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Abstract

This article characterizes the etiology of temporomandibular disorder with particular emphasis on emotional factors that have a major impact on the development of these dysfunctions and the most common their symptoms. They mainly affect people in the third and fourth decade of life and women predominate among this group of patients.
The article analyzes the current literature (Pub Med Database, Scopus and EMBASE) in relation to the conditions in the work environment, which often constitute important causes of emotional tensions, constant state of mental tension and susceptibility to the effects of stressors, which have an impact on the state of functioning of the musculoskeletal system of the masticatory system.
Despite the high frequency of temporomandibular disorders, unfortunately only a few studies describe the influence of harmful factors related to the work environment, and own experience (information from the patient’s interview) and data from the literature indicate a significant share of these factors in the devel-opment of temporomandibular disorder. The relationships and anatomical connections affecting the influence of stressors on the functioning of masticatory muscles and temporomandibular joints are also discussed. In conclusion, it should be stated that the work environment and the emotional tensions generated in it constitute a serious sociological problem and increase the risk of developing and intensify the symptoms of TMD.
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Authors and Affiliations

Małgorzata Pihut
1
Magdalena Orczykowska
1
Andrzej Gala
1

  1. Prosthodontic and Orthodontic Department, Dental Institute, Jagiellonian University Medical College, Kraków, Poland
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Abstract

TMD is a group of pathological changes including increased tension in the masticatory muscles, pain in the muscles and/or the temporomandibular joints, abnormal range of the mandibular movement or the presence of acoustic symptoms in the joints in the form of clicking or poping. The aim of the project was to compare the effectiveness of two methods of physiotherapeutic rehabilita-tion, used in adolescent patients with temporomandibular disorders.
Material and Methods: The material consisted of 68 patients, aged 14 to 17, of both sexes, generally healthy, who came to the Dental Prosthetics Department for treatment due to pain in the masticatory muscles. Dental examination and diagnostics revealed Ia in all cases in accordance with RDC/TMD protocol. Manual therapy was performed in group I (34 people) and kinesitherapy with massage was performed in group II (34 people). Patients were allocated randomly to both groups. Contraindications were considered for both methods.
Results: Within the first study, mean values of pain intensity between group I and group II were not significantly different (6.12 and 6.24 respectively). Within the second study significantly lower VAS scores in both groups have been revealed (0.92 and 0.74 respectively). Results of the first and second study differed significantly in both groups. Similar results were obtained for the maximum abduction of the mandible.
Conclusions: The results of the conducted studies indicate a beneficial effect of the assessed phy-siotherapeutic procedures in terms of functional rehabilitation of adolescent patients with temporoman-dibular disorders.
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Authors and Affiliations

Małgorzata Pihut
1
Elżbieta Zarzecka-Francica
1
Andrzej Gala
1

  1. Prosthodontics and Orthodontics Department, Dental Institute, Jagiellonian University Medical College, Kraków, Poland
Keywords pain headache PSS-10
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Abstract

Chronic pain in the head and face region has a predicted prevalence of 20% in Europe, and is more common in women than men. The etiology of temporomandibular disorder (TMD) is multifactorial, and high levels of psychological stress amplify its symptoms. We were interested in how headache reported in RDC/TMD is associated with stress. Individuals with an average age of 18 years were included in the study. They were all volunteer participants in a research project. Clinical evaluation of each subject was performed using the RDC/TMD dual-axis diagnostic system. All participants filled out the PSS-10 ques-tionnaire. A total of 138 individuals participated in the study, of which 107 were female. Headache was reported by 83 participants (59.4%), with females presenting higher scores on the PSS-10; this was statistically significant. A comparison between PSS-10 questionnaire results and headache level shows insignificant differences. However, the higher the stress level in the participant, the higher the headache score. Females are more susceptible to perceived stress, which can have an effect on TMD.
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Authors and Affiliations

Aneta Wieczorek
1
Małgorzata Pihut
1
Jolanta E. Loster
1

  1. Department of Prosthodontics and Orthodontics, Institute of Dentistry, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
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Abstract

Introduction: Temporomandibular disorders (TMD) are the second most common cause of chronic pain in the human musculoskeletal system. The triad of symptoms of TMD includes: pain within the temporomandibular joint (TMJ), limitation of its mobility and crepitations. The aim of the study was to present the methods of physiotherapy and to assess its effectiveness in patients with hypomobility of temporomandibular joints.

