***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: Individuals with Down 's syndrome ( DS ) have an increased prevalence of periodontal  disease  compared with otherwise normal , age-matched control groups and other mentally h and icapped patients of similar age distribution . The exaggerated immune-inflammatory response of the tissues can not be explained by poor oral hygiene alone and might be the result of an impaired cell-mediated and humoral immunity and a deficient phagocytic system . As far as the progression and severity of destruction , the oral manifestations of DS patients are consistent with the juvenile periodontitis ( JP ) disease pattern . The purpose of the present study was 1 ) to assess the periodontal clinical and microbiological status of 10 DS patients aged 20 to 31 years ( mean : 26.3 years ) relative to that of 11 patients with cerebral palsy ( CP ) aged 23 to 53 years ( mean : 36 years ) without defective immunological functions , and 2 ) to determine the effect of supragingival plaque control and oral hygiene instruction in these patient groups . Subsequent to the initial examination and a professional tooth cleaning program , clinical and microbiological parameters were monitored over a period of 12 weeks . The clinical examination included the recording of plaque index ( P1 ) , gingival index ( GI ) , probing depth ( PD ) , and clinical attachment level ( CAL ) . Subgingival plaque sample s were always obtained from the same pocket with the highest disease activity ( deepest bleeding site at baseline examination ) in each subject for a morphotype analysis by dark field microscopy and for identification and quantitation of Actinobacillus actinomycetemcomitans , Porphyromonas gingivalis , Prevotella intermedia , Eikenella corrodens , Bacteroides forsythus , Fusobacterium nucleatum , Treponema denticola , and Campylobacter rectus by DNA probes . The results of the baseline examinations demonstrated that DS patients and patients with cerebral palsy had inflamed gingiva associated with a high amount of plaque . The mean probing depth and percentage of sites with probing depth > 4 mm corresponded to age and poor oral hygiene in CP patients . Deep pockets in DS patients demonstrated a high prevalence of periodontal disease compared with age-matched children with mental retardation and non-h and icapped patients . Regarding the young age of onset , the severe destruction of periodontal tissues and pathogenesis of periodontitis in DS patients are consistent with the juvenile periodontitis disease pattern . The missing clinical benefit and alteration of the subgingival flora following supragingival plaque control in DS patients underlined the alteration in the immunological response The effect of local applications of sustained-release delivery polymer containing chlorhexidine as an adjunct to mechanical plaque removal was studied in institutionalized children with Down 's syndrome . Thirty children , ages 8 - 13 , participated in the study . Clinical parameters ( P1I , GI , papillary bleeding ) were recorded and bacterial sample s from selected permanent teeth were collected and processed before and following treatment . Following the registration of clinical findings and collection of plaque , all children had their teeth scaled and polished and were r and omized into three treatment groups of ten subjects each : Subjects in group I had their teeth coated with ethyl cellulose containing chlorhexidine ; those in group II had their teeth coated with placebo polymer and those in group III received no further treatment . Individual oral hygiene habits were not interfered with . The application of the solutions to the respective groups was done every 3 days for 21 days . Chlorhexidine treatment significantly reduced the PLI , GI total aerobic counts and S. viridans counts compared to no treatment . The placebo group showed similar effects to that of the chlorhexidine-treated group except for the total aerobic counts which were not affected . The results suggest that the use of chlorhexidine in a sustained-release dosage form applied to the tooth surfaces may prove useful in the control of plaque and its sequela in children with Down 's syndrome OBJECTIVES To determine the incidence of obstructive sleep apnea syndrome in children aged 2 to 4 years with Down syndrome and to determine parents ' ability to predict sleep abnormalities in this patient population . DESIGN Prospect i ve cohort study . SETTING Tertiary care pediatric referral center . PATIENTS Sixty-five children participating in a 5-year longitudinal study in which the otolaryngologic problems seen in Down syndrome were evaluated . Fifty-six completed  overnight polysomnography ( PSG ) between 4 and 63 months of age ( mean age , 42 months ) . INTERVENTIONS Overnight PSG was performed . Parents also completed a question naire regarding their impressions of their