5) grading. CONCLUSION: The findings provide insight into final-year students' views of dental curricula and suggestions on possible areas of reform in the dental curriculum. Further investigations are necessary to provide a curriculum that enables students to become competent, future-ready dental practitioners.

Quantitative and qualitative analyses of orthodontic-related videos on YouTube.

OBJECTIVES: To investigate content of orthodontic-related videos on YouTube to improve the understanding of orthodontic patients' perceptions and treatment experiences. MATERIALS AND METHODS: A systematic search was conducted on YouTube on March 20, 2018, and updated on August 4, 2019, to identify all relevant videos using search terms "orthodontic," "orthodontics," "braces," and "orthodontic braces." The data set was captured from YouTube Data API (Application Programming Interface) and stored in an Excel database using a query function written in Python. All videos captured were viewed and categorized by three independent dental investigators using thematic analysis. The top 100 videos (by view count) related to patients' treatment experience were further analyzed using discourse analysis. RESULTS: A total of 600 orthodontic videos were screened, and 546 were included in the study. Six main themes were identified: (1) individual review of orthodontic treatment (45.8%, n = 250), (2) entertainment (19.8%, n = 108), (3) education (18.3%, n = 100), (4) advertisements (6.6%, n = 36), (5) time lapse of orthodontic treatment (5.3%, n = 29), and (6) do-it-yourself orthodontics (4.2%, n = 23). Of the top 100 videos related to patient's individual review of treatment, patients' main focuses were on pain (24%), problems with chewing and swallowing (12%), and adhesive removal (10%). CONCLUSIONS: Orthodontic-related YouTube videos are diverse in nature. The most common video category was video providing an individual review of orthodontic treatment experience. Other popular video categories included entertainment, education, and advertisements. A range of do-it-yourself YouTube videos were also identified. YouTube may provide an opportunity for orthodontic professionals to disseminate health information.

Oral health knowledge and practice among orthodontic clients in China and New Zealand.

Background: The oral hygiene habits of clients wearing fixed orthodontic appliances is poorly understood. Assessment of oral hygiene behavioural patterns is essential for understanding clients' oral health care needs. The aim of this study was to investigate orthodontic clients' oral hygiene behaviours, brushing techniques, and oral hygiene awareness. Methods: A total of 200 orthodontic clients wearing fixed orthodontic appliances were consecutively recruited from the Sichuan Provincial Hospital, Chengdu, China, and the Faculty of Dentistry, University of Otago, Dunedin, New Zealand. A 47-item questionnaire was used to survey study participants. Results: The survey had a 92% response rate, with 67.5% of respondents being female and 32.5% male. Most were non-smokers (94.2%) and the majority (80.0%) brushed their teeth twice daily. Most (80.4%) brushed their teeth for 1 to 2 minutes, and 68.7% positioned their toothbrush both horizontally and vertically, with horizontal being the preferred direction of motion. One-third (33.5%) did not use any auxiliary oral hygiene aids; most snacked between meals; only 31.4% received professional tooth cleaning during orthodontic treatment; and 56.8% experienced an increased level of halitosis after appliance placement. Most respondents (79.4%) thought their oral hygiene was good, but 51.0% reported bleeding gums during tooth brushing, 31.4% found they rarely bled, and only 17.6% reported no bleeding. Most respondents agreed that good oral health was very important for orthodontic treatment and that their own efforts were the most important factors. Conclusions: Client awareness of the importance of oral hygiene during orthodontic treatment requires improvement. Clinician reinforcement of oral hygiene should become a priority for orthodontic clients.

