The periapical index: a scoring system for radiographic assessment of apical periodontitis.
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Biomedical subjects
Publications and source records attributed to H M Eriksen.
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The etiology of extrinsic tooth discolorations due to chemical, plaque-preventive agents is not fully understood. However, information from experimental investigations point to at least 3 possible mechanisms. (A) Non-enzymatic browning reactions (Maillard reactions). (B) Formation of pigmented metal (Fe, Sn)-sulfides. (C) Reaction products of food and beverage constituents and chemical, plaque-preventive compounds. Available evidence indicates that browning (A) and formation of pigmented metal sulfides (B) are the most likely causes of these discolorations while dietary factors (C) may play a modifying rôle.
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Stainers and non-stainers were selected on the basis of their individual tendency to develop extrinsic tooth discolorations from a chlorhexidine mouth rinse. Saliva proteins adsorbed to hydroxyapatite in vitro and in vivo pellicle from the participants were analyzed by gel filtration and ion-exchange chromatography. Two distinct anionic components were isolated. The elution patterns from stainers and non-stainers were identical. Amino acid analyses of the main peaks demonstrated a prevalence of serine, glycine, and glutamic acid.
Stainers and non-stainers were selected on the basis of their individual tendency to develop extrinsic tooth discolorations from a chlorhexidine mouth rinse. Pellicle was allowed to form in vivo on dental enamel slabs in both stainers and non-stainers. The slabs were then exposed to chlorhexidine 0.2% and a neutral iron salt solution extraorally either once or until a brownish discoloration appeared from the stainers. The pellicle was examined for its content and distribution of iron by Auger electron spectroscopy (AES). Pellicle from stainers showed higher concentrations of iron than pellicle from non-stainers.
A clinical model was introduced to study the ability of chlorhexidine, tannic acid, and iron to discolor dental plaque formed on acrylic resin surfaces. None of the agents caused discoloration when applied individually five times daily during a 5-day period. However, exposure of the dental plaque to either chlorhexidine or tannic acid before the iron applications produced marked staining. Possible mechanisms, among which denaturation appears to be significant, are discussed. The use of a strong oxidizing agent, peroxymonosulfate, completely bleached the established discolorations.
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Saliva coated hydroxyapatite was used as a model to study iron adsorption to pellicle material. The uptake of iron was markedly influenced by its concentration in the medium. Denaturation of the protein film by chlorhexidine, tannic acid, or heating up to 70 degrees C increased the adsorption significantly.
Extrinsic discoloration of teeth has frequently been observed in connection with the use of chemical plaque-preventive agents. Preliminary investigations have indicated that oxidizing peroxymonosulfate may effectively reduce this discoloration without interfering with the plaque-preventive capacity of chlorhexidine. In the present experiment a 0.2% chlorhexidine and a 1% peroxymonosulfate solution were used for oral rinsing in a group of 50 military recruits. A double-blind experimental design was followed. The plaque-preventive capacity of chlorhexidine was maintained, and a marked reduction in extrinsic tooth discoloration could be observed.
Individual differences in tooth discoloration have been observed after using chlorhexidine mouth rinses. To study the correlation between retention of chlorhexidine and the discoloration tendency, two groups, 'stainers' and 'non-stainers', were selected. The following parameters were tested: initial retention of chlorhexidine in vivo, retention of chlorhexidine to saliva-coated hydroxyapatite in vitro, and prolonged release of chlorhexidine in vivo. The initial oral retention of chlorhexidine was identical for the two groups, whereas in vitro retention of hydroxyapatite and prolonged release of chlorhexidine in vivo were higher among 'stainers'.
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Experiments were performed in a standardized rabbit model for examination of the potential of chlorhexidine and other denaturing agents to induce dental stain together with ferric ions. The studies supported the view that denaturation may be a major aspect of the mechanism of stain formation and that iron sulphide may be one important cause for extrinsic dental stain. Analytical microprobe analysis showed high amounts of Fe and S in the stain. The stain formation could be inhibited by SnF2, possibly by a red-ox reaction. Established stain could be removed by an oxidizing agent.
Experiments in a standardized rabbit model indicate that the yellow-golden stain formed on tooth surfaces during the use of SnF2 may consist of stannic sulfide. The nature of the stain, the presence of sulfur in the samples and the effect of an oxidizing agent on the stain support this view. It is suggested that the low pH of SnF2 caused denaturation of pellicle protein with exposure of sulfhydryl groups, which later form stannic sulfides through reactions with the stannous ions present in the preparations.
Extrinsic discoloration of teeth following a large consumption of tannin-containing beverages or a prolonged use of chlorhexidine mouthrinses is a well known observation. Tannins as well as chlorhexidine are denaturing agents. Based on preliminary studies revealing the presence of iron in chlorhexidine discolored pellicle material, the ability of iron to stain the integument after pretreatment with the two denaturants was studied in a human model. The denaturing effect of an acidic environment was also included. Enamel slabs fixed to acrylic appliances were carried in the oral cavity and alternately exposed to the test solutions in different sequences in vitro. Pretreatment with chlorhexidine or tannic acid led to marked discoloration upon iron application during 5-d tests, whereas the compounds individually had no such effect. A large content of the metal was found in the stained material. Stannous fluoride appeared to reduce the formation of the pigments, and strong oxidation completely bleached the established color. Possible mechanisms underlying the phenomena observed are discussed.
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