***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: To comprehend the results of a r and omised controlled trial ( RCT ) , readers must underst and its design , conduct , analysis , and interpretation . That goal can be achieved only through total transparency from authors . Despite several decades of educational efforts , the reporting of RCTs needs improvement . Investigators and editors developed the original CONSORT ( Consoli date d St and ards of Reporting Trials ) statement to help authors improve reporting by use of a checklist and flow diagram . The revised CONSORT statement presented here incorporates new evidence and addresses some criticisms of the original statement . The checklist items pertain to the content of the Title , Abstract , Introduction , Methods , Results , and Discussion . The revised checklist includes 22 items selected because empirical evidence indicates that not reporting this information is associated with biased estimates of treatment effect , or because the information is essential to judge the reliability or relevance of the findings . We intended the flow diagram to depict the passage of participants through an RCT . The revised flow diagram depicts information from four stages of a trial ( enrolment , intervention allocation , follow- up , and analysis ) . The diagram explicitly shows the number of participants , for each intervention group , included in the primary data analysis . Inclusion of these numbers allows the reader to judge whether the authors have done an intention- to-treat analysis . In sum , the CONSORT statement is intended to improve the reporting of an RCT , enabling readers to underst and a trial 's conduct and to assess the validity of its results PURPOSE The aim of this r and omised single-blind , cross-over trial was to assess the effect of tongue cleansing on morning oral malodour in periodontally healthy subjects . MATERIAL S AND METHODS Ten systemically healthy non-smoker subjects ( 6 males , 4 females ) , 24 - 38 years of age , completed two 4-day periods of oral hygiene cessation with a 7-day wash-out period . In one of these test periods , subjects were instructed to clean their tongues with a tongue scraper 2 - 3 times a day . Participants presented at least 20 teeth , without cavities , overhanging restorations/prostheses or periodontitis , and had no history of previous periodontal therapy or use of antibiotics in the 3 months prior to the study .  Volatile sulphur compounds ( VSC ; Interscan Halimeter ) and organoleptic scores were measured in exhaled mouth air once a day , early in the morning , by one examiner . Comparisons were performed using Wilcoxon 's signed rank test and Friedman 's test ( alpha = 0.05 ) . RESULTS VSC levels at baseline were 206.3 ppb ( SD 139.8 ) and 191.4 ppb ( SD 127.7 ) for periods of usage and non-usage of the scraper respectively ( p > 0.05 ) . VSC levels did not change significantly during the 4 days , independent of tongue cleansing ( Friedman , p > 0.05 ) . Only at day 3 did the use of the tongue scraper lead to a significantly lower level of VSC compared with controls ( 131.1 ppb and 199.3 ppb respectively ) . No significant differences in organoleptic scores were observed between groups at baseline . During the whole experimental period , there were also no significant changes in organoleptic scores when individuals used or did not use the tongue scraper . CONCLUSION Tongue cleansing with a scraper was unable to prevent morning oral malodour in the absence of tooth cleaning in periodontally healthy individuals For centuries , specific instruments or regular toothbrushes have routinely been used to remove tongue biofilm and improve breath odor .  Toothbrushes with a tongue scraper on the back of their head have recently been introduced to the market . The present study compared the effectiveness of a manual toothbrush with this new design , i.e. , possessing a tongue scraper , and a commercial tongue scraper in improving breath odor and reducing the aerobic and anaerobic microbiota of tongue surface . The evaluations occurred at 4 moments , when the participants ( n=30 ) had their halitosis quantified with a halimeter and scored according to a 4-point scoring system corresponding to different levels of intensity . Saliva was collected for counts of aerobic and anaerobic microorganisms . Data were analyzed statistically by Friedman 's test ( p<0.05 ) . When differences were detected , the Wilcoxon test adjusted for Bonferroni correction was used for multiple comparisons ( group to group ) . The results confirmed the importance of mechanical cleaning of the tongue , since this procedure provided an improvement in halitosis and reduction of aerobe and anaerobe counts . Regarding