***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 The aim of the present study was to evaluate the recommendations relating to the use of  approximal cleaning aids given by dental hygienists and dentists , the self-care practice s in a Swedish population and the ability to remove dental plaque . MATERIAL S AND METHODS A structured question naire was r and omly distributed to 500 dental hygienists and 500 dentists and a similar question naire was distributed to 1000 r and omly selected individuals , divided equally into the following age groups : 15 to 20 , 21 to 40 , 41 to 60 and > 60 years . A clinical examination evaluating the ability to remove approximal dental plaque was also carried out in a total of 60 regular users of approximal cleaning aids .  Plaque was scored before and after cleaning with a toothpick , dental floss or an interdental brush . RESULTS The response rate was 82 % , 79 % and 68 % for the three groups . The results reveal that dental hygienists give more detailed information about a majority of the aspects that are related to the use of approximal cleaning aids compared with dentists ( P < 0.01 or P < 0.001 ) . The majority of the dental staff give recommendations to children and adolescents firstly to prevent dental caries and to older individuals to improve periodontal health . The use of different approximal cleaning aids on a daily basis varied with respect to age group ( 2 % to 42 % ) ; dental floss dominated in the younger age groups and interdental brushes in the two oldest groups . In the clinical study , the largest plaque reduction was produced by the interdental brush ( 83 % ) , followed by toothpicks ( 74 % ) and dental floss ( 73 % ) . CONCLUSIONS The present study indicated the importance of individual recommendations related to the use of approximal cleaning aids This clinical study was conducted to compare the efficacy and safety of the new Braun Oral-B Interclean ( ID2 ) with that of dental floss in healthy adults . Volunteers with sufficient dental plaque and gingivitis were r and omized to use the ID2 ( n = 24 ) or American Dental Association-approved dental floss ( n = 24 ) in conjunction with toothbrushing once nightly for 6 weeks . All subjects received a  supragingival prophylaxis and polishing at the start of the study . Over the study period , both devices produced significant reductions in interproximal plaque , gingivitis and bleeding ( p < 0.01 ) . With the ID2 , there were reductions in interproximal plaque scores ( all sites ) of approximately 40 % compared with 28 % with dental floss . A decrease in gingivitis of 15 % was observed with the ID2 compared with 12 % for floss users . Bleeding on probing was reduced by 25 % with the ID2 and by 34 % with dental floss . There was a trend in favor of the ID2 with respect to reduction in plaque which achieved statistical significance ( p = 0.05 ) for the posterior three interproximal sites . Differences between treatment groups with respect to gingivitis and bleeding reductions were not statistically significant . No adverse events were reported or observed during the study . It is concluded that the ID2 has equivalent efficacy to dental floss for the reduction of interproximal plaque and gingivitis 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 Quality assurance ( QA ) and continuing competence ( CC ) programs aim to ensure acceptable levels of health care provider competence , but it is unknown which program methods most successfully achieve this goal . The objectives of the study reported in this article were to compare two distinct  QA/CC programs of Canadian dental hygienists and assess the impact of these two programs on practice behavior change , a proxy measure for quality . British Columbia ( BC ) and Ontario ( ON ) were compared because the former m and ates continuing education ( CE ) time requirements . A two-group comparison survey design using a self-administered question naire was implemented in r and omly selected sample s from two jurisdictions . No statistical differences were found in total activity , change opportunities , or change implementation , but ON study subjects participated in significantly more activities that yielded change opportunities and more activities that generated appropriate change implementation , meaning positive and correct approaches to providing care , than BC dental hygienists . Both groups reported implementing change to a similarly high degree . The findings suggest that ON dental hygienists participated in more learning activities that had relevancy to their practice and learning needs than did BC subjects . The findings indicate that the QA program in ON may allow for greater efficiency in professional learning Abstract Objective . To investigate associations between oral health-related quality of life assessed with the Oral Health Impact Profile (OHIP)-14 and demographic factors , number of teeth present , dental visits , dental health behaviour and self-rated oral health in a representative sample of 20–80-year-old Norwegians . Material and methods . The study was conducted in a stratified r and om sample of 3538 individuals .  