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Varellis MLZ, Bussadori SK, Pavesi VCS, Pereira BJ, Bezerra CDS, Silva FG, Castro GS, Afonso RCT, Barbosa Filho VF, Deana AM. Evaluation of photobiomodulation in the salivary production of patients with hyposalivation induced by antihypertensive drugs - A blind, randomized, controlled clinical trial. Complement Ther Clin Pract 2024; 56:101845. [PMID: 38608541 DOI: 10.1016/j.ctcp.2024.101845] [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] [Received: 12/04/2023] [Revised: 02/06/2024] [Accepted: 03/09/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Arterial hypertension is a systemic condition that affects about 35% of the world population. The drugs that are used for its control can produce hyposalivation. This work evaluated the effect of photobiomodulation on salivary flow rate, salivary pH, total protein concentration, and calcium concentration in individuals using antihypertensive medications. MATERIAL AND METHODS 41 subjects were randomly allocated in one of two groups: control (placebo) and photobiomodulation. The subjects had their salivary glands (20 sites) irradiated with a laser emitting at 808 nm, 4J/site once a week for 4 weeks and had their salivary flow measured before and after the whole treatment. RESULTS The intragroup analysis (before and after treatment) shows a significant difference for both non-stimulated and stimulated salivary flow in the photobiomodulation group (p = 0.0007 and p = 0.0001, respectively). Comparing the placebo with the photobiomodulation group, significant differences were found for both non-stimulated (p = 0.0441) and stimulated salivary flow (p = 0.0441) after the treatment. No significant differences were found in pH, total protein concentration, calcium concentration. CONCLUSION Despite the usage of drugs that influence the nervous system and typically result in a reduction of saliva production, photobiomodulation demonstrated a remarkable ability to enhance saliva production by a significant 75%.
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Affiliation(s)
- Maria Lucia Zarvos Varellis
- Post-graduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho, São Paulo, Brazil
| | - Sandra Kalil Bussadori
- Post-graduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho, São Paulo, Brazil
| | | | - Benedito Jorge Pereira
- Post-graduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho, São Paulo, Brazil
| | - Cícero Dayves Silva Bezerra
- Post-graduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho, São Paulo, Brazil
| | - Felipe Gonçalves Silva
- Post-graduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho, São Paulo, Brazil
| | - Gabriela Silva Castro
- Post-graduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho, São Paulo, Brazil
| | | | | | - Alessandro Melo Deana
- Post-graduate Program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho, São Paulo, Brazil.
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Oliveira SV, Batista JVF, Gutierres GG, Silva NP, Lino-Dos-Santos-Franco A, Rodrigues MFSD, Cecatto RB. The supportive use of photobiomodulation on salivary glands: a narrative review and meta-analysis. Eur Arch Otorhinolaryngol 2024; 281:2793-2805. [PMID: 38189964 DOI: 10.1007/s00405-023-08425-8] [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] [Received: 09/07/2023] [Accepted: 12/18/2023] [Indexed: 01/09/2024]
Abstract
PURPOSE Radiotherapy is one of the main strategies used in the treatment of cancer patients and it can cause early or late xerostomia and/or hyposalivation. Therapeutic management of xerostomia includes oral hygiene, sialogenic agents among others. METHODS This study reviews the use of extra-oral salivary glands photobiomodulation in treating xerostomia and/or hyposalivation after radiotherapy and performs a meta-analysis of this data. RESULTS After a broad search of the literature, eight clinical studies were selected. DISCUSSION In a safe way, the studies found that extra-oral stimulation of the salivary glands has benefits in the hyposalivation and changes in salivary flow resulting from lesions by radiotherapy. A meta-analysis found significant values in pain comparing the pre- and post-treatment moments (MD - 3.02, I2 95%, IC - 5.56; - 0.48) and for stimulated salivary flow at 30 days after the end of radiotherapy (MD 2.90, I2 95%, IC 1.96; 3.84). CONCLUSION The most promising parameters comprise wavelengths between 630 and 830 nm, radiant exposure from 2 to 10 J/cm2, two-to-three times a week, before the radiotherapy damage, and homogeneously in the glands. Therefore, Light-Emitting Diode (LED) stimulation of larger areas than the punctual stimulation of small millimeters of the Low-Level Laser Therapy (LLLT) appears to be promising.