child 's sleep patterns before PSG . MAIN OUTCOME MEASURES Polysomnograms were classified as abnormal if the obstructive index was greater than 1 , if the carbon dioxide level was greater than 45 mm Hg for more than two thirds of the study or greater than 50 mm Hg for more than 10 % of the study , and /or if there was unexpected hypoxemia less than 92 % during sleep or repeated intermittent desaturations less than 90 % . We also identified a group of children whose PSGs findings were normal except for an arousal index greater than 10 and were associated with increased work of breathing . RESULTS The PSGs revealed that 57 % of the children had abnormal results and evidence of obstructive sleep apnea syndrome . If we also include an elevated arousal index , 80 % of the PSGs had abnormal results . Sixty-nine percent of parents reported no sleep problems in their children , but in this group , 54 % of PSGs had abnormal results . Of the parents who reported sleep problems in their children , only 36 % had abnormal sleep study results . CONCLUSION Because of the high incidence of obstructive sleep apnea syndrome in young children with Down syndrome , and the poor correlation between parental impressions of sleep problems and PSG results , baseline PSG is recommended in all children with Down syndrome at age 3 to 4 years A sample of 44 adults with severe disabilities completed a r and omized single-blind cross-over study testing chlorhexidine swabbing under various conditions : with/without prior dental prophylaxis , reduced frequency of application ( 2 vs. 5 times per week ) , and prolonged use ( 42 weeks ) . All subjects received therapeutic doses of 10 mL 0.12 % chlorhexidine gluconate ( Peridex , Procter & Gamble ) and 10 mL 0.05 % NaF applied with a Toothette ( Sage Products ) . Clinical effectiveness of chlorhexidine swabbing compared with placebo was previously reported . In the present study , while initial benefits were observed to be independent of dental prophylaxis , significant reductions in periodontal scores were sustained by a combination of dental prophylaxis and swabbing protocol , at reduced frequency of application and over prolonged time . High levels of acceptance and compliance by subjects/caregivers were maintained . Subjects/caregivers reported improvements in dental health as well as in attitude , quality of life , and smile .  Chlorhexidine swabbing at maintenance frequency , combined with periodic dental prophylaxis , may offer an effective and pragmatic long-term preventive regimen for persons with disabilities AIM The aim of this single-blind , r and omized , parallel- design ed clinical trial ( RCT ) was to evaluate the clinical and microbiological effects of three sustained-release biodegradable polymers delivered into periodontal pockets following initial periodontal therapy . METHODS Forty-seven patients ( 28 females and 19 males ) with a mean age of 51 years ( range 29 - 71 ) underwent a periodontal examination at baseline ( i.e. Week 0 ) and after 18 weeks . This included the assessment of the Plaque Index ( PlI ) , Bleeding on Probing ( BOP ) , Pocket Probing Depths ( PPD ) and Probing Attachment Levels ( PAL ) at six sites per tooth . Two to 4 months prior to baseline , all subjects had received initial periodontal therapy including motivation , instruction in oral hygiene practice s and full-mouth scaling and root planing . At the treatment appointment ( i.e. Week 2 ) , the patients were r and omly assigned to receive either Atridox trade mark , Elyzol Dental Gel or PerioChip at all residual periodontal pockets with a probing depth > /= 5 mm and concomitant BOP . In accordance with the manufacturer 's recommendations , Elyzol Dental Gel was applied for a second time 7 days later . In addition to the clinical evaluation , subgingival microbiological sample s were collected prior to treatment ( i.e. Week 2 ) and at Weeks 4 and 18 . Analysis of variance/covariance was used to evaluate changes from baseline to Week 18 for the clinical parameters . RESULTS Between the baseline and 18-week examinations , subjects treated with Atridox showed a significantly greater gain in mean PAL of 0.33 mm + /- 0.09 ( SD ) than subjects treated with Elyzol Dental Gel [ 0.03 mm + /- 0.09 (SD)](p = 0.03 ) . However , the gain in PAL of 0.16 mm + /- 0.10 ( SD ) found after PerioChip application did not differ significantly from that obtained following the application of Atridox(p = 0.27 ) . Of the sites treated with Atridox , 42 % gained > /= 1 mm PAL and 9 % > /= 2 mm PAL as opposed to the sites treated with Elyzol Dental Gel , in which 34 % gained > /= 1 mm PAL and 8 % gained > /= 2 mm PAL . Of the sites treated with PerioChip , 36 % gained > /= 1 mm and 6 % gained > /= 2 mm PAL following a completed initial periodontal therapy . CONCLUSIONS The application of the three biodegradable sustained release devices tested following initial