***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: PURPOSE To determine differences in interproximal plaque mass and fluoride retention with different modes of toothbrushing and flossing . MATERIAL S AND METHODS Forty-seven subjects in good health used four treatments in a four-period , r and omized , crossover design : 1 ) manual brushing only ; 2 ) manual brushing and daily flossing ; 3 ) electric brushing using a rotational oscillation toothbrush ; and 4 ) electric brushing using a sonic toothbrush . Subjects used a st and ard sodium fluoride dentifrice during the eight-day experimental periods and a fluoride-free dentifrice during the seven-day washout periods between treatments . Interproximal plaque sample s were taken on Day 1 and on Day 8 , weighed , and analyzed for fluoride content . RESULTS The amount of interproximal plaque was lowest with sonic brushing , which left 43 - 65 % less plaque than all other treatments . Manual brushing and flossing yielded less plaque than manual brushing alone and rotational oscillation brushing . Differences were statistically significant ( p < 0.05 ) for treatment ; there was no time effect on plaque mass . For fluoride retention , at Day 1 sonic brushing gave at least 54 % more fluoride in the interproximal plaque than all other treatments , which was significant . All treatments demonstrated a significant increase in fluoride concentration with time except manual brushing and flossing , which showed a significant decrease . At Day 8 , the fluoride concentration was significantly higher for sonic brushing than for manual brushing or rotational oscillation brushing by over 40 % , and all treatments exhibited significantly greater fluoride than the manual brushing and flossing combination . CONCLUSION The mode of toothbrushing may impact the amount of plaque retained interproximally and its fluoride concentration A clinical trial was conducted to evaluate the effects of a sanguinaria-zinc chloride dentifrice on the prevention of plaque formation and gingivitis .  A total of 59 young adults , 18 to 30 years of age , either performed supervised brushing with a 0.075 % sanguinaria-0.05 % zinc chloride dentifrice , a 0.24 % sodium fluoride dentifrice , or rinsed daily with a 0.05 % NaF solution .  Clinical evaluations for plaque and gingivitis were performed after 7 , 14 , and 21 days of the test regimen . After 21 days , all subjects resumed twice daily supervised brushing and flossing and post-test evaluations were conducted after two weeks . The results showed that after 7 , 14 , and 21 days both groups using dentifrices had significantly less plaque and gingivitis than the group using the rinse , and there were no significant differences between the two groups using either the sanguinaria-ZnCl2 or the NaF dentifrices OBJECTIVE To evaluate the safety and efficacy of a newly developed automated flossing device ( AF ) . METHODOLOGY Subjects were recruited from a university campus via announcements , and were r and omly assigned to a control ( C ) , manual ( M ) , or automated ( A ) group . Subjects brushed twice a day and treatment groups used their respective floss daily . The safety assessment ( SA ) , plaque index ( PI ) , and gingival index ( GI ) were measured at days one , 15 , and 30 . A pre- and post-intervention PI was measured at days 15 and 30 . RESULTS The majority of subjects ( n=76 ) were students , mean age + /- SD of 23.3 + /- 5.2 years . Based on one-way analysis of covariance , C had a higher mean PI score than A at days 15 ( p = 0.019 ) and 30 ( p < 0.001 ) , and M had a higher mean PI score than A at day 30 ( p = 0.022 ) . The C had a higher mean GI score than A at day 30 ( p = 0.034 ) . The SA included trauma associated with improper use of the AF for two subjects . CONCLUSION At four weeks , the AF removed more interproximal plaque than M , and there was less interdental inflammation compared to brushing alone . The AF is safe and effective when used properly , and demonstrates great promise as an alternative to manual floss The purpose of the present study was to compare in untreated patients suffering from moderate to severe periodontitis the efficacy of dental floss ( DF ) and interdental brushes ( IDB ) in the reduction of plaque , gingival inflammation , and probing depth in a 6-week period prior to subgingival debridement . Twenty-six patients ( 12 female , 14 male ; mean age 37.4 years ; range 27 to 72 years ) were instructed to use DF for one side of the dentition and IDB for the other side as an adjunct to the daily toothbrushing for 6 weeks . Oral hygiene instructions for