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Affiliation(s)
- Susyane Vieira Oliveira
- Biophotonics-Medicine Post-Graduate Program, Universidade Nove de Julho/UNINOVE, 249 Vergueiro Street, Liberdade, São Paulo, SP, 01504-001, Brazil
| | - João Victor Falcão Batista
- School of Medicine of Universidade Nove de Julho UNINOVE, 249 Vergueiro Street, Liberdade, São Paulo, SP, 01504-001, Brazil
| | - Gabriela Godinho Gutierres
- School of Medicine of Universidade Nove de Julho UNINOVE, 249 Vergueiro Street, Liberdade, São Paulo, SP, 01504-001, Brazil
| | - Nicole Pantojo Silva
- School of Medicine of Universidade Nove de Julho UNINOVE, 249 Vergueiro Street, Liberdade, São Paulo, SP, 01504-001, Brazil
| | - Adriana Lino-Dos-Santos-Franco
- Biophotonics-Medicine Post-Graduate Program, Universidade Nove de Julho/UNINOVE, 249 Vergueiro Street, Liberdade, São Paulo, SP, 01504-001, Brazil
| | | | - Rebeca Boltes Cecatto
- Biophotonics-Medicine Post-Graduate Program, Universidade Nove de Julho/UNINOVE, 249 Vergueiro Street, Liberdade, São Paulo, SP, 01504-001, Brazil.
- School of Medicine of University of Sao Paulo, Instituto de Reabilitação Lucy Montoro HCFMUSP, IMREA Morumbi, R. Jandiatuba, 580 - Vila Andrade, São Paulo, SP, 05716-150, Brazil.
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3
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Liu D, Luo X, Jing Y, Wu T, Chen F. The Application of PBM Therapy in Patients Subjected to Oral GVHD: A Review. Photobiomodul Photomed Laser Surg 2024; 42:439-448. [PMID: 38900719 DOI: 10.1089/pho.2023.0153] [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: 06/22/2024] Open
Abstract
Background: Oral graft-versus-host disease (GVHD) is characterized by mucosal lesions, salivary gland dysfunction etc., accompanied by pain and oral dysfunction. The efficacy of photobiomodulation (PBM) in managing pain and inflammation has been demonstrated. PBM has been applied in oral GVHD and is regarded as a potent adjunctive therapy. Objective: To review the application of PBM for oral GVHD and summarize its biological mechanisms and recommended parameters. Materials and Methods: The article provides an overview of the therapeutic effects of PBM in oral GVHD cases. It analyzes the biological mechanisms from different aspects and explores the potential prospects of PBM, and appropriate parameters and frequency for GVHD are recommended. Conclusions: The efficacy of PBM in oral GVHD has been demonstrated through symptom alleviation and function improvement. It is recommended as an adjuvant therapy for oral GVHD. However, further research is required to explore optimal devices, parameters, and potential complications associated with using PBM in oral GVHD.
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Affiliation(s)
- Dongqi Liu
- Stomatological Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering, Chongqing, China
| | - Xiao Luo
- Stomatological Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering, Chongqing, China
| | - Yin Jing
- Stomatological Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering, Chongqing, China
| | - Tingting Wu
- Stomatological Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering, Chongqing, China
| | - Fangchun Chen
- Stomatological Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering, Chongqing, China
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4
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Sourvanos D, Zhu TC, Dimofte A, Busch TM, Lander B, Burrell JC, Neiva R, Fiorellini JP. A novel investigational preclinical model to assess fluence rate for dental oral craniofacial tissues. Photodiagnosis Photodyn Ther 2024; 46:104015. [PMID: 38373469 PMCID: PMC11139582 DOI: 10.1016/j.pdpdt.2024.104015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 02/06/2024] [Accepted: 02/09/2024] [Indexed: 02/21/2024]
Abstract
OBJECTIVE Photodynamic Therapy (PDT) and Photobiomodulation (PBM) are recognized for their potential in treating head and neck conditions. The heterogeneity of human tissue optical properties presents a challenge for effective dosimetry. The porcine mandible cadaver serves as an excellent model and has several similarities to human tissues of the dental oral craniofacial complex. This study aims to validate a novel modeling system that will help refine PDT and PBM dosimetry for the head and neck region. METHODS AND MATERIALS Light transmission was analyzed through several tissue combinations at distances of 2 mm to 10 mm. Maximum light fluence rates (mW/cm2) were compared across tissue types to reveal the effects of tissue heterogeneity. RESULTS The study revealed that light fluence is affected by tissue composition, with dentin/enamel showing reduced transmission and soft tissue regions exhibiting elevated values. The porcine model has proven to be efficient in mimicking human tissue responses to light, enabling the potential to optimize future protocols. CONCLUSION The porcine mandible cadaver is a novel model to understand the complex interactions between light and tissue. This study provides a foundation for future investigations into dosimetry optimization for PDT and PBM.