Material and Methods: 44 patients (40.2 ± 10.6 years) were examined for signs of TMD using the Manual Functional Analysis of masticatory system (MFA) questionnaire due to DC/TMD. In the above group, 20 patients showed hypomobility of TMJs and myofascial pain. They underwent a 3-week phy-siotherapy consisting of manual therapy and exercises. In the study group, linear measurements of TMJs mobility and palpation of selected masticatory muscles were performed. Pain was assessed before and after 3 weeks of therapy according to Numerical Rating Scale (NRS). Statistical processing of the data was done with STATISTICA 13 and was conducted considering significance at a p-value <0.05.

Results: Significant improvement in TMJ’s mobility, which increased on average by 6.6 mm (p = 0.0005) and reducing of pain, a decrease of 3 points on average on the NRS Scale (p = 0.00002) were achieved.

Conclusions: The applied physiotherapy algorithm, including manual therapy and exercises of mas-ticatory muscles, is effective in the case of improvement TMJ’s range of motion and reduction of pain in patients with hypomobility of TMJ’s.

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Authors and Affiliations

Joanna Piech
Małgorzata Pihut
Małgorzata Kulesa-Mrowiecka
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Abstract

Temporomandibular disorders includes abnormalities of the masticatory muscles, temporo-mandibular joints and the surrounding structures. The aim of the study was to carry out a retrospective assessment of the frequency of the pain form of TMD based on the analysis of medical records of patients treated at the Prosthodontics Department at Jagiellonian University in Kraków.
Material and Methods: The study included the results of a medical history and a clinical examina-tion of patients, who came for consultation at the Prosthodontics Department at Jagiellonian University in Kraków, due to pain of the masticatory muscles or/and TMJ and painless symptom of TMD like limitation of the jaw movements and joints’ sounds. Out of all the analyzed results of the examination of treated patients, a group of patients with a painless and painful TMD was selected.
Results: The study involved the results of a detailed specialized functional examination of 334 patients (210 women and 124 men), ranging from 41 to 68 years. Analysis of the results of clinical examinations conducted in all patients revealed that 161 had the painless form — SG (99 women and 62 men) and 173 patients had the pain form of the TMD — CG (111 women and 62 men). In the CG 104 patients reported mostly pain in the masticatory muscles, while the remaining (69 patients) had a history of pain in one or simultaneously two TMJs.
Conclusion: The analysis of the patients forms allows to conclude that more than half of patients seeking help are patients with the painful form of the TMD and these abnormalities occur more frequently in women than in men.
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Bibliography

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8. De Leeuw R., Bertoli E., Schmidt J., Carson C.: Prevalence of traumatic stressors in patient with temporomandibular disorder. J Oral Maxillofac Surg. 2005; 63 (1): 42–50.
9. Martins R., Garbin C., Garcia A.R., Garbin A., Miguel N.: Stress levels and quality of sleep in subjects with temporomandibular joint dysfunction. Rev Odonto Scien. 2010; 25: 32–36.
10. Grey R., Davies S., Quayle A.: The clinical guide to temporomandibular disorders. The clinical guide series. British Dental Journal. 2003: 23–30, 55–60.
11. Osiewicz M., et al.: Research diagnostic criteria for temporomandibular disorders (RDC/TMD) — the polish version af a dual-axis system for diagnosis of TMD RDC/TMD form. J Stoma. 2013; 66 (5): 576–649.
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16. Bertolli E., de Leeuw R., Schmidt J.E., Okeson J.P., Carlson C.R.: Prevalence and impact of post- traumatic stress disorder symptoms in patients with masticatory muscle or temporomandibular joint pain: differences and similarities. J Orofac Pain. 2007; 21: 107–119.
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20. Piech J., Pihut M., Kulesa-Mrowiecka M.: Physiotherapy in hypomobility of temporomandibular joints. Folia Med Cracov. 2020; 60 (2): 123–134.
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Authors and Affiliations

Małgorzata Pihut
1
Agnieszka Pac
2
Andrzej Gala
1

  1. Department of Prosthodontics, Jagiellonian University Medical College, Kraków, Poland
  2. Department of Epidemiology, Jagiellonian University Medical College, Kraków Poland
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Abstract

Temporomandibular disorders (TMD) is one of the most common problem in contemporary dentistry. It is a term covering dysfunction of the masticatory muscles and the temporomandibular joints. Patients are suffering from severe pain, followed by limited mandibular opening and sounds in the temporomandibular joints during jaw movement. TMD influences the quality of life because the symptoms can become chronic and difficult to manage. Radiofrequency waves (RF) are electromagnetic waves with low energy and high frequency. They provide pain relief without causing significant damage to the nervous tissue. The RF therapy is commonly used for physiotherapeutic treatment of skeletal muscle relaxation, as a supportive therapy. The rehabilitation effect of these waves is based on diathermy by means of high-voltage quick alternating current. RF has also found application in physical therapy, as a therapeutic tool for various types of chronic pain syndromes. The aim of this literature review is to show the beneficial effect of radiofrequency waves on the pain of the masticatory muscles in the course of TMD.

