***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 ability of two different toothbrush bristle ends to produce traumatic gingival abrasion was assessed in a double blind study of 15 male and 15 female young adults . Brushing was performed in a circular fashion using a modified Bass Technique . An apparatus allowing continuous visual feedback of the average brushing force permitted a degree of st and ardization of the system . The upper left canine and bicuspid area had to be brushed for 30 seconds with cut toothbrush bristles ( CP ) and with round ended toothbrush bristles ( RP ) respectively . A two week interval separated the two brushing sessions . Traumatic lesions of the attached gingiva were stained with a disclosing solution , photographed and evaluated planimetrically . The " cut bristles " caused gingival abrasions 30 % greater in extent than the round end bristles . The difference was not due to single brushing strokes accidentally greater for the " cut bristles " . The size of the lesions was not sex dependent . To prevent gingival damage it is desirable to either round the bristles in production or to rid the bristle ends at least of sharp edges BACKGROUND Inconclusive evidence exists in the literature with regard to the additional effect of the use of dentifrice on plaque removal .  The present study was undertaken to test whether the use of dentifrice during toothbrushing contributes to the instant cleaning efficacy of the brushing procedure . METHODS Three groups of patients , 40 subjects each , were r and omly assigned to one of three dentifrices that differed with respect to the relative dentin abrasivity ( RDA ) value . After a 48-hour plaque accumulation , subjects brushed under supervision in a split-mouth order with or without the use of dentifrice ( total time=2 minutes ) . RESULTS Plaque reductions varied between 51 % and 58 % for the three dentifrices . The overall analysis showed a mean difference of 3 % in plaque reduction in favor of brushing without dentifrice ( P=0.017 ) . The type of dentifrice did not influence this observed difference ( P=0.506 ) . Also , the order of the brushing procedure ( starting the brushing procedure with or without dentifrice ) had no interaction with the effect of dentifrice on the brushing ( P=0.187 ) . CONCLUSIONS The use of dentifrice does not contribute to the instant mechanical plaque removal during manual toothbrushing . A higher dentifrice abrasivity does not seem to contribute to increased plaque removal with a manual toothbrush . It appears that the mechanical action provided by the use of a toothbrush is the main factor in the plaque-removing process BACKGROUND The precise role of dentifrice in plaque removal has been debatable . While a considerable volume of literature attributes several beneficial properties and glorifies the role of dentifrice , a small body of research ers questions its efficacy . Lingering doubts are emerging about the plaque removal efficacy of toothpastes and probably a time has come to reassess its role in plaque removal . AIM The present study is used to evaluate the plaque removal efficacy of dentifrice alone during the manual brushing of teeth . MATERIAL S AND METHODS In a double blinded 2 Chi 2 crossover study design , 42 subjects had brushed r and omly with or without dentifrice under supervision , with a st and ard dentifrice and toothbrush , after 48 hours of plaque accumulation , for two minutes . RESULTS Plaque reduction with dentifrice was 57.35 % and without dentifrice was 66.19 % . This 9 % difference was statistically significant ( P < or = 0.001 ) . CONCLUSION Dentifrice use does not enhance plaque removal when used in conjunction with a toothbrush , and instead , may marginally lessen the brushing effect . The role of a toothbrush appears to be more crucial in the maintenance of oral hygiene OBJECTIVES The present study assessed whether 3-month-old used manual toothbrushes  are less effective in reducing plaque scores compared with new toothbrushes  with or without the use of dentifrice . MATERIAL AND METHODS The present study was performed employing a single-use , examiner-blinded , professional brushing model . Four brushing modalities were r and omly allocated to one of four quadrants , that is ,  3-month-old used toothbrushes and new toothbrushes both with and without the use of dentifrice .  