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Affiliation(s)
- Dennis Sourvanos
- Department of Periodontics, School of Dental Medicine, University of Pennsylvania, PA, USA; Center for Innovation and Precision Dentistry (CiPD), School of Dental Medicine, School of Engineering, University of Pennsylvania, PA, USA.
| | - Timothy C Zhu
- Department of Radiation Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania, PA, USA
| | - Andreea Dimofte
- Department of Radiation Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania, PA, USA
| | - Theresa M Busch
- Department of Radiation Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania, PA, USA
| | - Bradley Lander
- Department of Periodontics, School of Dental Medicine, University of Pennsylvania, PA, USA
| | - Justin C Burrell
- Center for Innovation and Precision Dentistry (CiPD), School of Dental Medicine, School of Engineering, University of Pennsylvania, PA, USA; Department of Oral and Maxillofacial Surgery, Hospital of the University of Pennsylvania and University of Pennsylvania School of Dental Medicine, University of Pennsylvania, PA, USA; Center for Neurotrauma, Neurodegeneration & Restoration, Corporal Michal J. Crescenz Veterans Affairs Medical Center, PA, USA
| | - Rodrigo Neiva
- Department of Periodontics, School of Dental Medicine, University of Pennsylvania, PA, USA
| | - Joseph P Fiorellini
- Department of Periodontics, School of Dental Medicine, University of Pennsylvania, PA, USA
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Efficacy of Photobiomodulation in Reducing Symptomatology and Improving the Quality of Life in Patients with Xerostomia and Hyposalivation: A Randomized Controlled Trial. J Clin Med 2022; 11:jcm11123414. [PMID: 35743485 PMCID: PMC9225194 DOI: 10.3390/jcm11123414] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/11/2022] [Accepted: 06/13/2022] [Indexed: 02/07/2023] Open
Abstract
Objectives: To evaluate the efficacy of photobiomodulation (PBM) treatment in patients with xerostomia and hyposalivation and assess their quality of life over a one year of follow-up. Material and methods: A single-blind randomized controlled trial. A total of 60 patients with xerostomia were included (30 PBM cases and 30 placebo controls). Photobiomodulation was performed with a diode laser (810 nm, 6 J/cm2), while the controls underwent simulated treatment. One weekly session was carried out for a total of 6 weeks (total six sessions). The study parameters were recorded at baseline, after three and six weeks, and at one year post-treatment. Xerostomia was assessed using a salivary flow visual analog scale (VAS) and the Xerostomia Inventory (XI). The Hospital Anxiety and Depression (HAD) scale, Oral Health Impact Profile (OHIP-14), Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) were also administered. Results: The patients subjected to PBM therapy showed a significant improvement of xerostomia based on the drainage test, and of oral quality of life (p < 0.001). The depression score of the HAD (HAD-D) and the ESS showed improvement, though without reaching statistical significance (p > 0.05). The placebo group showed significant changes in the xerostomia VAS score at 6 weeks (p = 0.009), with no variations in any of the other studied parameters (p > 0.05). The beneficial effects of the diode laser in the PBM group persisted at one year post-treatment. Conclusions: Photobiomodulation with the diode laser is effective in patients with xerostomia and hyposalivation, and thus should be taken into account as a treatment option.