Contexte: Les habitudes d'hygiène buccodentaire des clients qui portent des appareils orthodontiques fixes sont mal comprises. L'évaluation des modèles de comportement en matière d'hygiène dentaire est essentielle pour comprendre les besoins en soins de santé buccodentaire des clients. L'objectif de cette étude était d'étudier les comportements d'hygiène buccodentaire des clients orthodontiques, leurs techniques de brossage, et leurs connaissances en matière d'hygiène buccodentaire. Méthodologie: Un total de 200 clients orthodontiques portant des appareils orthodontiques fixes ont été recrutés consécutivement à l'Hôpital Sichuan Provincial, à Chengdu en Chine et à la Faculté de dentisterie de l'Université d'Otago, à Dunedin en Nouvelle-Zélande. Un questionnaire de 47 éléments a été utilisé pour sonder les participants à l'étude. Résultats: Le sondage avait un taux de réponse de 92 %; 67,5 % des répondants étaient des femmes et 32,5 % étaient des hommes. La plupart parmi eux étaient des non-fumeurs (94,2 %) et la majorité (80,0 %) se brossait les dents 2 fois par jour. Pour la plupart (80,4 %), le brossage durait entre 1 et 2 minutes, et 68,7 % plaçaient leur brosse à dents horizontalement et verticalement; la position horizontale étant la direction de mouvement préférée. Un tiers (33,5 %) des répondants n'utilisaient pas d'aides-auxiliaires d'hygiène buccodentaire, la plupart mangeaient une collation entre les repas, seulement 31,4 % ont obtenu un nettoyage dentaire professionnel au cours de leur traitement orthodontique, et 56,8 % ont connu une augmentation du niveau d'halitose après la pose d'un appareil. La plupart des répondants (79,4 %) pensaient avoir une bonne hygiène buccodentaire, mais 51,0 % parmi eux ont déclaré avoir des saignements de gencives pendant le brossage des dents, 31,4 % ont trouvé qu'ils saignaient rarement, et seulement 17,6 % ont déclaré ne pas saigner. La plupart des répondants ont convenu qu'une bonne santé buccodentaire était très importante pour le traitement orthodontique et que leurs propres efforts étaient les facteurs les plus importants. Conclusion: La sensibilisation des clients à l'importance de l'hygiène buccodentaire pendant le traitement orthodontique exige une amélioration. Le renforcement de l'hygiène buccodentaire par les cliniciens devrait devenir une priorité pour les clients orthodontiques.

Use of traditional medicine for dental care by different ethnic groups in New Zealand.

BACKGROUND: There is an increasing public interest in the use of TM internationally, yet there is a paucity of research on the use of TM by the public in the dental setting. This study aimed to explore the views, use of and access to TM in dentistry among different ethnic groups residing in New Zealand. METHODS: Qualitative study and in-depth interviews were used. An individual semi-structured questionnaire was used to collect data. Interviews were recorded, transcribed, and analysed using an inductive approach to identify the main themes. RESULTS: Three main themes were extracted from interviews with 14 participants from diverse cultural backgrounds: [1] the perspectives of TM varied among different ethnic groups and included the involvement of spirituality, the environment, knowledge and usage of TM. [2] The TM that was used by different ethnic groups included plants, herbs, massage, and other forms of healing. Reasons for choosing traditional or western medicines generally included family tradition, access to TM, and finding a competent traditional healer. [3] The barriers in accessing TM included the paucity of traditional healers, difficulty accessing plants and cost, therefore most would look for a substitution or alternative treatment. CONCLUSION: Even though the access to these TM in New Zealand was a challenge for the majority of the participants, they are still considered the first-line treatment for the majority. This study provided dental practitioners an insight into the different sort of TM used by the population. By understanding and acknowledging the use of TM, dental practitioners could create a supportive environment for patients to disclose their use of TM and allow them to educate patients on the use of TM.

Can the Measurement of Jaw-Opening Forces Assist in the Diagnosis of Temporomandibular Disorders?