the evaluated methods , the toothbrush 's tongue scraper and conventional tongue scraper had a similar performance in terms of breath improvement and reduction of tongue microbiota , and may be indicated as effective methods for tongue cleaning Bacterial proliferation and plaque accumulation on the surface of the tongue are major factors contributing to oral malodor . In this research , we used subjective and objective methods to evaluate the breath benefit of a triclosan-containing dentifrice ( Blend-a-Med Complete Night ) with and without tongue brushing in a r and omized , examiner-blinded , three-period crossover clinical trial . Twenty-nine adults ( mean age 40.2 years ) with morning malodor were r and omly assigned to a treatment sequence : triclosan dentifrice , triclosan dentifrice plus tongue brushing , and a control dentifrice ( Crest Cavity Protection ) . The subjects used each product four times in 27 h with a 2-day wash-out period between treatments . Halimeter measurements were taken at baseline and at 3 , 24 and 27 h. Subject question naire data assessing the breath quality were collected at 24 and 27 h. Both triclosan regimens showed significant improvement in oral malodor ( p<0.03 ) relative to the control . Significant ( p=0.035 ) malodor benefit was observed when tooth brushing with triclosan dentifrice was supplemented with tongue brushing . The triclosan dentifrice was associated with significant improvement ( p<0.05 ) in morning mouth feel and feeling of clean and fresh breath during the day relative to the control . There were no adverse events reported . The triclosan dentifrice was effective against overnight and daytime oral malodor . Supplementing routine brushing with tongue brushing result ed in additional breath improvement and breath benefits of the triclosan dentifrice were first-person noticeable The purpose of the study was to compare the efficacy of four mouthrinses in clinical outcomes of changes in oral malodor measurements in a 4-week , r and omized , double-blind , longitudinal clinical trial in adults . The four rinses were coded as Products 1 , 2 , 3 , and 4 so that neither the examiners nor subjects had the knowledge of treatment . Of the four mouthrinses , two were commercially available mouthrinses with essential oils ( EO ) or chlorine dioxide plus zinc ( CD/Zn ) as active ingredients ( Products 1 and 4 ) , one mouthrinse was a formulation containing cetylpyridinium chloride ( Product 2 ) , and one was a placebo ( Product 3 ) . A total of 99 subjects who met the study criteria were assigned r and omly to one of the four groups . At three separate visits ( 0 , 2 , and 4 weeks ) , subjects received an examination of the oral soft tissues and were assessed for baseline oral malodor by two organoleptic judges and a laboratory instrument that measures oral malodor . Subjects were instructed to use the assigned rinse , and the measurements were performed again after 2 and 4 hours . Throughout the 4-week study period , each subject was asked to use the assigned rinse twice daily per the manufacturer 's recommended directions . The results showed that the four mouthrinses reduced oral malodor within 4 hours after a single usage , with Product 2 being the most effective and the placebo being the least effective . Daily use of EO , CD/Zn , and placebo rinses for up to 4 weeks did not reduce oral malodor from week 0 baseline values , and the effects on oral malodor were comparable among these three mouthrinses . Product 2 was the only mouthrinse that reduced oral malodor from baseline values after 2 and 4 weeks of daily use Most systematic review s rely substantially on the assessment of the method ological quality of the individual trials . The aim of this study was to obtain consensus among experts about a set of generic core items for quality assessment of r and omized clinical trials ( RCTs ) . The invited participants were experts in the field of quality assessment of RCTs . The initial item pool contained all items from existing criteria lists . Subsequently , we reduced the number of items by using the Delphi consensus technique . Each Delphi round comprised a question naire , an analysis , and a feedback report . The feedback report included staff team decisions made on the basis of the analysis and their justification . A total of 33 international experts agreed to participate , of whom 21 completed all question naires . The initial item pool of 206 items was reduced to 9 items in three Delphi rounds . The final criteria list ( the Delphi list ) was satisfactory to all participants . It is a starting point on the way to a minimum reference st and ard for RCTs on many different research topics . This list is not intended to replace , but