toothbrushing and the use of the two devices were given at baseline and at week 3 . Measurements were carried out at baseline and at 6 weeks including plaque scores , probing depth , and 2 bleeding scores ( periodontal pocket bleeding index and angulated bleeding index ) . With the IDB , the approximal plaque score at baseline of 3.09 reduced to 2.15 at 6 weeks and with DF from 3.10 to 2.47 , respectively . IDB proved to remove significantly more plaque than DF . Baseline probing depth of 5.84 mm for IDB sites and 5.59 mm for DF sites was reduced to 5.01 mm at 6 weeks for both regimens . Analysis showed that the use of IDB result ed in a greater pocket reduction . Both bleeding indices were slightly reduced with IDB and DF , but no differences between devices were found . In relation to patient acceptance , more problems were observed with DF , and IDB were felt to be more efficacious . In conclusion , the results of the present study indicate that in combination with a manual toothbrush , the use of interdental brushes is more effective in removal of plaque and results in a larger reduction of probing depth than the use of dental floss . Although the differences were small , they indicate , in combination with patient preferences , that interdental brushes are to be considered preferable to floss for interdental plaque removal in patients suffering from moderate to severe periodontitis OBJECTIVE The study was conducted to compare the performance of three interdental products to dental floss in the control and removal of plaque , and in the reduction of gingivitis . METHODOLOGY One-hundred and twenty subjects were screened for the presence of interproximal sites of a size suitable for a GUMO Go-Betweens cleaner , and for being in compliance with inclusion and exclusion criteria . They were then assessed with the Plaque , Gingivitis , and Eastman Interdental Bleeding Indices ( EIBI ) at baseline , given a prophylaxis , r and omly assigned to one of four products ( Glide dental floss , Butler flossers , GUM Go-Betweens cleaners , and GUM Soft-Picks cleaners ) , and given product use instructions . Subjects returned at three weeks for a compliance review and at six weeks for a final visit . Plaque was assessed at the final visit before and after using the assigned products . Plaque , gingivitis , and bleeding scores were evaluated by analysis of covariance using the baseline measurements as the covariate . RESULTS All four interdental products significantly reduced interdental plaque from baseline to before-use at the final visit ( after six weeks ) employing baseline plaque as a covariate . Reductions were 16 % to 24 % . Similarly , use of the products at the final visit result ed in 26 % to 31 % reductions in plaque with the before-use plaque as a covariate . Interdental gingivitis scores showed a reduction both lingually and buccally , with reductions ranging from 27 % to 36 % for the former and 34 % to 53 % for the latter ( baseline was the covariate ) . No statistical differences were found between the products on the lingual interdental sites . The Go-Betweens cleaners showed a statistically greater reduction in the Gingival Index score buccally than the other three products . No differences were noted among the products for the EIBI . CONCLUSION In this study , dental floss , the recognized " gold st and ard " for gingivitis reduction , was matched in performance by flossers and an interdental cleaner with small elastomeric fingers , and surpassed by an interdental brush . All products performed comparably for plaque reduction and removal AIM The purpose of the present study was to compare 2 indices , i.e. , the  Eastman interdental bleeding ( EIB ) index  and the  bleeding on marginal probing ( BOMP ) index .  The comparison was made ( a ) in terms of the degree of bleeding provoked and the relationship with plaque in natural gingivitis and ( b ) for the ability of these 2 methods to detect differences between the development of experimental gingivitis in a control group and a group in which the development of gingival inflammation was suppressed by treatment . For the present studies , subjects were selected without interdental recession of the gingival tissues . METHODS EXPERIMENT 1 : In this experiment , 43 subjects having established moderate gingivitis were assessed using a r and om splitmouth design ( 1st and 3rd/2nd and 4th quadrant ) . Plaque was scored on all approximal sites after which the BOMP index was assessed in one half of the mouth and the EIB index in the other . RESULTS EXPERIMENT 1 : The BOMP index showed a bleeding score of 84 % and