1
|
Yazıcıoğlu İ, Çiftçi V. Evaluation of signs and symptoms of temporomandibular disorders and incisal relationships among 7-10-year-old Turkish children with sleep bruxism: A cross-sectional study. Cranio 2024; 42:243-249. [PMID: 34176445 DOI: 10.1080/08869634.2021.1939932] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To study the signs and symptoms of temporomandibular disorders (TMDs) and incisal relationships related to sleep bruxism and parafunctional habits among children. METHODS The study consisted of 106 children (53 with and 53 without bruxism) between the ages of 7 and 10. A general questionnaire and Diagnostic Criteria for Temporomandibular Disorders Axis I examination form were used for each child. RESULTS There were significant differences between children according to pain, headache, midline deviation, opening pattern, temporomandibular joint noise, overjet, overbite, corrected deviation, and pain disorders (p < 0.05). According to the logistic regression, the higher scores of "mouth breathing" and "horizontal incisal overjet" were independent risk factors for TMDs. The lack of "bruxism" and "sleeping with open mouth" were protective factors for TMDs. CONCLUSION Children with bruxism showed signs and symptoms of TMDs and divergence in incisal relationships.
Collapse
Affiliation(s)
- İffet Yazıcıoğlu
- Department of Pediatric Dentistry, Çukurova University, Adana, Turkey
| | - Volkan Çiftçi
- Department of Pediatric Dentistry, Çukurova University, Adana, Turkey
| |
Collapse
|
2
|
Shaffer SM, Naze GS. Evaluation and management of temporomandibular disorders. Part 2: an orthopaedic physical therapy update on examination and clinical reasoning. J Man Manip Ther 2023; 31:143-152. [PMID: 36171740 PMCID: PMC10288906 DOI: 10.1080/10669817.2022.2124617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Temporomandibular (TM) disorders afflict many people globally and, despite the presence of existing peer-reviewed material that assists conservative orthopedic providers, recent advances in knowledge indicate that updated resources are required for students, clinicians, and educators. This two-part series builds off previously published material to present newer supplementary information that can be useful during the evaluation and management processes. Content in Part 1 of this series includes a discussion about the factors that have been shown to contribute to TM disorders, an updated perspective of relevant pain science, a discussion of self-report outcome measures, and various different topics related to the examination of patients with TM disorders. Part 2 addresses information related to the temporomandibular joint disc, joint hypermobility, oral splints, and clinical reasoning. In combination with other available publications, this two-part series provides clinicians an opportunity to improve their delivery of effective and efficient clinical services for people diagnosed with TM disorders.
Collapse
Affiliation(s)
- Stephen M. Shaffer
- Department of Rehabilitation Sciences, College of Education, Nursing, and Health Professions, University of Hartford, West Hartford, CT, USA
| | - Garrett S. Naze
- Department of Physical Therapy, Congdon School of Health Sciences, High Point University, High Point, NC, USA
| |
Collapse
|
3
|
Shaffer SM, Naze GS. Evaluation and management of temporomandibular disorders. Part 1: an orthopedic physical therapy update on examination and clinical reasoning. J Man Manip Ther 2023; 31:133-142. [PMID: 36245265 PMCID: PMC10288910 DOI: 10.1080/10669817.2022.2123171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Temporomandibular (TM) disorders afflict many people globally and, despite the presence of existing peer-reviewed material that assists conservative orthopedic providers, recent advances in knowledge indicate that updated resources are required for students, clinicians, and educators. This two-part series builds off previously published material to present newer supplementary information that can be useful during the evaluation and management processes. Content in Part 1 of this series includes a discussion about the factors that have been shown to contribute to TM disorders, an updated perspective of relevant pain science, a discussion of self-report outcome measures, and various different topics related to the examination of patients with TM disorders. Part 2 addresses information related to the temporomandibular joint disc, joint hypermobility, oral splints, and clinical reasoning. In combination with other available publications, this two-part series provides clinicians an opportunity to improve their delivery of effective and efficient clinical services for people diagnosed with TM disorders.