AIMS: To investigate the effectiveness of a novel jaw-opening-force measuring device as a screening tool to aid in the diagnosis of temporomandibular disorders (TMD). METHODS: Symptomatic TMD patients (n = 58) and control TMD-free participants (n = 56) were screened by an oral medicine specialist according to the Diagnostic Criteria for TMD (DC/TMD). TMD patients were divided into three subcategories based on TMD symptoms (myofascial pain, disc displacement, and both combined). Jaw-opening forces were measured in both groups with an adjustable head device connected to a 1,000-N-load cell. Seven attempts were recorded at 10-second intervals by a data-capturing system. The geometric mean force values were obtained after discarding the first and last attempts. RESULTS: TMD-free participants had greater jaw-opening forces than TMD patients both without and with adjustments for age, sex, height, and weight (both P < .001). The geometric mean ± standard deviation values for TMD patients were 18.5 ± 1.62 N and 47.7 ± 1.53 N for TMD-free participants. Differences in jaw-opening forces among the three TMD subcategories were not statistically significant; however, patients with disc displacement (23.7 ± 1.46 N) had greater jaw forces than patients with myofascial pain (17.0 ± 1.74 N) and both myofascial pain and disc displacement (17.0 ± 1.56 N). CONCLUSION: This study demonstrated that differences in jaw-opening forces could be used as a diagnostic tool for TMD. Future studies should explore the potential of this device to measure improvement in jaw-opening forces following TMD treatment.

Malignant transformation in oral lichen planus and lichenoid lesions: a 14-year longitudinal retrospective cohort study of 829 patients in New Zealand.

OBJECTIVE: The aim of this study was to identify the rate of malignant transformation in a longitudinal cohort of patients with oral lichen planus and oral lichenoid lesion (OLP/OLL) and to assess the associations between clinicopathologic aspects and malignant transformation. STUDY DESIGN: Data were taken from the records of 829 patients histologically diagnosed with OLP/OLL in the years 2005 to 2018. RESULTS: Of the study patients, 548 (66.1%) were females and 281 (33.9%) were males. The average age at diagnosis was 57.3 years. The hyperplastic type was the most frequent (58.5%). Most patients had multiple sites of involvement, with the buccal mucosa being the most frequent site of biopsy. Oral epithelial dysplasia developed in 5 (0.6%) patients with a previous histologic diagnosis of OLP/OLL and developed oral squamous cell carcinoma (OSCC) in 23 patients (2.8%) during the follow-up period. The atrophic/ulcerative forms are 25.8 times more likely to progress to OSCC compared with the hyperplastic types (hazard ratio [HR] 25.8; P < .05). The HR increases by 5% with every year of age (HR 1.05; 95% confidence interval; P < .05). CONCLUSIONS: In our study, oral epithelial dysplasia developed in less than 1% of patients with OLP/OLL, and OSCC in 2.8%during the follow-up period. The atrophic/ulcerative forms are 25.8 times more likely to progress to OSCC compared with the hyperplastic types. The HR increases by 5% with every year of age.

Estimation of jaw-opening forces, energy expenditure and jaw-opening patterns in adults.

OBJECTIVES: The aims of this study were to investigate (1) the jaw-opening forces in different stages of jaw-opening, and determine the correlation among maximum jaw-opening force, maximum jaw-opening, and parameters such as age, height, weight, and gender, (2) the energy expenditure during jaw-opening, and (3) the jaw-opening patterns in adults. DESIGN: This was a cross-sectional study. The sample consisted of 87 participants were recruited from Dunedin, New Zealand. Jaw-opening forces were measured using an adjustable, rigid extra-oral device connected to a 1000 N load cell. MAIN RESULTS: Outcomes were highly skewed. The median (IQR) value of maximum jaw-opening was 48 mm (8 mm). The median of maximum jaw-opening force (40.0 N) was higher than jaw-opening force at maximum jaw-opening (35.2 N) (P < 0.01). The median (IQR) of the work was 1.30 J (1.28 J), ranging from 0.38 J to 4.03 J. The median of maximum jaw-opening force and work was higher in males (54.8 N; 1.22 J) than females (33.5 N; 0.74 J) (P < 0.05). Four jaw-opening force patterns (Pattern 1, 2, 3 and 4) were fitted and generated using Origin Pro software. CONCLUSION: A wide range of variation in jaw-opening force and work was observed, and they displayed a non-parametric, highly skewed distributions. The maximum jaw-opening force did not correspond to the maximum jaw-opening. Further studies could explore the potential association among the jaw-opening force pattern, the work of jaw-opening and TMJ diseases.

