***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Thirty patients took part in a 4 week ' double-blind ' clinical trial . Following initial oral hygiene instruction and scaling , half the patients were instructed to brush with a 1 % Chlorhexidine gel in the evenings , the other half to use placebo . A st and ard dentifrice was used in the morning . In both groups there was a marked improvement in all parameters recorded , and although final plaque scores showed a statistically significant difference in favor of the test group , there was virtually no difference in rate or degree of resolution of gingivitis . The use of st and ard dentifrice was only partially successful in preventing staining Objective : This parallel controlled clinical trial evaluated the effect of a gel containing Lippia sidoides essential oil on plaque and gingivitis control . Methods : Thirty patients ( n=30 ) were r and omly selected and allocated into three groups : Lippia sidoides ( LS , n=10 ) , chlorhexidine ( CLX , n=10 ) or placebo ( control , n=10 ) . Plaque and bleeding index were recorded at baseline and after three months . All volunteers were instructed to brush with the gel three times a day throughout the experiment period . Results : There was a significant reduction on plaque and gingivitis in the test groups ( P<.05 ) , but no statistically significant difference was observed between them ( P>.05 ) . Conclusion : A gel preparation containing 10 % Lippia sidoides essential oil was an efficient herbal antiplaque and antigingivitis agent AIM To evaluate the clinical efficacy of two gel formulations containing chlorhexidine gluconate and neem extract with a commercially available chlorhexidine gluconate mouthwash . METHOD An open labelled r and omised six-week clinical study with parallel group design in 48 subjects divided into four groups . Plaque accumulation and gingival condition were recorded using plaque index and gingival index . On the basis of mean baseline plaque and gingival scores , subjects were allocated to four different groups , using their assigned products twice a day , before bed and after breakfast . Plaque and gingival scores were recorded after three and six weeks . RESULTS Mean plaque and gingival scores were reduced over the six-week trial period for experimental and control groups . Chlorhexidine gluconate gel reduced the plaque and gingival scores significantly more ( p<0.05 ) than the chlorhexidine gluconate mouthwash . Neem extract gel also showed significant ( p<0,05 ) reduction in plaque and gingival scores when compared with the control group . But there was no significant difference between the groups treated with chlorhexidine gel and neem extract gel . CONCLUSION The results of this clinical study indicate that better therapeutic efficacy can be achieved using gels for treating oral infections than conventional treatments using mouthwash An experimental clinical trial design is described in which the onset of gingival bleeding was used as an indicator of early gingivitis . Twenty-nine dental students participated in a double-blind crossover trial utilising chlorhexidine as a known plaque inhibitor . The onset of gingival bleeding was assessed in three ways , one of which yielded a statistically significant difference in favour of the active mouthrinse ( P = 0.02 ) . The method has a role in screening agents believed to be active against gingivitis The experimental gingivitis model has long been used to evaluate chemotherapeutic agents in mouthrinses . Only recently however has the model been modified to test undiluted dentifrices by using a toothshield both to apply dentifrice and to protect selected teeth from toothbrushing . This also enables participants to brush the rest of the mouth and avoid the unpleasantness of 3 weeks without oral hygiene . Because of its well-documented efficacy , chlorhexidine was used in a toothpaste formulation to investigate the validity of the partial-mouth , experimental gingivitis model for evaluating therapeutic dentifrices . Optimal gingival health was established in 88 adults , who then were r and omly assigned to two equal groups . A toothshield was constructed for each subject to fit the teeth of one m and ibular quadrant . During the trial chlorhexidine or placebo dentifrice was applied undiluted to the test teeth via the toothshield , which also prevented plaque removal during brushing of the remaining dentition . After 21 days , plaque and gingivitis had developed in both groups . However , the chlorhexidine group had significantly less plaque and gingivitis than the placebo group . No adverse soft tissue effects were observed . This study demonstrated that the partial-mouth , experimental gingivitis model allowed unhindered development of plaque and gingivitis that was comparable to whole-mouth studies in which oral hygiene was suspended for 3 weeks . By corroborating with chlorhexidine , it is concluded that this short-term clinical model is valid