Collapse
Affiliation(s)
- Stephen M. Shaffer
- College of Education, Nursing, and Health Professions, Department of Rehabilitation Sciences, University of Hartford, West Hartford, CT, USA
| | - Garrett S. Naze
- Congdon School of Health Sciences, Department of Physical Therapy, High Point University, High Point, NC, USA
| |
Collapse
|
4
|
Hussain A, Rizvi M, Vohra U, Kohli K, Asim S, Fikree M, Ovais Z, Ahmed SA. Prevalence of Bruxism among the Students of Gulf Medical University: A Cross-Sectional Questionnaire Study. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2021; 13:S501-S505. [PMID: 34447142 PMCID: PMC8375866 DOI: 10.4103/jpbs.jpbs_644_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 10/12/2020] [Accepted: 11/30/2020] [Indexed: 12/02/2022] Open
Abstract
Introduction: Bruxism is a multifactorial phenomenon that involves grinding or clenching of teeth. The parafunctional habit includes abnormal tooth wear, tooth fracture, pain, and tooth mobility, along with headaches and facial muscle hypertrophy. It is imperative for students to be conscious of teeth grinding along with its possible causes. The student will be alert to visit the dentist if required and contribute to the recognition of etiological factors, to eliminate them. Objective: This study aims to find the prevalence and understanding of bruxism among Gulf Medical University (GMU) students. Materials and Methods: A cross-sectional, questionnaire-based study was conducted among 451 GMU students. The parameters for data collection were age, gender, prevalence, associated signs and symptoms, causes, genetic predisposition, time of day, and effect on the appearance of teeth. Results: While 35.9% were unaware, 41.7% of our samples reported bruxism. The majority recognized temporomandibular joint and facial pain as causative, and 24.8% reported symptoms. Headache (26.4%) was prime and 7.5% were associated with fracture and abnormal tooth wear to bruxism (38.1%) experienced night bruxism. A significant number of students (32.4%) identified abnormal anterior teeth relationship as the cause and (64.3%) associated bruxism and esthetics. Conclusion: Nearly 41.7% of the students reported bruxism. Around 35.9% of the samples were uninformed. Nearly 20.8% believed that bruxism had genetic relevance. Nearly 51.9% of the participants were asymptomatic. Around 38.1% had night bruxism and 32.4% identified abnormal anterior teeth relationship as the cause. The majority of the sample (64.3%) connected bruxism to negative effects on teeth and esthetics.
Collapse
Affiliation(s)
| | | | - Umika Vohra
- Interns, Gulf Medical University, Ajman, UAE
| | | | - Sundus Asim
- Interns, Gulf Medical University, Ajman, UAE
| | | | | | - Sura Ali Ahmed
- Diagnostic and Surgical Dental Sciences Department, Gulf Medical University, UAE
| |
Collapse
|
5
|
Soares JP, Moro J, Massignan C, Cardoso M, Serra-Negra JM, Maia LC, Bolan M. Prevalence of clinical signs and symptoms of the masticatory system and their associations in children with sleep bruxism: A systematic review and meta-analysis. Sleep Med Rev 2021; 57:101468. [PMID: 33836485 DOI: 10.1016/j.smrv.2021.101468] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/05/2021] [Accepted: 01/27/2021] [Indexed: 11/26/2022]
Abstract
Sleep bruxism (SB) is a behavior of central origin that is related to different factors. This systematic review aimed to determine the prevalence of clinical signs and symptoms of the masticatory system and their association in children with SB. A structured search in ten databases were taken. Two authors independently selected studies, extracted the data, study quality assessment and graded the evidence. A meta-analysis of proportion and association was performed under random-effect model, confidence interval of 95% and p < 0.05 for pulled values. Were included 22 studies, and their overall quality was poor. The more common clinical signs and symptoms of the masticatory system in children with SB were primary canine wear (P:84.13, 95% CI:78.13-89.32; p = 0.248; I2 25.05), dental wear (P:73.76, 95% CI:38.73-96.91; p < 0.001; I2 97.62) and headache (P:52.85, 95% CI:38.92-66.56; p < 0.001; I2 93.65). The prevalence of SB in children was 31.16% (P:31.16, 95% CI:22.18-40.92; p < 0.001; I2 98.56). There was no significant risk of dental wear and headache in children with SB. There is low to very low certainty of the evidence. The more prevalent clinical signs and symptoms of the masticatory system presented in children with SB were primary canine wear, dental wear and headache. Further studies of high quality are still needed to elucidate these important questions.