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Authors and Affiliations

Michał Górnicki
Andrzej Gala
Małgorzata Pihut
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Abstract

TMD is a disease within the masticatory system that increases its reach among the society every year in the third and fourth decade of life. The etiology of TMD is complex and it is often difficult to establish the cause in a specific case. The aim of the study was to determine the impact of TMD on pathomorphological changes within the temporomandibular joints, evaluated in USG examinations and evaluation the assessment of differences in the number of pathological changes between various forms of TMD.
Material and Methods: The study material included a group of 386 patients, both sexes, aged 20 to 46 years, who came for prosthetic treatment due to symptoms of TMD. Ultrasound examination of the temporomandibular joints supplemented the clinical diagnosis of TMD in all the subjects. Axis I of the DC/TMD were used.
Results: Group I included 116 women and 89 men, group II consisted of 102 women and 79 men. Pathological morphological changes in the temporomandibular joints were found in all the examined patients. The changes in soft tissue structures were significantly increased in group II, but numerous pathomorphological changes were also present in the group of patients with the muscle form of TMD.
Conclusion: The results of the conducted studies with the use of USG temporomandibular joints revealed numerous pathomorphological changes within the temporomandibular joints. This indicates the usefulness of the USG examination in additional diagnostic tests in the group of patients with TMD.
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Authors and Affiliations

Małgorzata Pihut
1
Andrzej Gala
1
Małgorzata Kulesa-Mrowiecka
2

  1. Prosthodontic and Orthodontic Department, Dental Institute, Jagiellonian University Medical College, Kraków, Poland
  2. Department of Rehabilitation in Internal Diseases, Institute of Physiotherapy, Faculty of Health Science, Jagiellonian University, Kraków, Poland
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Abstract

The objective of this study was to review the current knowledge based on in vitro and in vivo studies, that evaluated the enamel damage connected with removal of metal and ceramic orthodontic brackets taking into account different debonding methods. Brackets fracture was also assessed. The protocol for this study was constructed according to the PRISMA statement. The literature review was performed in MEDLINE via PubMed, Cochrane and Scopus databases in May 2021. The searching was repeated in Journal of Stomatology, Orthodontic Forum and grey literature was screened using Google Scholar. Out of eligible studies 207 were screened by title and abstract, 85 subjected to full-text analysis and 30 were qualified for the research. The prevalence of enamel fracture ranged from 0 to 94.4%. The results of our review do not allow to identify the manual method of debonding that minimizes the risk of enamel damage. Thermal method and laser irradiation reduce the risk of enamel fracture.
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Authors and Affiliations

Marta Gibas-Stanek
1
Piotr Pełka
2
Małgorzata Pihut
1

  1. Department of Prosthodontics and Orthodontics, Dental Institute, Jagiellonian University Medical College, Kraków, Poland
  2. 5th Military Clinical Hospital with Policlinic, Orthodontic Clinic, Kraków, Poland
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Abstract

Temporomandibular disorders (TMD) encompass a diverse group of abnormalities in the functioning of the masticatory muscles, temporomandibular joints, and surrounding structures within the facial skull. One of the important etiological factors, contributing to the development of TMD are psychoemotional disorders, which include: depression, dysthymia, personality disorders, panic attacks as well as states and anxiety neuroses.
The aim of the study was to carry out a retrospective evaluation of the occurrence of psychoemotional disorders reported in the application form of medical interview of patients treated at the Consulting Room of Temporomandibular Disorders in Dental Institute (University Dental Clinic) for TMD.
The research material consisted of a subjective survey according to the protocol of the RDC/TMD questionnaire, axis II, of the 360 patients (224 women, 136 men), aged 19 to 43 who came to the University Dental Clinic in Krakow due to TMD management.
Result: The results of the conducted studies indicate the common occurrence of emotional disorders in the group of patients treated for TMD, both in the group of muscular and joint form of dysfunctions. The most often the patients selected: loss of sexual interest or pleasure, crying easily, feeling lonely, indifference to every-thing and feeling of worthlessness. These aspects show a significant influence of emotional factors on TMD.
Conclusion: The results of the conducted research indicate a significant frequencies of psychological and emotional disturbances reported in a survey among patients with TMD. Key
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Authors and Affiliations

