***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: Twenty-five subjects were assessed for plaque and soft tissue safety monitored by gingival irritation the first thing in the morning of day one following no toothbrushing for 12 - 14 hours . Subjects then brushed with either the Dentrust ( manual toothbrush ) , Crest Complete ( manual toothbrush ) or Interplak ( mechanical toothbrush ) for a timed three minutes under supervision . The toothbrush assignments were by a table of r and om numbers . Following brushing , the subjects were assessed immediately for levels of plaque and gingival irritation . The subjects were then recalled three hours later for another assessment of plaque levels and residual gingival irritation from the morning toothbrushing . After three or four days the subjects were recalled to test an alternate toothbrush . Three or four days later the subjects were recalled to test the final toothbrush . Levels of irritation severity were evaluated using st and ard soft tissue examination procedures , and after rinsing with disclosing solution and photography , with subsequent blind judging of stain intensity and area on the gingiva by a panel of three experienced investigators . In the first morning assessment there was no significant difference among plaque or gingival appearance or stain uptake levels of the three groups before using the three toothbrushes . Immediately following toothbrushing , the three groups exhibited similar levels of plaque removal and clinical or stain-related gingival irritation . There was no significant statistical difference among the plaque or safety evaluations , although the Interplak toothbrush demonstrated higher irritation levels judged by stain uptake than the manual toothbrushes . ( ABSTRACT TRUNCATED AT 250 WORDS OBJECTIVES To compare the use of sonic powered or manual toothbrush in patients with intellectual disability ( ID ) in terms of plaque ( PlI ) and gingival ( GI ) indices and adverse effects . MATERIAL AND METHODS Subjects with ID were recruited for this cluster-r and omized , single blinded ( examiner ) , 6-month clinical trial , comparing powered versus manual toothbrushing . Outcome variables included PlI and GI , evaluated at baseline and 3 months after supervised toothbrushing and after 3 additional months of unsupervised used . Clinical outcome variables were analysed by repeated measures ANCOVA considering time and group as factors and respective baseline values as covariates ( generalized linear model ) . RESULTS Sixty-four patients ( 34 male , mean age 34.5 ) in six clusters were included in the study . No statistically significant effect of toothbrushing group was observed for PlI or GI . A significant effect of time was identified ( p < 0.001 ) with mean reductions ranging 0.44 - 0.45 for PlI and 0.30 - 0.36 for GI from baseline to 3 - 6 months . No relevant adverse effect or technical problems were observed . CONCLUSION The tested sonic powered toothbrush was as effective and safe as the manual toothbrush . The use of powered or manual toothbrushes , together with fluoride toothpaste , may improve plaque and gingivitis levels , in patients with mild to limit ID INTRODUCTION Plaque and trapped debris that accumulate gingivally to orthodontic wire are difficult to remove . The triple-headed toothbrush ( TH-TB ) was design ed to reach the gingival tooth margin . In this study , we examined its effectiveness in improving the oral health of orthodontic patients as compared with conventional and orthodontic toothbrushes . METHODS Orthodontic patients ( n = 94 ; mean age , 15.6 + /- 3.9 years ) receiving edgewise treatment in both arches were r and omly assigned to 1 of 3 groups ( TH-TB , orthodontic toothbrush , and conventional toothbrush ) . After toothbrushing instruction , each participant received professional tooth cleaning .  Tooth plaque index , bracket plaque index , gingival index , and bleeding index were recorded at baseline and after 4 weeks of usage . Satisfaction level was obtained after 4 weeks . RESULTS The TH-TB was significantly more effective than conventional and orthodontic toothbrushes in tooth-plaque removal by 2-fold and 1.5-fold , respectively ( P < .001 ) ; in bracket-plaque removal by 3-fold and 2-fold , respectively ( P < .001 ) ; and in improving gingival health by 6-fold and 1.5-fold , respectively ( P = .011 ) . Patients who used the TH-TB were significantly more satisfied than those who used the other toothbrushes ( P < .001 ) . CONCLUSIONS The TH-TB is a practical alternative to other manual toothbrushes to improve tooth and gingival health in orthodontic patients wearing fixed appliances Tooth brushing is a very simple and effective method for removing daily dental deposits and for preventing dental and periodontal diseases . However , it can cause considerable manipulative difficulties among some population s , e.g. , young children , physically h and icapped and mentally retarded patients . In order to test and compare the efficiency of a newly design ed toothbrush ( Superbrush ) , we have performed a pilot study on patients staying at the " Reine Fabiola Village No. 1 " , an institution for patients who are followed for mental retardation at different levels . 