Collapse
Affiliation(s)
- Josiane Pezzini Soares
- Department of Pediatric Dentistry, School of Dentistry, Universidade Federal de Santa Catarina, Florianopolis, SC, Brazil.
| | - Juliana Moro
- Department of Pediatric Dentistry, School of Dentistry, Universidade Federal de Santa Catarina, Florianopolis, SC, Brazil
| | - Carla Massignan
- Department of Pediatric Dentistry, School of Dentistry, Universidade de Brasília, Brasilia, DF, Brazil
| | - Mariane Cardoso
- Department of Pediatric Dentistry, School of Dentistry, Universidade Federal de Santa Catarina, Florianopolis, SC, Brazil
| | - Júnia Maria Serra-Negra
- Department of Pediatric Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Lucianne Cople Maia
- Department of Pediatric Dentistry, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Michele Bolan
- Department of Pediatric Dentistry, School of Dentistry, Universidade Federal de Santa Catarina, Florianopolis, SC, Brazil
| |
Collapse
|
6
|
DelRosso LM, Picchietti DL, Spruyt K, Bruni O, Garcia-Borreguero D, Kotagal S, Owens JA, Simakajornboon N, Ferri R. Restless sleep in children: A systematic review. Sleep Med Rev 2020; 56:101406. [PMID: 33341437 DOI: 10.1016/j.smrv.2020.101406] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/28/2020] [Accepted: 07/30/2020] [Indexed: 02/06/2023]
Abstract
This systematic review assessed the prevalence of restless sleep in children, documented the association of restless sleep with other conditions, and summarized the existing evidence regarding whether restless sleep should be considered a distinct sleep disorder. A comprehensive search of electronic databases was performed using the broad search term "restless sleep" in all fields. Of the 266 articles retrieved, 107 were retained for inclusion in this review. The majority (n = 93) were observational studies. The studies were grouped under several pathologic/condition categories: sleep-disordered breathing (n = 19); adenotonsillectomy (n = 7); respiratory disorders, otitis media, and smoke exposure (n = 12); sleep-related movement disorders and restless sleep disorder (n = 11); neurologic or psychiatric disorders (n = 7); Down syndrome/other neurodevelopmental disorders (n = 10); sleep-related bruxism and other sleep disorders (n = 7); and restless sleep in the general population/mixed clinical samples (n = 18). A high prevalence of restless sleep was found in children with many of these underlying conditions, likely related to associated inherent sleep disruption and frequent awakenings (e.g., apnea and periodic limb movements), pain, sleep instability, and caregiver perception. The majority of studies identified restless sleep as reported by the caregiver, only 34 studies attempted to define restless sleep further. Four studies provided supportive evidence for designating restless sleep as an independent sleep disorder, restless sleep disorder (RSD). This review highlights the fact that the prevalence, etiology and sequelae (including daytime impairments) of restless sleep in children are important topics deserving of further research and that clinical definitions based on empirical evidence need to be developed. The designation of "primary" versus "secondary" restless sleep may be a useful construct, especially with regard to developing clinical trials and treatment algorithms.
Collapse
Affiliation(s)
- Lourdes M DelRosso
- University of Washington, Seattle Children's Hospital, Seattle, WA, USA.
| | - Daniel L Picchietti
- University of Illinois School of Medicine, Carle Illinois College of Medicine, and Carle Foundation Hospital, Urbana, IL, USA.
| | - Karen Spruyt
- Lyon Neuroscience Research Center, INSERMU1028-CNRS UMR 5292 - Waking Team, University Claude Bernard, School of Medicine, Lyon, France.
| | - Oliviero Bruni
- Department of Developmental Neurology and Psychiatry, Sapienza University, Rome, Italy.
| | | | - Suresh Kotagal
- Department of Neurology and the Center for Sleep Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Judith A Owens
- Division of Neurology, Boston Children's Hospital, Harvard Medical School, Waltham, MA, USA.
| | | | | | | |
Collapse
|
7
|
Kapos FP, Exposto FG, Oyarzo JF, Durham J. Temporomandibular disorders: a review of current concepts in aetiology, diagnosis and management. ORAL SURGERY 2020; 13:321-334. [PMID: 34853604 PMCID: PMC8631581 DOI: 10.1111/ors.12473] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/18/2020] [Indexed: 12/18/2022]
Abstract
Temporomandibular disorders (TMD) is a collective term for a group of musculoskeletal conditions involving pain and/or dysfunction in the masticatory muscles, temporomandibular joints (TMJ) and associated structures. It is the most common type of non-odontogenic orofacial pain and patients can present with pain affecting the face/head, TMJ and or teeth, limitations in jaw movement, and sounds in the TMJ during jaw movements. Comorbid painful and non-painful conditions are also common among individuals with TMD. The diagnosis of TMD have significantly improved over time with the recent Diagnostic Criteria for TMD (DC/TMD) being reliable and valid for most common diagnoses, and an efficient way to communicate in multidisciplinary settings. This classification covers 12 most common TMD, including painful (myalgia, arthralgia and headache attributed to TMD) as well as the non-painful (disc displacements, degenerative joint disease and subluxation) TMD diagnoses. Recent studies have demonstrated that the pathophysiology of common painful TMD is biopsychosocial and multifactorial, where no one factor is responsible for its development. Importantly, research has suggested different predisposing, initiating and perpetuating factors, including both peripheral and central mechanisms. This is an active field of investigation and future studies will not only seek to clarify specific causal pathways but translate this knowledge into mechanism-directed diagnosis and treatment. In accordance with this complex aetiology, current evidence supports primarily conservative multidisciplinary treatment including self-management strategies, behavioural therapy, physical therapy and pharmacotherapy. The aim of this review is to present an overview of most recent developments in aetiology, pathophysiology, diagnosis and management of TMD.
