***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 purpose of this study was to investigate the effects of oral care using simple tools and methods on the cleanliness of the oral cavity in the elderly . Enrolled were 84 elderly subjects with a mean ( + /-S.D ) age of 85.1+/-7.0 years in a nursing home . They were given tongue and oral mucosa cleaning ( the oral care ) after lunch every day or every other day for two consecutive weeks by the authors . The effect of the oral care was studied in terms of C and ida scores in tongue coating , concentration of volatile sulfur compounds ( VSC ) which are the main causative substance of bad breath , and change in tongue coating scores . The above parameters were measured five times ; just before the oral care program , weekly during , and at the end of the oral care program . The groups of patients , who were given the oral care , especially the group of patients cared with sponge brushes every day , showed a significant reduction in C and ida scores but not in VSC concentration and tongue coating scores . The present method of oral care proved effective in cleaning the tongue and oral mucosa , and the C and ida scores appeared to be a reliable indicator for evaluation . It is suggested that this way of oral care is simple , easy and useful not only for the elderly at a nursing home but for the house-bound elder people who will rapidly increase in the near future in Japan 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 The CONSORT ( Consoli date d St and ards of Reporting Trials ) statement is used worldwide to improve the reporting of r and omized , controlled trials . Schulz and colleagues describe the latest version , CONSORT 2010 , which up date s the reporting guideline based on new method ological evidence and accumulating experience . 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 PURPOSE S To compare the oral malodor protection efficacy of a 0.454 % stannous fluoride dentifrice versus a negative control ( 0.243 % sodium fluoride ) using a sulfide monitor ( halimeter ) as the measurement . A secondary objective was to assess the effects of tongue brushing . METHODS This was a four-treatment , five-period , examiner-blinded , crossover , r and omized study . Healthy subjects who met the entrance criteria were enrolled into the study . A 5-day acclimation period , in which subjects brushed twice daily in their customary manner with a st and ard sodium fluoride dentifrice , occurred prior to baseline . After baseline halimeter measurements , subjects were r and omly assigned to one of four treatments ( SnF2 dentifrice groups , with or without tongue brushing ; negative control dentifrice groups , with or without tongue brushing ) based on baseline halimeter scores , age , and gender . Test products were used three times a day . Breath measurements were taken 24 hours after baseline ( after three product uses ) . Subjects then brushed again with the product treatment . Final breath measurements were taken 4 hours later , 28 hours after baseline . A 5-day washout separated each treatment period . RESULTS 33 subjects were enrolled and completed the study . The adjusted mean volatile sulfur compound ( VSC ) levels were significantly lower in the SnF2 groups than the NaF groups , at both 24 ( P < 0.01 ) and 28 ( P < 0.001 ) hours post baseline time points . Tongue brushing did not provide additional statistically significant breath benefits when compared to toothbrushing alone . Both dentifrices were well tolerated 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 3.22 ( + /- 0.85 ) to 2.32 ( + /- 0.87 ) respectively ( P = 0.000 ) . It was concluded that tongue scraping twice daily for 7 days had significant effect on MS and Lb bacteria and also decreased oral OBJECTIVES To characterize a comprehensive outline of the oral microflora related to pneumonia in older adults . DESIGN Prospect i ve and retrospective longitudinal study . SETTING Community . PARTICIPANTS Long-term hospitalized patients and people in nursing homes ( 343 subjects , aged > or = 65 ) . MEASUREMENTS Subjects were assessed at baseline for pneumonia-related health problems . The flora of the tongue coating was characterized according to terminal restriction fragment length polymorphism ( T-RFLP ) analysis . All subjects were followed prospect ively for 6 months for a diagnosis of pneumonia . The number of febrile days ( > 37.5 degrees C ) was assessed in 299 subjects who were observed for 12 months ( retrospectively for 6 months and prospect ively for 6 months ) . The follow-up data were analyzed using multivariate regression analyses in relation to the baseline data , including T-RFLP patterns . RESULTS T-RFLP patterns outlining the floral composition of the tongue coating were grouped into Clusters A , B , C , and D. According to Cox regression analysis , the subjects in Clusters C ( hazard ratio (HR)=4.0 , 95 % confidence interval (CI)=1.1 - 15.1 ) and D ( HR=4.9 , 95 % CI=1.2 - 21.1 ) were at a significantly greater risk of pneumonia than those in Cluster A , independent of other confounding factors . Logistic regression analysis adjusting for the same covariates indicated that the number of subjects with more than 9 febrile days per year was significantly lower in Cluster A than in the other clusters . CONCLUSION The comprehensive microfloral profile of the tongue coating is closely related to pneumonia-related health problems in institutionalized older adults BACKGROUND Halitosis is a common problem in humans , and is a social and psychological h and icap for those affected by it . Halitosis has a positive correlation with the accumulation of bacterial plaque in the oral cavity . AIMS The aim of the present study was to determine the effect of tongue brushing on oral malodor in adolescents . METHODS The subjects of the investigation were 28 adolescents who had oral malodor and whose average age was 16 + /- 0.12 years . Subjects were chosen to participate in the study if they had an established routine of oral care , and did not have systemic or periodontal disease or dentures ( such as fixed prosthesis or partial and total dentures ) . The subjects with oral malodor were r and omly assigned into two groups . Individual 
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Discussion : The use of toothbrushing plus tongue cleaning compared with toothbrushing alone significantly reduced the indicators of halitosis and TC .
However , there is insufficient evidence to recommend frequency , duration , or delivery method of tongue cleaning .