rather to be used alongside , existing criteria lists BACKGROUND The purpose of this study was to assess treatment responses to dental flossing in twins . METHODS The study was a two-treatment , examiner-blind , r and omized parallel group , controlled study . Fifty-one twin pairs between 12 and 21 years of age were r and omized to a 2-week supervised and unsupervised treatment regimen consisting of 1 ) tongue brushing and toothbrushing ( TB ) and 2 ) TB + flossing ( TB + Fl ) . Clinical endpoints were gingival bleeding ( papillary bleeding score [ PBS ] ) and oral malodor ( levels of volatile sulfur compounds [ VSC ] ) . Analysis of variance and covariance method ologies were employed to analyze the data . RESULTS Baseline average PBS values were 1.352 and 1.345 for the TB + Fl and TB groups , respectively ( P=0.937 ) . After 2 weeks of treatment , the TB + Fl group had a statistically significant decrease in PBS values of 0.558 ( 41.5 % versus baseline ) , whereas the TB group showed no improvement from baseline . The change from baseline for the TB + Fl group was superior to that for the TB group ( P<0.001 ) . Similar findings were observed for the number of baseline papillary bleeding sites . Baseline average intraoral halimeter values were 45.91 and 41.75 for the TB+Fl and TB groups , respectively ( P=0.504 ) . Both treatment regimens demonstrated highly statistically significant reductions in intraoral halimeter values versus baseline ( all P<0.001 ) and the difference between treatment groups was not statistically significant ( P=0.339 ) . Similar findings were found for expired air . CONCLUSIONS In a well-matched twin cohort , tongue and toothbrushing plus flossing significantly decreased gingival bleeding after 2 weeks BACKGROUND It is estimated that approximately 85 % of all halitosis cases have their origin within the mouth ; of these , 50 % are caused by tongue residues . Previous studies have established that hydrogen sulfide and mercaptans are the primary components of halitosis . Thus , tongue cleaning gains importance as a means of halitosis management . METHODS This investigation compared the efficacy of two mechanical methods for tongue cleaning through a h and held sulfide monitor . This crossover trial was carried out with 10 healthy subjects , 20 to 50 years old . Before the baseline measurement of the volatile sulfur compounds ( VSCs ) , the subjects were instructed to refrain from any tongue cleaning method for 48 hours . The 10 participants were then placed in one of two groups ( five each ) : 1 ) first week : tongue scraper , second week : soft-bristle toothbrush ; 2 ) first week : toothbrush , second week : tongue scraper , with a 48-hour wash-out period between each week . RESULTS The baseline measurements were compared with those of the end of each week using the Dunn method ( alpha = 0.01 ) . The tongue scraper showed a 75 % reduction in VSCs , while the toothbrush only achieved a 45 % reduction in VSCs . CONCLUSION Although the tongue coating was removed by both methods , the tongue scraper performed better in reducing the production of volatile sulfur compounds Tongue cleaning is an ancient habit . Recent literature has shown that tongue cleaning leads to healthy oral environment . The aims of this study were to assess the effect of tongue scraper among male adult patients with caries and periodontal disease , on Mutans streptococci ( MS ) and Lactobacilli ( Lb ) bacteria and secondly to assess the effect on self perceived oral malodour .  Sixty male patients completed the study . The age ranged from 20 - 55 years ( 32 + /- 9.53 ) . Fifty percent of the subjects were with university education level . Mean DMFT score was 9.17 ( + /-5.46 ) , while 88 % of the subjects were with early to moderate periodontitis assessed by CPITN . Thirty one percent of the subjects were smoker , while 86.7 % had tea/coffee drinking habit and tooth brushing . Only 28 % cl aim ed of using miswak ( chewing stick ) . All patients were advised to use a tongue scraper twice daily for at least 2 minutes per day for 7 days . No effort was made to change tooth brushing or dietary habits of patients . Self perceived oral malodour was reported by 41.7 % at baseline and 30 % after use of tongue scraper . Salivary count of Mutans Streptococci and Lactobacilli had significant decrease 3.37 ( + /- 0.71 ) to 2.27 ( + /- 0.80 ) and 3 
    Output:
    
All experiments show a positive effect of mechanical tongue cleaning in addition to toothbrushing on various parameters of oral malodour .
CONCLUSIONS This review demonstrated that mechanical approaches , such as tongue brushing or tongue scraping to clean the dorsum of the tongue , have the potential to successfully reduce breath odour and TC .