for evaluating the chemotherapeutic effects of dentifrices The effect of daily toothbrushing with 0.5 % chlorhexidine-containing gel for 12 months was evaluated in a double-blind study in 37 dental students . The active gel did not markedly influence plaque formation , gingival conditions , or caries as compared with placebo gel treatment . Salivary bacterial counts were performed on subgroups of six subjects using chlorhexidine gel and on six using placebo gel . No differences in the effect of treatment on the microorganisms studied in the two subgroups could be detected except for S. sanguis . The percentage of this species decrease in the placebo group and increased in the chlorhexidine group . The difference became significant after 2 weeks . A tendency to a greater reduction of S. mutans noted in the chlorhexidine group was most marked in individuals who had high initial counts of this species . The proportion of S. sanguis , which could grow on chlorhexidinei-containing mitis salivarius medium , increased and after 12 months of chlorhexidine treatment averaged 34 % of cultivable S. sanguis compared with 0.002 % prior to treatment . The number of less sensitive S. sanguis decreased in the 12 months following termination of treatment . There was no observed tendency for the selection or proliferation of other streptococci , gram-negative rods , yeasts , or staphylococci AIMS A single-centre , r and omized single-blind parallel study was undertaken to compare staining seen with three brushing regimens and to determine subject perception of side effects such as staining and effects on taste . METHODS This 6-week parallel study used 157 volunteers who were r and omized into one of three treatment groups : ( i ) brushing in the morning and evening with a normal dose of a 1 % chlorhexidine gel , ( ii ) brushing with a low dose of chlorhexidine gel in the evening and a whitening dentifrice in the morning , and ( iii ) brushing with a st and ard fluoride paste in the morning and evening . Following home usage of their allocated products , the study volunteers returned after 3 and 6 weeks to record the amount of stain present . After the 6-week period , subject perception of taste and stain acceptability was determined using a question naire . RESULTS After 6 weeks of use of the low-dose chlorhexidine gel and whitening dentifrice , significantly more stain was seen compared with the use of a st and ard dentifrice ( P<0.0001 ) . Similarly , significantly more stain was seen with use of the normal-dose chlorhexidine gel compared with the low-dose gel and whitening dentifrice ( P=0.0007 ) . Approximately 30 % of individuals on the low-dose chlorhexidine gel regimen found the amount of stain unacceptable and 10 % noted an effect on their taste perception . CONCLUSIONS The use of low dose of chlorhexidine gel at night and a whitening paste in the morning produced a significant amount of stain that 30 % of subjects considered unacceptable BACKGROUND Previous studies have shown that using an oxidising agent in addition to chlorhexidine reduces staining . AIM The purpose of the present study was to investigate whether , compared to chlorhexidine alone , the use of an oxidising mouthrinse as an adjunct to chlorhexidine is efficacious in reducing stain , plaque and gingivitis . METHOD This study had a single-blind , 2-group parallel design , including a 14-day experimental non-brushing period during which 1 group ( n= 14 ) used chlorhexidine alone ( CHX ) ( chlorhexidine mouthrinse , 0.12 % Oral-B laboratories , Irel and ) , and the other ( n= 14 ) used chlorhexidine in combination with an oxidising agent ( sodiumperborate-monohydrate-Bocasan , Oral-B laboratories , Irel and ) . Patients were r and omly assigned to either group . All participants received a scaling and polishing before the start of the trial . No oral hygiene instructions were given . Since , at the start of the experiment , all stain and plaque were removed , only the gingival condition was evaluated at baseline by means of bleeding on marginal probing . The examination after 14 days of rinsing included the evaluation of plaque , bleeding on marginal probing and stain ( GMSI : gingival modification of the stain index ) . RESULTS The results showed at day 14 , a significant difference between the 2 groups for plaque ( CHX : 0.18 , CHX+PER : 0.08 , p=0.03 ) and gingival bleeding ( CHX : 0.38 , CHX+PER : 0.21 , p<0.001 ) . The proportion of stained surfaces was less in the CHX+PER group ( 28 % ) , than in the chlorhexidine group ( 48 % ) ( p=0.04 ) . CONCLUSIONS In conclusion , the adjunctive use of an oxidising agent peroxyborate to chlorhexidine , proved to be superior to chlorhexidine alone with regard to the inhibition of plaque and development of gingivitis . In addition , the proportion of stained surfaces was significantly less when adding the oxidising mouthrinse to chlorhexidine BACKGROUND Certain plants used in folk medicine serve as a source of therapeutic