Prebrushing and post-brushing plaque scores ( Quigley Hein plaque index ) and gingival abrasion ( GA ) scores were obtained . A dental hygienist performed the professional brushing procedure . The  3-month-old used toothbrushes  were assessed for wear . RESULTS No significant differences were observed among the treatments with regard to the prebrushing scores . The post-brushing plaque scores ranged from 1.59 for the new brush with dentifrice to 1.76 for the old brush with dentifrice . There was a significant difference ( P = 0.036 ) among the four treatments regarding the old brush with dentifrice , which removed less plaque than the other treatment modalities . Regarding GA scores , no significant differences were observed . With regard to toothbrush wear after 3 months of use , the scores varied widely among the individually evaluated brushes . CONCLUSION The present study did not show a clinical ly relevant difference in plaque score reductions following a 2-minute brushing exercise among 3-month-old used and new manual toothbrushes . However , the wear rate of the brushes seemed to be the determining factor in loss of efficacy , rather than the age of the toothbrush . Furthermore , dentifrice did not show an additional effect on instant plaque removal The clinical trial was primarily design ed to determine to what extent the stiffness of toothbrush bristles and the abrasiveness of dentifrices influence the degree of gingival erosion . Further , the plaque removing effectiveness of the toothbrushes and dentifrices tested was evaluated . 24 dental hygienist students with clinical ly healthy gingivae volunteered for the study . A " soft " toothbrush with a bristle thickness of 0.15 mm , a " hard " toothbrush with a bristle thickness of 0.23 mm and 2 dentifrices of different abrasiveness were used for the experiment . The 2 brushes were also used without a dentifrice . Prior to each examination the teeth of the test subjects were brushed by the same dental hygienist . Evident signs of laceration or.ulceration at any 1 of 4 gingival aspects of each tooth were recorded as brushing injuries . The teeth were then stained with basic fuchsin and the amount of remaining plaque was assessed according to the PLQ Index ( Bay & Ainamo 1974 ) . The use of the hard brush result ed in lower plaque scores and , at the same time , more gingival erosions than the use of the soft brush . With both brushes a significantly greater number of lesions was recorded after use of an abrasive powder than when no dentifrice was employed . The difference in the amount of erosions occurring when utilizing either brush , without a dentifrice or with a moderately abrasive toothpaste , was not , however , found to be statistically significant . When assessed separately for the 2 brushes , the slight tendency towards lower PLQ scores with increasing abrasiveness of the dentifrice was not considered statistically significant . The study showed that the modes decrease observed in mean PLQ scores with increasing stiffness of the toothbrush bristles and with increasing abrasiveness of the dentifrice is accompanied by increased damage caused to the soft gingival tissues AIM This study was design ed to test whether the approximal efficacy of a powered toothbrush ( Braun Oral-B 3D Plaque Remover ) can be improved when a pointed-shaped brush head ( PBH ) specifically design ed for these approximal areas is used as compared with the st and ard cup-shaped brush head ( CBH ) . MATERIAL AND METHODS Forty non-dental students were included . They all received the powered toothbrush and two different brush heads ( CBH+PBH ) . Instructions were given to use each brush head twice every day ( 2 min . with the CBH followed by 1 min . with the PBH ) . Two weeks later they received an appointment for the first experiment ( Exp 1 ) , prior to which they abstained from all oral hygiene procedures for 48 h. Plaque was assessed at 6 sites/tooth . Next , the dental hygienist brushed for 2 min . ( 30 s/quadrant ) with the CBH . Plaque was scored again . Subsequently , the dental hygienist brushed the approximal areas for another minute : in two r and omly selected contra-lateral quadrants for 30 s with the CBH and in the opposing quadrants for 30 s with the PBH . The next approximal plaque was scored a third time . After 2 - 3 weeks , Exp 2 was carried out comparable to Exp 1 ; only this time the panelists brushed themselves . RESULTS Exp 1 showed approximal plaque scores at the baseline of 1.70 and 1.72 and at post-brushing 0.21 and 0.26 for the CBH + PBH and CBH only , respectively ( p<0.05 ) . The additional increase in approximal plaque reduction after 30 s of brushing with PBH was 22 % and for the CBH 19 % ( p<0.05 ) . Exp 2 showed approximal plaque scores at baseline of 1.76 and 1.74 and post-brushing of 0.21 and 0.24 for the CBH+PBH and the CBH , respectively . The additional approximal plaque reduction of 30 s brushing with PBH was 19 % and 18 % with the CBH ( no significant difference ) . DISCUSSION / CONCLUSION An additional 1 min . showed minor differences ( 1 - 3 % ) between brush heads . The effect of the 1 min . extra brushing ( + /-18 % ) itself was much larger . It seems therefore beneficial to advise the patient to brush longer . A second different brush head may stimulate to do so 
    Output:
    
CONCLUSION Tooth brushing is effective in reducing levels of dental plaque .
With respect to gingivitis power toothbrushes have a benefit over manual toothbrushes .
The greatest body of evidence was available for oscillating-rotating brushes .
Tooth brushing generally can be considered safe for the teeth and their investing tissues