Małgorzata Pihut
1
Magdalena Krasińska-Mazur
1
Joanna Biegańska-Banaś
2
Andrzej Gala
1

  1. Consulting Room of Temporomandibular, Disorders, Dental Institute, Prosthodontics Department, Jagiellonian University Medical College, Kraków, Poland
  2. Institute of Nursing and Midwifery, Department of Health Psychology, Jagiellonian University Medical College, Kraków, Poland
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Abstract

Significant impact factor and psycho-emotional stress in the etiology of dysfunction indicate the need of the routine approach in the treatment of patients with temporomandibular joint disorders to be changed. The aim of the study was to obtain data, documented test results as to the efficiency of progressive muscle relaxation in the treatment of pain caused by temporomandibular joint disorders, as a supplement to previous methods using occlusal splint and other physical therapies. The study included 100 patients of both sexes, aged from 20 to 35 years who were diagnosed with pain due to temporomandibular joint disorders accompanied with high muscle tension of musticatory muscles which were treatment by relaxation therapy. All patients underwent physical examination, specialized functional examination of the masticatory system in accordance with the Polish version of the study RDC/TMD (The Research Diagnostic Criteria of Temporomandibular Disorders, Axis I — physical assessment, Axis II — assessment of psychosocial status and pain — related disability) and assessment of psycho emotional factor and stress, based on the survey developed for their own purpose. The results of the research were obtained using specialized statistical package “R” i386 3.2.3. The results of examinations aft er relaxation therapy showed a signifi cant reduction in the intensity of myofascial pain in all patients. Progressive muscle relaxation can be successfully used as an supportive therapy treatment of patient with dysfunction.

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Authors and Affiliations

Ewa Ferendiuk
Joanna Marta Biegańska
Piotr Kazana
Małgorzata Pihut
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Abstract

Temporomandibular disorder (TMD) is a disease of multifactorial etiology and a complex of symptoms, related to disorders of the masticatory muscles, temporomandibular joints and the surround-ing orofacial structures. One of the main problems in the course of TMD disorders is the systematic increase in the tension of the masticatory muscles (masseter muscles, temporalis and medial and lateral pterygoid muscles), what is the cause of many damages and the development of pathological conditions in the stomatognathic system.
The article discusses the differences in the structure of the masticatory and skeletal muscles, as well as the different nature and isoforms of myosin, which determines the much faster generation of contraction in the masticatory muscles and consequently easier generation of excessive, harmful tensions in the masti-catory muscles.
The article describes the causes of increased tension in the masticatory muscles and methods of their relaxation used in the basic and supportive treatment of temporomandibular disorders. The use of occlusal splints, physiotherapeutic procedures and TMD treatment with botulinum toxin type A were character-ized. A role of psychological support and the methods used for patients with TMD were emphasized.
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Authors and Affiliations

Małgorzata Pihut
1
Magdalena Orczykowska
1
Piotr Ceranowicz
2
Ilona Korzonek
3
Andrzej Gala
1

  1. Prosthodontic and Orthodontic Department Dental Institute, Jagiellonian University Medical College, Kraków, Poland
  2. Department of Physiology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
  3. Department of Nutrition-Related Disease Prevention, Medical University of Silesia, Katowice, Poland
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Abstract

The prevalence of TMD indicates a need to develop new tools that are useful in the case of screening examinations. These methods can support diagnosis at the early stage of the disorder. The purpose of this research was to develop a comprehensive tool that would function as both a database of sounds generated by TMJ and as software which facilitates automated diagnosis. The software would also use the data from the RDC/TMD questionnaire. Such a tool may significantly reduce the time spent by dentists on making manual RDC/TMD diagnoses. Moreover, this solution would enable dentists who do not specialise in TMD to make effective diagnoses. 95 patient took part in the clinical examination: 30 man and 65 females. The mean age of the participants was 33 years. Patients participating in the clinical process were examined according to the Polish version of the RDC/TMD questionnaire (Axis I and Axis II). Subsequently, all subjects were auscultated with an electronic stethoscope. An application has been im-plemented based on the RDC/TMD diagnostic flow chart. This tool was used for the automated generation of RDC/TMD diagnoses for all patients. As a result of the kind permission and participation of the patients under examination, it was possible to store records of ninety-five people. Each record contains RDC/TMD questionnaire data, auscultation signals and RDC/TMD diagnoses. For the first time, a database was created that has the potential to facilitate further examination. However, the developed system is universal and can therefore be adapted to new DC/TMD criteria.
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Authors and Affiliations

