***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: OBJECTIVE To determine which  child-rearing practice s are associated with nursing caries . DESIGN Cross-sectional study . SETTING Hospital-based general pediatric clinic . PARTICIPANTS Sequential sample of 110 healthy children aged 18 to 36 months . OUTCOME MEASURES  Feeding practice s of children , limit- setting issues , and familial dental health were determined by maternal interview .  Nursing caries were diagnosed by dental examination . RESULTS Nursing caries were found in 22 ( 20 % ) of the children . Ninety percent of children with and without caries were bottle-feeding at 12 and 18 months of age . Ninety-one percent of children with caries and 84 % without were still drinking a nighttime bottle at 18 months ( P = .33 ) . The mothers of children with caries were found to have fewer years of education , 8.9 vs 10.8 years ( P = .02 ) , and were more likely to have eight or more cavities , 55 % vs 19 % ( P = .002 ) . More infants in the caries group had been breast-fed , 72 % vs 46 % ( P = .02 ) , although length of breast-feeding was similar , 5.4 vs 6.7 months . Fewer children with caries drank fluori date d tap water , 27 % vs 54 % ( P = .05 ) , but there were no differences in topical fluoride use , dental hygiene practice s , or visits to the dentist . CONCLUSIONS These findings fail to substantiate a straightforward relationship between child-rearing practice s and nursing caries and suggest that well- design ed prospect i ve studies are needed to clarify the etiology of early caries OBJECTIVES To evaluate the effectiveness of a xylitol pediatric topical oral syrup to reduce the incidence of dental caries among very young children and to evaluate the effect of xylitol in reducing acute otitis media in a subsequent study . DESIGN Double-blind r and omized controlled trial . SETTING Communities in the Republic of the Marshall Isl and s. PARTICIPANTS One hundred eight children aged 9 to 15 months were screened , and 100 were enrolled . Intervention Children were r and omized to receive xylitol topical oral syrup ( administered by their parents ) twice a day ( 2 xylitol [ 4.00-g ] doses and 1 sorbitol dose ) ( Xyl-2 x group ) or thrice per day ( 3 xylitol [ 2.67-g ] doses ) ( Xyl-3x group ) vs a control syrup ( 1 xylitol [ 2.67-g ] dose and 2 sorbitol doses ) ( control group ) . MAIN OUTCOME MEASURES The primary outcome end point of the study was the number of decayed primary teeth . A secondary outcome end point was the incidence of acute otitis media for reporting in a subsequent report . RESULTS Ninety-four children ( mean [ SD ] age , 15.0 [ 2.7 ] months at r and omization ) with at least 1 follow-up examination were included in the intent-to-treat analysis . The mean ( SD ) follow-up period was 10.5 ( 2.2 ) months . Fifteen of 29 of the children in the control group ( 51.7 % ) had tooth decay compared with 13 of 32 children in the Xyl-3x group ( 40.6 % ) and eight of 33 children in the Xyl-2x group ( 24.2 % ) . The mean ( SD ) numbers of decayed teeth were 1.9 ( 2.4 ) in the control group , 1.0 ( 1.4 ) in the Xyl-3x group , and 0.6 ( 1.1 ) in the Xyl-2x group . Compared with the control group , there were significantly fewer decayed teeth in the Xyl-2x group ( relative risk , 0.30 ; 95 % confidence interval , 0.13 - 0.66 ; P = .003 ) and in the Xyl-3x group ( 0.50 ; 0.26 - 0.96 ; P = .04 ) . No statistical difference was noted between the 2 xylitol treatment groups ( P = .22 ) . CONCLUSION Xylitol oral syrup administered topically 2 or 3 times daily at a total daily dose of 8 g was effective in preventing early childhood caries The aim was to study the effect of substitution of invert sugar for sucrose , in combination with fluoride varnish ( Duraphat ) treatment twice a year , on caries development in preschool children . One hundred and eighty-seven 4-years-olds were divided r and omly into four sugar groups : ( 1 ) sucrose ( S ) , ( 2 ) sucrose-Duraphat ( SD ) , ( 3 ) invert sugar ( I ) , and ( 4 ) invert sugar-Duraphat ( ID ) . All families were asked to buy beverages , biscuits , breakfast cereals , marmalade , ice cream , jam , ketchup , sweets and table sugar , totally 32 different food items , sweetened with invert sugar or sucrose . The substitution was , thus , restricted to a number of sugar-rich between-meal products . The study was carried out double-blind for 2 years . The children of those parents who did not want to participate in the sugar groups were divided r and omly into one of the following two groups : ( 5 ) Duraphat ( D ) , and control ( C ) . Because of lack of cooperation , only 114 of the 187 children ( 61 % ) were considered to have completed the study . The mean caries increment , including initial lesions , was 3.86 dmfs in the combined groups S and SD ( n = 63 ) and 3.10 dmfs in the combined groups I and ID ( n = 51 ) during the 2 years ( p = 0.34 ) . The corresponding values for the 2nd year only were 1.84 and 0.67 dmfs , respectively ( p = 0.09 ) . The mean caries increment was 2.86 dmfs in group D ( n = 113 ) and 4.10 dmfs ( p = 0.08 ) in group C ( n = 93 ) . If initial caries lesions were excluded from the index , the difference between groups D and C was significant ( p = 0.008 ) . ( ABSTRACT TRUNCATED AT 250 WORDS The objective of this study was to assess the effect of six-monthly professional applications of chlorhexidine varnish on the prevention of dental caries in primary molars in Chinese preschool children . In a double-blinded , r and omized , placebo-controlled clinical trial , 334 children aged 4–5 years were r and omly divided into two groups . Children in the test group received six-monthly applications of a 40 % chlorhexidine varnish , and the control children received a placebo varnish .  Caries status of the children was assessed by two calibrated examiners at baseline and after 24 months , according to criteria recommended by the World Health Organization . The two-year mean caries increments in the test and the control group children were 1.0 and 1.6 decayed , missing , or filled molar surfaces ( dmfs-molar ) , respectively , a 37.3 % reduction ( t test , p = 0.036 ) . No side-effects were found . It was concluded that six-monthly applications of chlorhexidine varnish were effective in reducing the incidence of dental caries in primary molars OBJECTIVE To evaluate the caries-inhibiting effect of a fluoride drops program in two kindergartens in Chengdu , Sichuan Province , a fluoride-deficient area . METHODS For 3 years , participating children ingested in school 0.25 mg fluoride daily , in the form of drops for 2 to 3-year-olds and 0.5 mg for children age 3 years and older . These systemic fluoride supplements were made available for over 180 days each year and they were distributed by teachers who maintained attendance records . Annual examinations were conducted for 176 2-year-olds who had used the supplements in the kindergartens and 148 control children . After 3 years , 128 test and 112 control children remained in the study . RESULTS The results demonstrated a marked reduction in dental caries in the control group : test children had 2.21 decayed , missing , or filled teeth (DMFT)-versus 4.32 in the control group , a reduction rate of 48.84 % . The mean DMFT increments over the 3-year period were 1.76 and 3.92 , respectively . Over a 1- to 3-year period of supplement use , the group provided with the fluoride drops had consistently lower caries prevalence than the control group . The differences were statistically significant . CONCLUSIONS This treatment regimen demonstrated an effective caries-inhibiting effect BACKGROUND The aim of this study was to evaluate the effect of fluoride varnish on enamel caries progression in the primary dentition . METHODS One hundred forty-two children in Head Start schools ( 3 to 5 years old ) were r and omized into the varnish and control groups . Children in the varnish group received fluoride varnish ( Duraphat , Colgate-Palmolive Co. ) at baseline and after four months , and children in the control group received no professional fluoride applications . Two calibrated examiners performed the examinations at baseline and at nine months . RESULTS At nine months , the authors found that in the control group , 37.8 percent of active enamel lesions on occlusal , buccal and lingual surfaces became inactive , 3.6 percent progressed and 36.9 percent did not change . In the varnish group , 81.2 percent became inactive , 2.4 percent progressed and 8.2 percent did not change . The difference between the groups was statistically