Question naires including questions on demographic factors , number of remaining teeth , dental visits , dental health behaviour , self-rated oral health and OHIP-14 were mailed to the sample . Bivariate and multivariate analyses were performed . Results . The response rate was 69 % . The mean OHIP-14 score was 4.1 ( st and ard deviation = 6.2 ) . No problem was reported by 35 % of the respondents . The most frequently reported problems were : physical pain ( 56 % ) , psychological discomfort ( 39 % ) and psychological disability ( 30 % ) . When the effect of all independent variables was analysed in multivariate analysis , self-rated oral health , frequency of dental visits , number of teeth , age and sex were significantly ( P < 0.05 ) associated with the prevalence of having problems and frequent problems . Self-rated oral health had the strongest association with having problems [ odds ratio ( OR ) 4.5 ; 95 % confidence interval ( CI ) 3.4–6.0 ] and with having frequent problems ( OR 4.0 ; 95 % CI 2.7–5.8 ) . Dental health behaviour , use of floss and toothpicks and oral rinsing were not associated with having problems related to oral quality of life in multivariate analyses . Conclusion . In this Norwegian adult sample , self-rated oral health , frequency of dental visits , number of teeth , age and sex were associated with having problems as estimated using the OHIP-14 The aim of the present study was to examine the dental status and smoking habits in r and omized sample s of 35- , 50- , 65- , and 75-year-old subjects ( n = 1093 ) , recruited for a cross-sectional epidemiological study in the County of Värml and , Sweden . The following clinical variables were recorded by 4 well-calibrated dentists : number of edentuolous subjects , number of missing teeth , probing attachment level , furcation involvement , CPITN scores , DMF surfaces , plaque and stimulated salivary secretion rate ( SSSR ) . In addition , the subjects reported in a question naire their tobacco habits , oral hygiene habits , dietary habits etc . The percentage of smokers in 35- , 50- , 65- , and 75-year-olds was 35 % , 35 % , 24 % and 12 % , respectively . In 75-year-olds , 41 % of the smokers were edentulous compared to 35 % of non-smokers . The difference in number of missing teeth between smokers and non-smokers was 0.6 ( p=0.15 ) , 1.5 ( p=0.013 ) , 3.5 ( p=0.0007 ) and 5.8 ( p=0.005 ) in the 4 age groups . Smokers had the largest mean probing attachment loss in all age groups . The differences between smokers and non-smokers in mean attachment level were 0.37 ( p=0.001 ) , 0.88 ( p=0.001 ) , 0.85 ( p=0.001 ) and 1.33 mm ( p=0.002 ) in the 35- , 50- , 65- , and 75-year-olds , respectively . Treatment need assessed by CPITN was in all age groups greatest among smokers . The number of intact tooth surfaces was fewer in 35- , 50- , and 75-year-old smokers than in non-smokers . The number of missing surfaces ( MS ) was higher in 50- , 65- , and 75-year-old smokers than in non-smokers . In addition , 35-year-old smokers exhibited a significantly larger number of decayed and filled tooth surfaces ( DFS ) than non-smokers . Male smokers had significantly higher SSSR than non-smoking males ( p=0.012 ) . Plaque index and oral hygiene were similar in smokers and non-smokers . Smokers reported a more frequent intake of sugar containing soft drinks ( p=0.000 ) and snacks ( p=0.003 ) than non-smokers . The opposite was reported for consumption of fruit ( p=0.003 ) . It was concluded that smoking is a significant risk indicator for tooth loss , probing attachment loss and dental caries The objective of this double-blind , four-week clinical study was to evaluate the efficacy of BrushPicks , a new cleaning aid , and Glide floss on the reduction of plaque area , gingivitis and bleeding on probing , and to monitor safety when these products were used in addition to toothbrushing with an ADA-Accepted toothbrush ( Oral-B P35 ) and an ADA-Accepted fluoride-containing dentifrice 
    Output:
    
There was insufficient evidence to determine whether interdental brushing reduced or increased levels of plaque when compared to flossing