***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: The main purpose was to evaluate the association between periodontal disease and the incidence of breast cancer in a prospect i ve study of 3273 r and omly selected subjects aged 30–40 years at baseline . Breast cancer incidence was registered from 1985 to 2001 according to the WHO International Classification of Diseases criteria . At baseline , 1676 individuals also underwent a clinical oral examination  ( Group A ) whereas 1597 subjects were not clinical ly examined  but were registered ( Group B ) . The associations between breast cancer , periodontal disease , and missing molars were determined using multiple logistic regression models with several background variables and known risk factors for cancer . In total 26 subjects in group A and 15 subjects in group B had breast cancer .  The incidence of breast cancer was 1.75 % in subjects who had periodontal disease and /or any missing molars , and 0 in subjects who had periodontal disease but had no missing molars . For periodontally healthy subjects with no missing teeth the breast cancer incidence was 1 % . For group B the respective incidence was 0.94 % . Female gender ( odds ratio ( OR ) 13.08 ) and missing any molar in the m and ible ( OR 2.36 ) were explanatory variables for breast cancer . Of the subjects with periodontal disease and any missing molars in the m and ible 5.5 % had breast cancer in comparison to 0.5 % of the subjects who had periodontal disease but no missing molars in the m and ible ( P < 0.02 ) . Chronic periodontal disease indicated by missing molars seemed to associate statistically with breast cancer Design R and omisation to intervention groups using Zelen 's design with a non-participant community control group recruited at 24 months . Intervention Patients were allocated to either the home visit ( HV ) group ( n=236 ) or telephone contact ( TC ) group ( n=89 ) .  HVs and TCs were conducted at 6,12 and 18 months . Bacterial tests were given to both groups at baseline and 24 months . The HV group had an additional bacterial test at six months . A community control ( reference group ) was recruited from the same district at 24 months . All three groups ( HV , TC and reference ) were examined for caries at 24 months . Outcome measureThe primary outcome measure was dental caries ( dmft ) , secondary measures were Streptococcus mutans ( MS ) and lactobacilli ( LB ) levels . Results There was no statistically significant difference in caries between HVs and TCs . However there were statistically significant differences respectively in caries levels between HV/TC and the reference group . There was a statistically significant difference in MS levels between the HV group and both the TC and reference groups , with fewer children with high MS levels in the HV group(28 % ) compared with either the TC group(47 % ) or reference group ( 35 % ) . Conclusions Both HVs and TCs conducted six-monthly from birth are effective in reducing early childhood caries prevalence compared to RC by24 months . HVs are also associated with fewer children with MS compared with TC and reference group at 24 months Background Supervised toothbrushing programs using fluoride dentifrice have reduced caries increment . However there is no information about the effectiveness of the professional cross-brushing technique within a community intervention . The aim was to assess if the bucco-lingual technique can increase the effectiveness of a school-based supervised toothbrushing program on preventing caries . Methods A r and omized double-blinded controlled community intervention trial to be analyzed at an individual level was conducted in a Brazilian low-income fluori date d area . Six preschools were r and omly assigned to the test and control groups and 284 five-year-old children presenting at least one permanent molar with emerged/sound occlusal surface participated . In control group , oral health education and dental plaque dying followed by toothbrushing with fluoride dentifrice supervised directly by a dental assistant , was developed four times per year . At the remaining school days the children brushed their teeth under indirect supervising of the teachers . In test group , children also underwent a professional cross-brushing on surfaces of first permanent molar rendered by a specially trained dental assistant five times per year . Enamel and dentin caries were recorded on buccal , occlusal and lingual surfaces of permanent molars during 18-month follow-up . Exposure time of surfaces was calculated and incidence density ratio was estimated using Poisson regression model . Results Difference of 21.6 lesions per 1,000 children between control and test groups was observed . Among boys whose caries risk was higher compared to girls , incidence density was 50 % lower in test group ( p = 0.016 ) . Conclusion Modified program was effective among the boys . It is licit to project a relevant effect in a larger period suggesting in a broader population substantial reduction of dental care needs . Trial registration IS RCT N18548869 OBJECTIVES The purpose of this study was to investigate the caries-reducing effect of an amine fluoride toothpaste when used under real-life conditions in a community preventive program . METHODS Approximately 12,500 children 3 - 12 years of age were provided with toothpaste ( four tubes or 360 grams annually during three years ) to be used in kindergartens or schools and once a day at home . The teachers supervised daily toothbrushing sessions . R and om sample s of children in each of the ages 3 , 6 , 9 , and 12 years were selected from the intervention and the reference communities at both the start of the study and after three years , and examined for dental caries experience . RESULTS Amine fluoride dentifrice seemed to provide a reduction in dental caries prevalence compatible to the most commonly used fluoride dentifrice compounds . CONCLUSIONS The implemented fluoride toothpaste program is a feasible and practical method of improving the  oral health status of children Objectives We tested a dental health program in remote Aboriginal communities of Australia 's Northern Territory , hypothesizing that it would reduce dental caries in preschool children . Methods In this 2-year , prospect i ve , cluster-r and omized , concurrent controlled , open trial of the dental health program compared to no such program , 30 communities were allocated at r and om to intervention and control groups . All residents aged 18–47 months were invited to participate . Twice per year for 2 years in the 15 intervention communities , fluoride varnish was applied to children 's teeth , water consumption and daily tooth cleaning with toothpaste were advocated , dental health was promoted in community setting s , and primary health care workers were trained in preventive dental care . Data from dental examinations at baseline and after 2 years were used to compute net dental caries increment per child ( d3mfs ) . A multi-level statistical model compared d3mfs between intervention and control groups with adjustment for the clustered r and omization design ; four other models used additional variables for adjustment . Results At baseline , 666 children were examined ; 543 of them ( 82 % ) were re-examined 2 years later . The adjusted d3mfs increment was significantly lower in the intervention group compared to the control group by an average of 3.0 surfaces per child ( 95 % CI = 1.2 , 4.9 ) , a prevented fraction of 31 % . Adjustment for additional variables yielded caries reductions ranging from 2.3 to 3.5 surfaces per child and prevented fractions of 24–36 % . Conclusions These results corroborate findings from other studies where fluoride varnish was efficacious in preventing dental caries in young children Background Adherence to oral self-care behaviors is low among adolescents . Purpose This study aims to examine effects of two message framing interventions on oral self-care behaviors and health among Iranian adolescents . Methods Cluster-r and omized controlled trial , with four schools r and omly assigned to receive gain-framed , loss-framed , or no messages .  Brushing/flossing , attitudes , intentions , oral health related quality of life ( OHRQOL ) , and clinical examinations were measured at baseline , two and twenty-four weeks . Data were analyzed using multilevel modeling . Results At 2 weeks , loss-frame participants reported higher brushing and flossing rates , and more favorable attitudes and intentions to brush , compared to the other groups . At 24 weeks , loss-frame participants showed better OHRQOL , gingival health and less dental plaque compared to the other groups . Attitudes and intentions mediated intervention effects for the loss-framed group . Conclusions Loss-framed messages were more effective than gain-framed messages in encouraging oral self-care behaviors among Iranian adolescents . These effects were mediated through attitudes and intentions . ( clinical trials.gov number NCT01421108 . OBJECTIVE To assess the impact of oral health promotion integrated with a health promoting school ( HPS ) initiative on the oral health outcomes of secondary school students . MATERIAL S AND METHOD Using an urban-rural stratified cluster r and omized approach , the intervention was applied to secondary school students in Arusha , Tanzania . In the urban , three control ( n = 315 ) and two intervention ( n = 214 ) schools performed oral clinical examination and question naires at baseline . In rural the corresponding figures at baseline were two ( n = 188 ) and three ( n = 360 ) schools . After 2 years , 374 and 