Justyna Grochala
1
Marcin Kajor
2
Małgorzata Pihut
1
Jolanta E. Loster
3

  1. Jagiellonian University Medical College, Department of Dental Prosthetics and Orthodontics, Institute of Dentistry, Kraków, Poland
  2. AGH University of Science and Technology, Department of Automatics, Computer Science and Biomedical Engineering, Faculty of Electrical Engineering, Kraków, Poland
  3. Prof. Loster’s Orthodontics, Kraków, Poland
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Abstract

Pain in the masticatory muscles or temporomandibular joints may in some cases be a symptom of other afflictions occurring in this region. The aim of the study was to present the differential diagnosis of temporomandibular disorders (TMD) and other diseases in the craniofacial area, based on review of the literature. Using the key words: “differential diagnosis of TMD”, “pain of non-dental origin” and “chronic orofacial pain”, PUBMED and Scopus databases were systematically searched for articles in English from 2005 to 2020. Additionally, the PUBMED database was supplementarily reviewed using the keywords “Lyme disease orofacial symptoms” for the English-language articles published in the years 1996–2020. Out of 445 publications from PUBMED and Scopus databases as well as other sources, 57 articles describ-ing the pathogenesis and characteristic symptoms of diseases that may cause pain similar to that occurring in TMD as well as diagnostic methods used in differential diagnosis of TMD were selected for analysis. Dental and jawbones-related conditions, ear and maxillary sinus diseases, as well as ailments of neuro-pathic and vascular origin, were taken into account. Neoplastic processes taking place in this region and less often occurring diseases caused by viruses, bacteria and parasites were also described. Conclusions. Correct diagnosis of temporomandibular disorders is based on medical history and thorough physical examination, as well as results of additional tests. Pain localized in the head and neck structures may have diverse, sometimes complex aetiology, and may require multidisciplinary treatment. Observation of the patient’s behaviour and — in selected cases — the results of additional laboratory tests, also play a sig-nificant role.
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Authors and Affiliations

Magdalena Krasińska-Mazur
1
Paulina Homel
1
Andrzej Gala
1
Justyna Stradomska
1
Małgorzata Pihut
1

  1. Department of Prosthodontics and Orthodontics, Institute of Dentistry, Jagiellonian University Medical College, Kraków, Poland
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Abstract

Introduction: Dentin hypersensitivity is a painful clinical condition. The frequency of its occurrence varies from 8 to 57%, depending on tested group and different methods of investigations. Recommended desensitizing agents have different mechanism of action and effectiveness. We are still looking for solutions that will improve their effectiveness and simultaneously allow for wider use of e.g. as a base material, counteracting postoperative hypersensitivity, reducing marginal microleakage. The aim of the study was to assess the effect of a selected desensitizing agent occluding dentin tubules with calcium hydroxyapatite on marginal microleakage formation of a class V composite restorations subjected to thermocycles.

Materials and Methods: In study it was used 40 molars and premolars, which were alternately assigned into two groups. In both groups standardized cavities were prepared. In the study group (study group — SG) before application of bonding agent Teethmate Desensitizer (f. Kuraray, Noritake Dental Inc., Okayama, Japan) was used. In the control group (control group — CG) OptiBond All-in-one (f. Kerr, Bioggio, Switzerland) bonding agent was used and cavities were filled using composite material Gradia Direct (f. GC Europe N.V., Leuven, Belgium). After storage in saline, teeth were subjected to 600 thermo-cycles, passive dye penetration test was done, teeth were cut in the area of filling, according to its long axis. Under light microscope magnification value of microleakage was measured and marginal microleakage rate (M) was counted. The results of the tests were statistically analyzed using the package STATISTICA 12.0 (StatSoft, USA).

Results: The average value of M for the SG group was 0.46 (min 0.05, max 0.76, SD 0.226) and for CG was 0.22 (min 0, max 0.74, SD 0.235). The differences between M values were statistically significant (p = 0.0094).

Conclusion: A reduction in the number of retention sites for the bonding system, facilitates the formation of microleakage in the experimental conditions and reduces the degree of adhesion of the composite material to the hard tissues of the tooth.

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Authors and Affiliations

Elżbieta Zarzecka-Francica
Joanna Gołda
Olga Górnicka
Barbara Śliwowska
Przemysław Kustra
Małgorzata Pihut
Joanna Zarzecka

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