periodontal therapy result ed in a statistically significant gain in mean PAL for AtridoxTM and a significant reduction in PPD for all three devices during the study period . Furthermore , when sites treated with Atridox were compared with sites treated with Elyzol , a significant difference in mean PAL gain ( 0.3 mm ) was observed BACKGROUND Individuals with Down 's syndrome ( DS ) differ in their oral condition compared with the healthy population . Periodontal disease in persons with DS under the age of 30 years is very high . Immune deficiencies are also present . For dental practitioners it is difficult to decide on a particular course of treatment . In this study , patients with DS were selected in order to 1 ) evaluate the effectiveness of surgical and non-surgical periodontal therapies and 2 ) assess their immunological status . METHODS The population consisted of 14 DS patients ( 14 to 30 years old ) .  Surgical and non-surgical periodontal therapies were compared in a split-mouth design . Clinical measurements of plaque index ( PI ) , gingival index ( GI ) , probing depth ( PD ) , and clinical attachment levels ( CAL ) were taken at baseline , posttreatment , 6 months , and 1 year . Immunomodulatory activity of neutrophils was analyzed in vitro by chemotaxis ( Boyden migration chamber ) , phagocytic activity , and production of super-oxide anion ( NBT reduction ) tests and compared between DS patients and healthy controls . RESULTS Both surgical and non-surgical therapies showed a significant improvement in all the clinical parameters compared to baseline . There were no differences between surgical and nonsurgical therapy in PI or GI . There was a significant PD reduction with the non-surgical therapy at 1 to 3 mm PD . However in PD > 3 mm the surgical therapy , although not statistically significant , showed better results . Neutrophil chemotaxis , phagocytic activity , and production of super-oxide anion were significantly decreased in the DS patients . CONCLUSIONS After a year , both surgical and non-surgical therapies have similar periodontal clinical improvement in DS patients . There is partial impairment of immunological functions in DS individuals which does not seem to affect the clinical response to therapy OBJECTIVE To evaluate the mechanical and chemical control of dental biofilm in patients with Down syndrome , using different experimental dentifrices . MATERIAL AND METHODS Forty institutionalized children between ages 7 and 13 years in the mixed dentition phase participated in this study . An experimental cross-over , blind clinical trial was used , having the following protocol s : fluori date d dentifrice ( protocol G1 ) ; fluori date d dentifrice + chlorhexidine ( protocol G2 ) ; fluori date d dentifrice + chlorhexidine + plaque-disclosing agent ( protocol G3 ) ; and fluori date d dentifrice + plaque-disclosing agent ( protocol G4 ) . Each experimental stage lasted 10 days with a 15-day washout . The evaluated parameters were Plaque Index and gingival bleeding . RESULTS The initial clinical conditions between each stage were similar . Statistical differences were observed ( P < 0.001 ) for the clinical conditions evaluated before and after the treatments . The dentifrices containing plaque-disclosing agent , irrespective of their association with chlorhexidine , produced a greater reduction in the final plaque index . As for gingival bleeding , the dentifrice containing erythrosine and the one containing chlorhexidine produced similar results . The dentifrice containing an association of chlorhexidine and erythrosine gave the best results . CONCLUSION With the methodology employed , it was possible to conclude that the combination of drugs ( chlorhexidine , fluorine and erythrosine ) within one dentifrice can be useful in controlling dental biofilm and in the reduction of gingival bleeding BACKGROUND Periodontal disease in Down 's syndrome ( DS 
    Output:
    
The results demonstrated the importance to introduce youngest DS patients in preventive programs , as well as participation of parents , caregivers or institutional attendants in supervising/performing oral hygiene .
In studies with higher frequency of attendance , all age groups presented superior preventive and therapeutic results , irrespective of the therapeutic approach used ( surgical/nonsurgical/periodontal care program ) .
The important factors for reducing periodontal parameters were the frequency of the appointments and association with  chlorhexidine/plaque disclosing agents  as adjuvant treatment .
This systematic review demonstrated that early introduction in periodontal care , participation of parents/caregivers/institutional attendants , frequency of attendance and association with chemical adjuvants ( independently of the periodontal treatment adopted ) seems to improve periodontal outcomes in preventive and periodontal treatment of DS patients .