358 students remained in the intervention and control arms . RESULTS Mean number of decayed teeth ( DT ) increased in the intervention ( mean score 1.0 vs 1.7 , p < 0.001 ) and control schools ( mean score 1.2 vs 1.7 , p < 0.001 ) . Mean number of teeth with plaque decreased significantly in intervention and control schools . No significant difference in caries increment and plaque decline scores was observed between groups . Mean number of teeth with bleeding decreased ( 0.5 vs 0.3 , p < 0.05 ) in intervention schools , whereas no change was observed in the control schools ( 0.4 vs 0.5 , p = 0.051 ) . Increment in mean number of DT between baseline and follow-up was largest and smallest in students who , respectively , deteriorated and improved their plaque and bleeding scores . CONCLUSION The intervention activities did not show any effect with respect to dental caries , calculus and plaque status among the students investigated . Compared with the control group , more favorable changes in the intervention group occurred with respect to bleeding on probing , suggesting a weak but positive effect on students ' oral hygiene status Background There are no r and omized controlled trials to assess the impact of treating dental caries on various aspects of children ’s health . This study was conducted to assess the impact of dental treatment of severe dental caries on children ’s weight , height and subjective health related outcomes , namely dental pain , satisfaction with teeth and smile , dental sepsis and child ’s appetite . Methods The study was a community-based , r and omized , controlled trial in schoolchildren aged 6 - 7 years with untreated dental caries . Participants were r and omly assigned to early ( test ) or regular ( control ) dental treatment . The primary outcome was Weight-for-age Z-score . Secondary outcomes were Height-for-age and BMI -for-age Z-scores , dental pain , dental sepsis , satisfaction with teeth and child ’s appetite . Results 86 children were r and omly assigned to test ( 42 children ) and control ( 44 ) groups . Mean duration of follow-up was 34.8 ( ±1.1 ) weeks . There were insignificant improvements in anthropometric outcomes between the groups after treatment of caries . However , treated children had significantly less pain experience ( P = 0.006 ) ( OR 0.09 , [ 0.01 - 0.51 ] ) and higher satisfaction with teeth ( P = 0.001 ) ( OR 9.91 , [ 2.68 - 36.51 ] ) compared to controls . Controls had significantly poorer appetites ( P = 0.01 ) ( OR 2.9 , [ 1.24 - 6.82 ] ) compared to treated children . All treated children were free of clinical dental sepsis whereas 20 % ( 9 of 44 ) of controls who were free of sepsis at baseline had sepsis at follow-up . Conclusions Although dental treatment did not significantly improve the anthropometric outcomes , it significantly improved the dental outcomes and children ’s satisfaction with teeth , smile and appetite . This is the first study to provide evidence that treatment of severe dental caries can improve children ’s appetite . Trial registration Effect of Dental Treatment on Children 's Growth . Clinical Trial Gov ID # OBJECTIVES This pragmatic r and omized trial evaluated the effectiveness of a tailored educational intervention on oral health behaviors and new untreated carious lesions in low-income African-American children in Detroit , Michigan . METHODS Participating families were recruited in a longitudinal study of the determinants of dental caries in 1021 r and omly selected children ( 0 - 5 years ) and their caregivers . The families were examined at baseline in 2002 - 2004 ( Wave I ) , 2004 - 2005 ( Wave II ) and 2007 ( Wave III ) . Prior to Wave II , the families were r and omized into two educational groups . An interviewer trained in applying motivational interviewing principles ( MI ) review ed the dental examination findings with caregivers assigned to the intervention group ( MI + DVD ) and engaged the caregiver in a dialogue on the importance of and potential actions for improving the child 's oral health . The interviewer and caregiver watched a special 15-minute DVD developed specifically for this project based on data collected at Wave I and focused on how the caregivers can ' keep their children free from tooth decay ' . After the MI session , 
    Output:
    
This review provides evidence of low certainty suggesting that community-based oral health promotion interventions that combine oral health education with supervised toothbrushing or professional preventive oral care can reduce  dental caries in children .
Other interventions , such as those that aim to promote access to fluoride , improve children 's diets or provide oral health education alone , show only limited impact .
We found no clear indication of when is the most effective time to intervene during childhood .