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Moskvin SV, Strazhev SV. [Low-level laser therapy in oncology - what's new? Analysis of 2018-2021 publications]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOI FIZICHESKOI KULTURY 2022; 99:56-66. [PMID: 36538405 DOI: 10.17116/kurort20229906156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Low-level laser therapy (LLLT) is included in the Federal project «Fight against oncological diseases», which provides for equipping all specialized medical institutions in Russia with the appropriate devices until 2026. PURPOSE OF THE STUDY Publications analysis on the use of LLLT in oncology. MATERIAL AND METHODS To search for publications, databases and libraries were used: PubMed, Scopus, ResearchGate, Google Scholar, J-STAGE, eLibrary.ru for the period 2018-2021. For analysis, publications were selected that are of interest from the point of view of improving the methodology of LLLT, the prospects for the development of this method in the prevention, treatment and rehabilitation of patients. A total of 223 publications were found, including 39 reviews and meta-analyses, mostly in English (165) and Portuguese (41). RESULTS AND DISCUSSION The inclusion of LLLT in the ISOO/MASCC/ASCO recommendations for the treatment of complications such as mucositis, salivary gland hypofunction and xerostomia caused by non-surgical methods of treating cancer patients should be considered as a promising trend. An extremely low level of quality of LLLT techniques was noted, most often the replacement with meaningless «doses», «fluences» instead of the necessary parameters: wavelength, operating mode, power, frequency, exposure, etc. The use of only local illumination instead of systemic methods of LLLT does not allow obtaining the best results of treatment and prevention. Eliminating the shortcomings of treatment protocols with a focus on Russian experience, when laser blood illumination (intravenously or externally) and laser acupuncture are also necessarily carried out with local illumination of the lesion, will bring the effectiveness of LLLT to a qualitatively new, higher level.
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Affiliation(s)
- S V Moskvin
- Academy of Postgraduate Education of Federal Scientific and Clinical Center for Specialized Types of Medical Care and Medical Technologies of the Federal Medical and Biological Agency, Moscow, Russia
| | - S V Strazhev
- City Polyclinic No.212 of the Department of Health of the City of Moscow - Branch No. 70, Moscow, Russia
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Impact of photobiomodulation therapy on the morphological aspects of submandibular gland submitted to excretory duct ligation and hypothyroidism: an animal study. Lasers Med Sci 2021; 37:2005-2015. [PMID: 34797432 DOI: 10.1007/s10103-021-03463-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 11/04/2021] [Indexed: 10/19/2022]
Abstract
The aim of this study was to evaluate the impact of photobiomodulation therapy (PBMT) on histomorphological aspects of submandibular gland (SMG) submitted to salivary gland duct obstruction in hypothyroid rats. Fifty-six male Wistar rats (250 to 300 g) were divided into 4 groups (n = 14): euthyroid (EU), EU + PBMT, hypothyroid (HYPO), and HYPO + PBMT. Duct obstruction of the left submandibular gland (LSMG) was performed in all animals by a ligature procedure. For the induction of hypothyroidism, total thyroidectomy was performed. PBMT groups received irradiation with AlGaInP diode laser (808 nm, 0.04 W, 0.04cm2 spot size, 60 s, 2.4 J per point, 60 J/cm2, 1 W/cm2). Irradiation was performed immediately, 24 h, and 48 h after the obstruction of the salivary gland duct, in one point, extra oral and perpendicular to the gland. Animals were sacrificed after 24 h and 72 h after duct ligature. Our results indicated that salivary duct obstruction and hypothyroidism caused negative modifications on the salivary glands' histomorphology, especially acinar atrophy, after 24 h and 72 h. HYPO + PBMT showed a significant reduction of the inflammatory infiltrate, congested blood vessels, and acinar atrophy in the SMG submandibular salivary gland in 72 h compared to 24 h (p < 0.05). In conclusion, obstruction of the salivary gland excretory duct and hypothyroidism causes severe sialoadenitis with expressive atrophy of the glandular parenchyma. However, PBMT was able to modulate the inflammatory process and delaying acinar atrophy. This study provided insights to better understand the role of the PBMT on the altered salivary gland by duct ligation and associate hypothyroidism.
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Effect of Physical Therapy Modalities on Quality of Life of Head and Neck Cancer Survivors: A Systematic Review with Meta-Analysis. J Clin Med 2021; 10:jcm10204696. [PMID: 34682818 PMCID: PMC8539984 DOI: 10.3390/jcm10204696] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/05/2021] [Accepted: 10/11/2021] [Indexed: 12/16/2022] Open
Abstract
The objective was to describe the effectiveness of different physical therapy modalities to improve Quality of Life (QoL) in Head and Neck Cancer (HNC) survivors. PubMed, Scopus, Web of Science, CINAHL and Cochrane Library were searched for randomized clinical controlled trials published until 30 April 2020. Risk of bias assessment and meta-analysis were conducted using the Cochrane tools. A total of 251 records were retrieved, and 10 met the inclusion criteria. Interventions whose parameters focus on a 12-week exercise programs of aerobic activity (walking) or Progressive Resistance Training (PRT) for the whole body are effective and safe modalities improving QoL in HNC survivors. Electrophysical agents did not show significant results between groups. As for the assessment of methodological quality, 4 of the 10 articles included had a high risk of overall bias. Only five articles provided sufficient information to conduct a meta-analysis for exercise program intervention on QoL, showing a tendency in favor of intervention group, even when the global results did not show statistically significant improvements (pooled Cohen's d 0.15; 95% CI: -0.25 to 0.54; I2 45.87%; p heterogeneity = 0.10). The present review and meta-analysis identified meaningful benefits of exercise on QoL of HNC survivors; this has been confirmed in a meta-analysis. This review adds evidence supporting exercise interventions on Head and Neck Cancer population whose opportunities for successful recovery after medical treatment are more limited.