the EIB index of 87 % . The significant correlation between plaque and gingival bleeding for the BOMP index ( 0.55 ) was higher than for the EIB index ( 0.44 ) . METHODS EXPERIMENT 2 : For this experiment , 25 subjects participated in an experimental gingivitis trial of the lower jaw . At baseline , first the BOMP index and immediately thereafter the EIB index  were assessed at all approximal sites . Experimental gingivitis ( EG ) was carried out in one r and omly assigned quadrant and as a treatment modality only floss was used in the other ( FL ) . RESULTS EXPERIMENT 2 : In the EG quadrant , the BOMP index increased to 69 % and the EIB index to 73 % . Both indices showed a significant correlation with plaque ; 0.60 and 0.64 respectively . In the FL quadrant , the BOMP index increased to 38 % and the EIB index to 30 % . No significant correlation between both gingivitis indices and the amount of plaque was present in the FL quadrant . CONCLUSION The ability of the BOMP index and the EIB index to assess the level gingival inflammation appears to be comparable Overemphasis on hypothesis testing-- and the use of P values to dichotomise significant or non-significant results --has detracted from more useful approaches to interpreting study results , such as estimation and confidence intervals . In medical studies investigators are usually interested in determining the size of difference of a measured outcome between groups , rather than a simple indication of whether or not it is statistically significant . Confidence intervals present a range of values , on the basis of the sample data , in which the population value for such a difference may lie . Some methods of calculating confidence intervals for means and differences between means are given , with similar information for proportions . The paper also gives suggestions for graphical display . Confidence intervals , if appropriate to the type of study , should be used for major findings in both the main text of a paper and its abstract BACKGROUND Manual floss is often difficult to use , particularly in hard to reach posterior teeth . Many prefer automated flossers because of their ease of use . The aim of the present study was to compare the effectiveness of an automated flosser to manual floss for anterior , premolar , and molar teeth using the plaque index ( PI ) and gingival ( GI ) index . METHODS A 10-week , two-treatment period , crossover design was used . The subjects were r and omly assigned to control ( C ) , manual ( M ) , or automated ( A ) groups . The PI and GI were measured interdentally at baseline and days 15 and 30 . Treatment subjects were assigned to the opposite group at the second baseline visit after a 2-week washout period . Subjects brushed twice a day . Treatment subjects used their respective floss once per day . Subjects refrained from oral hygiene 24 hours before study visits . The PI was measured pre- and postintervention on days 15 and 30 . Mixed-effect analysis of covariance crossover models were used to test group effects at days 15 and 30 from both periods with the corresponding mean preintervention and baseline score as covariates for PI and GI , respectively . Within-subject treatment comparisons were made , and carryover effects were evaluated . RESULTS The majority of subjects ( N = 102 ) were students ( mean age , 23.3 + /- 5.0 [ SD ] years ) with minimal gingivitis at baseline . At days 15 and 30 , the M group had more plaque than the A group for all regions ( P < or = 0.008 ) , and the C group had more plaque than the A ( P < 0.001 ) and M groups ( P < or = 0.021 ) for all regions . No regional treatment effect was observed for the GI . Within-subject analyses were more favorable for the A group than the M group . No significant carryover effect was observed . CONCLUSIONS The automated flossing device removed significantly more interproximal plaque in molar , premolar , and anterior teeth compared to manual floss at days 15 and 30 . There was no significant difference in interdental inflammation between groups OBJECTIVE The objective of this examiner-blind clinical study was to investigate the efficacy of three oral hygiene regimens for the control of gingivitis and supragingival plaque . METHODOLOGY Following a baseline examination for gingivitis and suprag 
    Output:
    
A greater part of the studies did not show a benefit for  floss  on plaque and clinical parameters of gingivitis .
In light of the results of this comprehensive literature search and critical analysis , it is concluded that a routine instruction to use floss is not supported by scientific evidence