Collapse
Affiliation(s)
- Flavia Penteado Kapos
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, United States
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, United States
| | - Fernando Gustavo Exposto
- Section of Orofacial Pain and Jaw Function, Department of Dentistry, Health, Aarhus University, Aarhus, Denmark
- Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark
| | - Juan Fernando Oyarzo
- Orofacial Pain and TMD Program, Faculty of Odontology, Universidad Andres Bello, Santiago, Chile
| | - Justin Durham
- Centre for Oral Health Research & Institute of Health and Society, Newcastle University, Newcastle, United Kingdom
| |
Collapse
|
8
|
Correlation between Parental-Reported Tooth Grinding and Sleep Disorders: Investigation in a Cohort of 741 Consecutive Children. Pain Res Manag 2020; 2020:3408928. [PMID: 32802220 PMCID: PMC7415113 DOI: 10.1155/2020/3408928] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/06/2020] [Accepted: 07/13/2020] [Indexed: 01/17/2023]
Abstract
Purpose A possible relationship between sleep bruxism (SB) and several sleep disorders has been suggested in children, which could influence sleep quality and quality of life. This study aims to assess such correlations in a large sample of school children. Methods Parents of 741 consecutive children aged between 8 and 12 years filled the Sleep Disturbance Scale for Children (SDSC). It evaluated 45 items grouped in 8 components: duration of night-time sleep, sleep latency, bedtime problems, sleep quality, night awakenings, nocturnal symptoms, morning symptoms, and daytime sleepiness. An item evaluating parental-reported tooth grinding was also included. Correlation analysis was performed between parental-reported tooth grinding and all the other items. Results A significant correlation between parental-reported tooth grinding and several sleep disorders concerning bedtime problems, night awakenings, nocturnal symptoms, and morning symptoms has been found. In general, correlation strength of significant pairs was low, ranging from 0.092 (sleep apnea) to 0.234 (movement while falling asleep). Conclusions Parental-reported tooth grinding in children is correlated, even if weakly, with some sleep disorders concerning the sphere of bedtime problems, night awakenings, nocturnal symptoms, breathing symptoms, and morning symptoms. Further studies are needed to confirm these findings, with particular regard to the consistency of correlation outcomes between the parental reports and the sleep laboratory measures.
Collapse
|
9
|
Johansson AK, Norring C, Unell L, Johansson A. Diet and behavioral habits related to oral health in eating disorder patients: a matched case-control study. J Eat Disord 2020; 8:7. [PMID: 32128206 PMCID: PMC7045484 DOI: 10.1186/s40337-020-0281-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 01/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients suffering from eating disorders (ED) have a substantially increased risk for developing poor oral health. In this regard, dietary habits in combination with obsessive behavior as well as the expression and intensity of the disease are of utmost importance. This study aimed to investigate diet and behavioral habits in patients with ED compared to healthy controls. METHODS All patients who initiated treatment in an ED clinic during 1 year were invited to participate in the study. Sixty-five patients were admitted out of which 54 agreed to participate: 50 women and 4 men, mean age 21.5 years, range 10-50 years. From a public dental health clinic, 54 sex-and age-matched controls where selected. In all participants a comprehensive questionnaire was completed. ED patients were analyzed with respect to their self-perceived disease state: when they felt "relatively good" (ED-good) and "bad" (ED-bad) as well as if they reported vomiting or not. RESULTS The ED-good patients reported significantly higher intake of caffeine-containing and cola light soft drinks and both study groups reported a lower intake of regularly sweetened carbonated drinks compared to controls. ED-bad reported significantly lower intake of number of meal and sweet intake while both study groups brushed their teeth more frequently than controls. As regards awareness of detrimental dietary intake and the possible risk for oral health complications did not differ between patients and controls except that the ED groups were more aware that vomiting and brushing thereafter could damage their teeth. ED patients went less often to the dentist for regular checkups than controls. Vomiting ED patients differed in several of the parameters related to dietary and other behaviors compared to no vomiting subjects. According to regression analyses and compared to healthy controls, predictive variables for ED-good were: higher intake of caffeine containing drinks (OR 1.34, CI 1.10-1.64) and lower intake of regular soft drinks (OR 0.57, CI 0.35-0.94). For ED-bad, lower frequency intake of lunch meals (OR 0.59, CI 0.39-0.88) and sweet biscuits were predictive (OR 0.15, CI 0.05-0.48). CONCLUSIONS ED patients present a number of dietary and other types of behavior that are potentially harmful for oral health. It is important to retrieve reports on the ED behaviors in both relatively good and bad disease state in order for the medical team to prescribe adequate advice and treatment.