significant ( P < .0001 ) . The mean decayed surfaces , or ds , value in the varnish group was significantly lower after nine months than it was at baseline ( P < .0001 ) . When enamel lesions were included in the data analysis ( along with dentinal lesions ) , the decayed with initial enamel lesions , missing and filled surfaces , or dEmfs , values ; decayed with initial enamel lesions , missing and filled teeth , or dEmft , values ; and decayed surfaces with initial enamel lesions , or dEs , values were significantly lower in the varnish group after nine months than they were at baseline ( P < .0001 ) . CONCLUSIONS These results suggest that fluoride varnish applications may be an effective measure in reversing active pit- and -fissure enamel lesions in the primary dentition . CLINICAL IMPLICATION S Fluoride varnishes are safe , easy to apply and well-accepted by patients . This study shows that fluoride varnish may offer an efficient , nonsurgical alternative for the treatment of decay in children Abstract 705 children took part in a controlled trial in which they were given the vitamin A and D drops routinely supplied by Swedish child-welfare centres with or without a supplement of sodium fluoride . The children were examined by a dentist each year from the age of one to the age of six ( longer in some cases ) . At the third , fourth , fifth , and sixth examinations the mean number of decayed teeth was around 50 % lower in the fluoride group . It is recommended that fluoride be given in vitamin drops where the local fluoride content of drinking-water is below 0.6 p.p.m . Such a scheme could be voluntary . Other advantages would be simplicity and cheapness Summary A clinical study was conducted which included815 children between 18 and 39 months of age residing in three different fluoride-deficient communities . The children received chewable tablets containing vitamins , vitamins plus fluoride , or fluoride alone and were examined for dental caries initially and at 6 month intervals . The findings during the first two years of the 5 year study indicate that a significant reduction in the incidence of dental caries of about 37 per cent was observed after six months in the children ingesting either the fluoride or vitamin-fluoride supplements . This degree of protection increased to about 55 and 63 per cent , respectively , after the children had used the supplement for one and two years . No differences in efficacy were observed between the fluoride and vitamin-fluoride preparations . No toxicity related to the use of fluoride was encountered PURPOSE The purpose of this study was to assess the efficacy of antimicrobial therapy in the prevention of early childhood caries ( ECC ) . METHODS The study population consisted of 83 subjects ( age : 12 to 19 months ( x= 15.6 ) ; gender : 40 females and 43 males ) . Inclusion criteria included : ( 1 ) unremarkable medical history ; ( 2 ) presence of 4 maxillary primary incisors ( MPI ) with no visible defects ; ( 3 ) clinical ly caries free ; ( 4 ) use of a nursing bottle at naptime and /or bedtime which contained a cariogenic substrate ; ( 5 ) 2 consecutive ms positive cultures from pooled MPI plaque . The subjects were r and omized into 2 groups . The 39 subjects in the experimental group and the 44 subjects in the control group were evaluated every 2 months during the study period . At each evaluation , the subjects had 10 % povidone iodine ( experimental group ) or placebo ( control group ) applied to their dentition . Treatment failure was defined as the appearance of a white spot lesion(s ) on any of the MPI during the study period . RESULTS Using the Kaplan-Meier procedure , the estimated percents ( + /- SES ) of participants to experience 12 months of disease-free survival were 91 + /- 5 % 
    Output:
    
New observational studies were consistent with previous evidence showing an association between early childhood fluoride use and enamel fluorosis .
: There is no direct evidence that screening by primary care clinicians reduces  early childhood caries .
Evidence previously review ed by the US Preventive Services Task Force found oral fluoride supplementation effective at reducing caries incidence , and new evidence supports the effectiveness of fluoride varnish in higher-risk children