30 patients were included in the study , aged between 18 to 40 years . Among these 30 , five had to be eliminated for their incapacity to follow the initial training in how to brush their teeth . The comparison was made with a normal single headed tooth brush , in a double blind trial , based on bleeding and plaque indexes , performed on 6 different teeth on day 0 , 7 and 21 . The results of this study indicate that there is no significant difference between the two types of toothbrushes with respect to the ability of plaque removing and gingivitis prevention , during the period of time of this study . However , the easiness of manipulating this newly design ed toothbrush renders it a useful tool for the dental hygiene for this special part of the dental compromised population PURPOSE The purpose of this study was to evaluate the effect of toothbrush design on the ability of  parents to effectively brush their children 's teeth .  METHODS Parents of children ( mean age=5.1±0.75 years old ) from 4 kindergarten schools were r and omly assigned to receive instruction in brushing their children 's teeth using a manual single-headed toothbrush ( 2 schools ) or a triple-headed toothbrush ( 2 schools ) . The parents ' ability to brush their children 's teeth was evaluated according to a novel toothbrush performing skill index ( Ashkenazi Index ) , based on 2 criteria : ( 1 ) placement of the toothbrush on each tooth segment to be brushed ( " reach " ) ; and ( 2 ) completion of enough strokes on each segment ( " stay " ) . One month after instruction , tooth-brushing ability was re-evaluated and plaque index of the children 's teeth was assessed . RESULTS One month after instruction , parents using the triple-headed toothbrush received significantly higher scores on the tooth-brushing performance index ( ~86 % ) , than did those in the single-headed group ( ~61 % ; P=.001 ) . The plaque index was significantly higher in the single-headed group ( 0.97±0.38 ) vs the triple-headed group ( 0.72±0.29 ; P<.01 ) . The tooth-brushing performance index correlated negatively with the plaque index ( P<.01 ) . CONCLUSIONS A triple-headed toothbrush promotes more consistent tooth-brushing by parents than does a single-headed toothbrush The efficacy and safety of two manual toothbrushes ( Dentrust and the Oral-B P35 ) were evaluated in orthodontic patients classified by their treating orthodontist as having established gingivitis . Fifty-seven healthy adolescent subjects , who were fully bonded and b and ed with fixed orthodontic appliances , were r and omly assigned to use one of the two toothbrushes for the duration of the four-month study . The subjects were given instructions with their new assigned toothbrush and agreed to use only these products at home , twice a day between orthodontic visits . On evaluation days at one , two and four months the patients reported to the clinic having not brushed for 12 - 16 hours , and were evaluated for plaque area and gingivitis in this single blind study . Gingivitis scores decreased significantly in the Dentrust group from baseline to the conclusion of the study . There was no significant statistical decline in gingivitis in the Oral-B P35 group until the four-month evaluation . Overnight plaque formation scores were similar for both groups during the study . After brushing for a timed one-minute period , both toothbrushes removed significant plaque area throughout the study . On total plaque levels , the Dentrust group was significantly lower on after-toothbrushing plaque area mean scores compared to the Oral-B P35 group at two and four months . No side effects were reported or observed during the study attributed to the use of the assigned toothbrushes Clinical study guidelines have been established by the American Dental Association for assessing plaque and gingivitis reductions with chemotherapeutic agents . Two six-month studies are required . While the toothbrush is also instrumental in plaque and gingivitis reduction , there are currently no study requirements by the ADA for manual brush efficacy . It was thought to apply the long-term