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Carroll JD. 2021 July Summary of Photobiomodulation Literature. Photobiomodul Photomed Laser Surg 2021; 39:682-684. [DOI: 10.1089/photob.2021.0118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- James D. Carroll
- Founder, CEO at THOR Photomedicine Ltd., Chesham Bois, England, UK
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Golež A, Frangež I, Cankar K, Frangež HB, Ovsenik M, Nemeth L. Effects of low-level light therapy on xerostomia related to hyposalivation: a systematic review and meta-analysis of clinical trials. Lasers Med Sci 2021; 37:745-758. [PMID: 34409539 DOI: 10.1007/s10103-021-03392-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 07/26/2021] [Indexed: 02/06/2023]
Abstract
Hyposalivation is a condition represented by a reduced salivary flow and may include symptoms such as mouth dryness (xerostomia), loss of taste, pain, dysphagia, and dysphonia, all of which greatly affect an individual's quality of life.The aim of the present study was to systematically review the effects of low-level light therapy irradiation (photobiomodulation) on salivary gland function in patients with hyposalivation.The main question of the systematic review was: "Does low-level light irradiation therapy of the salivary glands affect salivary flow rate or indicators of salivary function (ion and protein concentrations) in patients with xerostomia or hyposalivation?" The question was based on the PICO (participant, intervention, control, outcome) principle and followed the PRISMA guidelines. Databases were explored and papers published between the years 1997 and 2020 were reviewed for the following Mesh-term keywords and their corresponding entry terms in different combinations: "Low-level light therapy," "Xerostomia," "Saliva," "Salivary glands," "Salivation."The initial sample consisted of 220 articles. Of those, 47 articles were used for full-text analysis and 18 were used for a systematic review, 14 were used in meta-analysis. According to their individual quality, most articles were classified as high quality of evidence according to the GRADE score. Meta-analysis of the evidence observed increase of unstimulated salivary flow 0.51 SMD compared to placebo (95% CI: 0.16-0.86), I2 = 50%, p = 0.005.The findings of our review revealed evidence of a beneficial effect of photobiomodulation therapy on salivary gland function. The therapy alleviates xerostomia and hyposalivation. However, these effects are reported short term only and did not induce lasting effects of photobiomodulation therapy on patients' quality of life.
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Affiliation(s)
- Aljaž Golež
- Institute of Physiology, Faculty of Medicine, University of Ljubljana, Zaloska cesta 4, Ljubljana, Slovenia
| | - Igor Frangež
- Department for Surgical Infections, University Medical Center Ljubljana, Zaloska cesta 2, 1000, Ljubljana, Slovenia.,Department of Surgery, Faculty of Medicine, University of Ljubljana, Zaloska cesta 7, Ljubljana, Slovenia
| | - Ksenija Cankar
- Institute of Physiology, Faculty of Medicine, University of Ljubljana, Zaloska cesta 4, Ljubljana, Slovenia
| | - Helena Ban Frangež
- Department of Gynaecology and Obstetrics, Faculty of Medicine, University of Ljubljana, Slajmerjeva 3, 1000, Ljubljana, Slovenia.,Department of Obstetrics and Gynaecology, University Medical Center Ljubljana, Slajmerjeva 3, 1000, Ljubljana, Slovenia
| | - Maja Ovsenik
- Department of Orthodontics and Dentofacial Orthopaedics, Faculty of Medicine, University of Ljubljana, Hrvatski trg 6, Ljubljana, Slovenia
| | - Lidija Nemeth
- Department of Dental Diseases and Normal Dental Morphology, Faculty of Medicine, University of Ljubljana, Hrvatski trg 6, Ljubljana, Slovenia.,Division of Stomatology, University Medical Centre Ljubljana, Stomatoloska klinika, Hrvatski trg 6, 1000, Ljubljana, Slovenia
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