Final year dental students' career plans, work patterns, work-life balance and domestic life in New Zealand and Australia.

INTRODUCTION: Having insight into final year dental students' career planning is vital in maintaining and enhancing the quality of dental education. The aim of this study was to investigate final year dental students' career plans, work patterns, work-life balance and domestic life, in New Zealand and Australia. METHODS: The design of the study was a two-centred cross-sectional study. RESULTS: A total of 148 students, including 95 females (64%) and 53 males (36%), completed the survey (response rate = 87%). The mean age of students across two Australasian universities was 23 ± 3 years. Findings from this study demonstrate that students prefer their first job is an urban, full-time and salary-based with a good mentor. However, when describing their long-term planning, work-life balance becomes more important. The growth in the number of female dentists will continue to shape the future patterns of our dental profession. CONCLUSION: The current study has highlighted several similarity and differences in career plans, work patterns, work-life balance and domestic life between two Australasian universities. The information might be useful for the policymakers involved in future workforce planning and infrastructure and for those involved in the delivery of dental education.

A rare case of accessory maxilla: a case report and literature review of Tessier no. 7 clefts.

Bilateral Tessier no. 7 clefts are rarely reported in the literature. Here, we describe the presence of accessory maxilla with supernumerary teeth in a patient who exhibited bilateral Tessier no. 7 clefts; the diagnosis was established based on the patient's history, clinical presentation, and computed tomography images. A review of the available literature revealed 24 patients with Tessier no. 7 clefts from 2000 to 2020, including our patient. The most common clinical manifestation in patients with Tessier no. 7 clefts comprises bilateral facial clefts. Additionally, Tessier no. 7 clefts are more frequently found in boys or men, rather than in girls or women. The presence of an accessory maxilla with supernumerary teeth in a patient with bilateral Tessier no. 7 clefts is extremely rare. Early detection of craniofacial abnormalities is important, because it may influence patient prognosis and management.

Referrals by general dental practitioners and medical practitioners to oral medicine specialists in New Zealand: a study to develop protocol guidelines.

OBJECTIVE: The aim of this study was to examine the awareness level among general dental practitioners and medical practitioners with regard to common oral mucosal diseases and orofacial pain, investigate their orofacial screening and oral medicine referral practices, assess the information to be included in the referral, and evaluate the perceived need for supplementary resources and guidelines for referral. STUDY DESIGN: In total, 51 general dental practitioners and medical practitioners were recruited to investigate their orofacial screening and oral medicine referral practices. Three oral medicine specialists were interviewed to understand the referrals received from dentists and physicians. RESULTS: Of the participants, 87.5% dentists and 52.6% physicians considered orofacial screening as treatment priority. However, 71.9% dentists performed orofacial screening routinely, whereas none of the physicians did. Of the dentists, 50% referred relevant patients to oral medicine specialists every time they encountered such cases, and 31.6% of the physicians did so. Referrals should include the patient's background and medical history, full descriptions of the lesions, and results and photos from special tests. Of the participants, 65.6% of the dentists and 78.9% of the physicians believed that continuing professional development courses in oral medicine would be beneficial, and 93.8% of the dentists and 89.5% of the physicians agreed that standardized national referral guidelines would be useful. CONCLUSIONS: Standardized national referral guidelines, as well as continuing professional development courses in oral medicine, would be helpful to dental practitioners in the management of patients.