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While radiation induces ROS production that has a key role in induction of DNA double-strand breaks and activation of apoptosis signaling pathways, recent studies have shown that treatment with L-carnitine and its derivatives as potent antioxidants can inhibit DNA damage and activate DNA-repair genes through ROS reduction (65)

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Exogenous pigmentations can also occur from old materials used in endodontic fillings, which can traverse the bone and tissues, causing pigmentation of the mucosa at the level of the involved tooth apex