Collapse
Affiliation(s)
- Ann-Katrin Johansson
- 1Department of Clinical Dentistry-Cariology, Faculty of Medicine, University of Bergen, Årstadveien 19, 5009 Bergen, Norway
| | - Claes Norring
- 2Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Lennart Unell
- 3School of Health and Medical Sciences, Örebro University and Region Örebro County Council, Örebro, Sweden
| | - Anders Johansson
- 4Department of Clinical Dentistry-Prosthodontics, Faculty of Medicine, University of Bergen, Bergen, Norway
| |
Collapse
|
10
|
Alouda R, Alshehri M, Alnaghmoosh S, Shafique M, Al-Khudhairy MW. Mother's Work Status on Children's Bruxism in a Subset of Saudi Population. J Int Soc Prev Community Dent 2017; 7:S170-S178. [PMID: 29285473 PMCID: PMC5730980 DOI: 10.4103/jispcd.jispcd_384_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 11/10/2017] [Indexed: 11/10/2022] Open
Abstract
Aims and Objectives: The aims and objectives of this study were to determine if an association exists between mothers work status and her children's incidence of bruxism and habits related to bruxism. Materials and Methods: A cross-sectional study was conducted through data collection of a questionnaire answered by 561 mothers’ about their working status and their child's habits and behaviors. The survey consisted of 5 parts with a total of 34 questions: mother's information, child's behavior, child's sleeping pattern, mother's knowledge about bruxism, and child's medical history. Odds ratios, Chi-square, and their corresponding 95% confidence intervals are reported. Statistical significance was set at P ≤ 0.05. Results: The work status of the mother was not statistically significant in increasing the incidence of a child to have bruxism. However, this study clearly elucidates that 7 of the 15 habits correlate significantly with a status of bruxism. According to this sample, a child, that is, reported to be aggressive is more than twice as likely to have nocturnal bruxism. Likewise, any child that bites their nails, complains of headaches, drools in their sleep, snores, complains of muscle cramps, and colic is more than twice as likely to be a nocturnal bruxer than a child that does not have these habits. Conclusion: The prevalence of children's bruxism in this convenient sample was 34.5% (n = 141). The concerning habits related to bruxism can serve the pediatric dentist, general dentist, general practitioner, and primary care provider of children having these red flags as indicators of bruxism. It is imperative that parents of these children be made aware these habits that may occur together, alone or even simultaneously with bruxism.
Collapse
Affiliation(s)
- Rana Alouda
- Department of Dental Interns, Riyadh Colleges of Dentistry and Pharmacy, Riyadh, Kingdom of Saudi Arabia
| | - Maram Alshehri
- Department of Dental Interns, Riyadh Colleges of Dentistry and Pharmacy, Riyadh, Kingdom of Saudi Arabia
| | - Shoog Alnaghmoosh
- Department of Dental Interns, Riyadh Colleges of Dentistry and Pharmacy, Riyadh, Kingdom of Saudi Arabia
| | - Maryam Shafique
- Department of Dental Interns, Riyadh Colleges of Dentistry and Pharmacy, Riyadh, Kingdom of Saudi Arabia
| | - May Wathiq Al-Khudhairy
- Department of Diagnostic Sciences and Oral Maxillofacial Surgery, Riyadh Colleges of Dentistry and Pharmacy, Riyadh, Kingdom of Saudi Arabia
| |
Collapse
|