efficacy requirements for chemotherapeutic agents to two manual toothbrushes to assess their efficacy for comparative purpose s. Forty-eight subjects using the Dentrust toothbrush and forty-five subjects using the Oral-B toothbrush completed a six-month study to assess safety , plaque removal and gingivitis reduction . The subjects were r and omly assigned to use either the newly design ed ( three sided ) Dentrust toothbrush or the traditional flat-headed toothbrush . The subjects took their respective toothbrushes home following a baseline evaluation , and were subsequently assessed at three and six months by the same examiners with the same indices in this single-blind trial . There were no significant differences between the two groups on plaque removal during the study . At six months , the Dentrust group removed a significant amount of both buccal and lingual plaque and the flat-headed toothbrush removed a significant amount of buccal plaque only . On gingivitis the groups had no significant differences at baseline ; however , by six months the Dentrust group was significantly better than the flat-headed toothbrush on gingivitis reduction . Long-term use of the Dentrust toothbrush can be said to significantly contribute to gingival health overall , and especially in the hard to reach lingual areas compared to long-term use of a traditional flat-head toothbrush OBJECTIVE To evaluate the effect of toothbrush design on brushing skills and plaque removal among young healthy adults . METHOD AND MATERIAL S A population of 200 healthy young adults was approached . Patients were r and omly assigned to one of two research groups : one used a manual single-headed toothbrush , while the other used a manual triple-headed toothbrush . At the start of the study , participants were asked to brush their teeth using the provided toothbrush with no prior guidance or instructions . Plaque Index ( PI ) was measured . Immediately afterward , participants were personally instructed on how to brush their teeth using the provided toothbrush . Toothbrushing performance skill was evaluated and scored using the toothbrushing performance skill index ( TB-PS-I/Ashkenazi index ) following the first brushing , as well as on a recall visit 1 week later . RESULTS Following the first , uninstructed brushing , PI values ranged from 0.41 to 1.33 , with higher plaque scores for the single-headed toothbrush group . One week after receiving brushing instructions , PI decreased in the both toothbrush groups and ranged between 0.12 and 0.81 , with higher PI scores for the single-headed toothbrush group . Following the first , uninstructed brushing , total TB-PS-I scores , as well as component scores ( " reaching " and " staying " ) showed no difference between the two toothbrush groups . One week after receiving brushing instructions , the TB-PS-I in the triple-headed toothbrush group was significantly higher than that in the single-headed toothbrush group . CONCLUSION The triple-headed toothbrush was found to promote easier toothbrushing and plaque removal both before and after receiving toothbrushing instructions UNLABELLED Brushing with a single-tufted toothbrush in conjunction with a manual toothbrush has been widely recommended , although its effectiveness has not been proven . This study investigated the effectiveness of orthodontic and triple-headed toothbrushes when used alone or in conjunction with the single-tufted toothbrush in patients with fixed lingual orthodontic appliances . METHODS In this r and omized , single-blinded , controlled clinical trial , orthodontic patients ( N = 26 , mean age 27.3 years ) with lingual fixed appliances were asked to brush with a triple-headed or an orthodontic toothbrush alone for one month , followed by brushing in conjunction with the single-tufted toothbrush for an additional month . Teeth were professionally cleaned at baseline and one month later . A clinician blinded to group assignments examined the patients and evaluated tooth plaque index , bracket plaque index , modified gingival index and bleeding on probing at baseline at one month and two months . RESULTS After one month of brushing with the orthodontic toothbrush , the mean plaque index for tooth and bracket , bleeding index and gingival index were higher by 74.4 % ( 0.68 vs. 0.39 , p = 0.026 ) , 54.2 % ( 0.37 vs. 0.24 ) , 15.4 % ( 0.15 vs. 0.13 ) and 30 % ( 0.26 vs.  
    Output:
    
CONCLUSION From this review emerges the recommendation that the use of a triple-headed manual toothbrush instead of a single-headed manual toothbrush might be favorable with respect to plaque removal in case a care-dependent individual is brushed by a caregiver