agent by having antimicrobial and other multi-potential effects . This prospect i ve , r and omized , placebo and positively controlled clinical trial was design ed to evaluate the short-term clinical effects of a commercially available gel containing Acacia arabica in the reduction of plaque and gingival inflammation in subjects with gingivitis . METHODS Ninety subjects diagnosed with chronic generalized gingivitis were selected and r and omly divided into three groups : Group I - placebo gel , Group II - gumtone gel and Group III - 1 % chlorhexidine gel . Clinical evaluation was undertaken using the gingival index of Loe and Silness and the plaque index at baseline , 2 weeks , 4 weeks and 6 weeks . A subjective evaluation was undertaken by question naire . RESULTS Gumtone gel showed significant clinical improvement in gingival and plaque index scores as compared to a placebo gel . This improvement was comparable to 1 % chlorhexidine gel . Unlike chlorhexidine gel , gumtone gel was not associated with any discolouration of teeth or unpleasant taste . CONCLUSIONS Gumtone gel may be a useful herbal formulation for chemical plaque control agent and improvement in plaque and gingival status An intraindividual double-blind crossover study was design ed in order to see if a 1 % chlorhexidine gel used twice a day could substitute for ordinary toothpaste in group of maintenance-care patients with poor oral hygiene . Twenty patients from a student clinic participated , each with a long history of maintenance-care problems . A 4-week test period with chlorhexidine gel or placebo gel was followed by an intermediate period with ordinary toothpaste , and then by another 4-week test period . Plaque-covered surfaces ( % ) , bleeding sites ( % ) and extraneous staining ( color slides ) were recorded at each sitting . The results demonstrated that brushing with chlorhexidine gel significantly influenced both the oral hygiene level and the gingival inflammation . The only adverse effect observed was a marked increase in the amount of brown staining , especially on the facial surfaces of the nonsmokers . In this short-term study , the staining was not considered cosmetically unacceptable by the patients . The total amount of staining was always greater in smokers than in nonsmokers BACKGROUND There is a need for an anti-plaque agent that can be used on a daily basis without the side effects of antibacterial chemicals such as chlorhexidine . The present study was design ed to evaluate the clinical and microbiologic effects of commercially available gel and powder containing Acacia arabica in subjects with gingivitis . METHODS One hundred and twenty subjects with chronic generalized gingivitis were selected and r and omly divided into four groups : Group 1 - placebo group ; Group 2 -Acacia arabica gel group ; Group 3 -Acacia arabica powder group ; and Group 4 - 1 % chlorhexidine gel group . Microbial counts of plaque sample s , the gingival index of Loe and Silness and the plaque index were evaluated at baseline , 6 weeks , 12 weeks and 24 weeks . Microbial counts of plaque sample s were evaluated at all visits . RESULTS Acacia arabica gel and powder showed significant clinical improvement in gingival and plaque index scores as compared to a placebo . This improvement was comparable to 1 % chlorhexidine gel . The difference between gel and powder with regard to clinical and microbiological parameters was not found to be significant at any time interval . CONCLUSIONS Both Acacia arabica gel and powder may be useful herbal formulations for chemical plaque control in subjects with gingivitis Students at a vocational school participated in a double-blind , cross-over study to test the effect of brushing with a 1 % chlorhexidine-containing gel once a day . In the control period , a placebo gel was used . Each treatment period lasted for 4 weeks . This was subsequently followed by 4 weeks of ordinary toothbrushing . Any toothbrushing additional to the therapeutic brushing was performed with a st and ard commercial dentifrice without ab 
    Output:
    
Regarding plaque score reduction , the majority of the experiments using a CHX dentifrice provided a significant positive effect .
All studies assessing gingival bleeding as parameter for gingivitis observed a significant reduction in favour of CHX dentifrice over placebo dentifrice .
Tooth surface discoloration was more pronounced with CHX dentifrice .
The combined data concerning parameters of interest for CHX gel compared with a placebo did not show a trend towards a beneficial effect on plaque and bleeding scores .
CONCLUSIONS Within the limitations of this analysis , it may be concluded that toothbrushing with a CHX gel does not provide conclusive evidence .
Brushing with a CHX dentifrice can be effective with regard to the control of plaque and gingivitis .
Tooth surface discoloration was observed as side effect , which potentially can have a negative impact on patients ' compliance