***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: BACKGROUND The issue of dental fear and anxiety still poses a significant problem in treating children . Various caries management protocol s have been tried to make the dental visit more compatible to the child patients . AIM The aim of the study was to evaluate and compare the behavioral and physiological responses to chemo-mechanical caries removal ( CMCR ) and conventional drilling method ( CDM ) . MATERIAL S AND METHODS A total of 20 children with an age range of 7 to 11 years with bilateral frank carious lesions were included in this study . They were r and omized into two groups : Group A -- treated with CDM first followed by CMCR and Group B -- treated with CMCR first followed by CDM . The physiological signs ( pulse , blood pressure and oxygen saturation ) were noted prior to treatment , during treatment , post treatment and 5 min after treatment . The behavioral responses were assessed by face , legs , activity , cry , and consolability scale and facial image scale . The participants were interviewed about pain , discomfort , taste , smell , preference and overall experience after every procedure . The pediatric dentist filled in details about patient behavior , time utilized and need for local anesthesia . The results were statistically analyzed using t-test and Chi-square test appropriately ( SPSS version 11 ) . RESULTS There was no significant difference in any of the physiological parameters assessed between the two groups . Discomfort was significantly more ( P < 0.025 ) in the CDM group than CMCR group . The time taken by the dentist was significantly lesser ( P < 0.01 ) in the CDM group . CONCLUSION Techniques which enhance the behavioral response in children should be considered for a better pediatric dental practice PURPOSE The purpose of this controlled clinical trial was to compare the working time for caries removal in primary teeth , the need for local anesthesia and patient cooperation , when the chemomechanical Carisolv or the conventional mechanical method were used . METHODS The sample consisted of primary teeth of children who had occlusal or buccal carious lesions into dentin .  High speed and /or low speed were used as the conventional mechanical method of caries removal . The efficiency in caries removal was judged on the basis of clinical criteria . Length of working time , need of local anesthesia , and level of patient cooperation were recorded for both methods . Statistical analysis was performed using the student 's t test and chi-square test . RESULTS Working time with the chemomechanical method was much more prolonged than with the mechanical method ( P < .001 ) , but it did not negatively affect children 's cooperation . Furthermore , the chemomechanical method reduced the need for administration of local anesthesia for Class V cavity preparations . CONCLUSIONS The chemomechanical method , although more prolonged , is effective in caries removal in primary teeth , does not influence children 's cooperation and may reduce the need of local anesthesia in Class V restorations The aim of the present study was to assess pain and the need for anesthesia during chemomechanical caries removal with Papacarie gel and the traditional method ( low-speed bur ) in pediatric patients . A r and omized , controlled , clinical trial with a “ split-mouth ” design was carried out involving 20 children ( 10 girls and 10 boys ) aged four to seven years . Forty primary teeth ( two per child ) were r and omly allocated to either Group 1 ( G1 : chemomechanical caries removal with Papacarie gel ) or Group 2 ( G2 : removal of carious dentin with low-speed bur ) . A face scale was used to classify the sensation of pain during the procedure ( 1 : absence of pain ; 2 : mild pain ; 3 : moderate pain ; 4 : moderately intense pain ; 5 : intense pain ; and 6 : extremely intense pain ) . Statistical analysis of the data was performed using the Wilcoxon-Mann-Whitney ( U ) test . Pain scores were higher in G2 , with statistically significant differences in comparison to G1 ( U = 148.0 ; W = 358.0 ; P = 0.041 ) . Chemomechanical caries removal with Papacarie provides a lesser degree of pain in comparison to conventional caries removal and does not require the use of local anesthesia . The clinical trial registration number is NCT01811420 Background :  Chemomechanical caries removal  is an effective alternative to the traditional rotary drilling method . The advantages of chemomechanical techniques in terms of the need for anesthesia , pain perception and patient preference are systematic ally review ed and a meta- analysis of the time required for caries removal is reported . Method : R and omized controlled studies of comparison of chemomechanical techniques with conventional rotary drill were selected from a systematic search of st and ard biomedical data bases , including the PubMed and Cochrane clinical trials . Non-repeated search results were screened for relevance and risk of bias assessment , followed by methodology assessment . Statistical models were applied to the outcome parameters - time required , pain perception , need of anesthesia and patient preference - extracted from the studies . Results : Out of the 111 non-repeated search results , 26 studies receiving a low bias score were selected for the review , and 16 r and omized clinical trials of rotary and Carisolv techniques were considered for meta- analysis . Meta- analysis by fixed effect as well as r and om effect models indicate that Carisolv takes more time ( 3.65 ± 0.05 and 4.09 ± 0.29 min ) than rotary drill ( 8.65 ± 0.09 and 8.97 ± 0.66 min ) method . Advantages of reduced pain ( 14.67 for Carisolv vs. 6.76 for rotary drill ) , need for anesthesia ( 1.59 % vs. 10.52 % ) outweigh the longer time requirement and make it the preferred ( 18.68 % vs. 4.69 % ) method . Conclusion : Chemomechanical techniques st and out as a minimally invasive and preferred method based on the meta-analyses . Evaluation of pain experienced using robust methods is needed to strengthen the evidence for their use The purpose of this study was to evaluate the clinical efficiency and patient acceptance of the chemomechanical caries removal agent Carisolv ™ in deciduous teeth . Contralateral primary molars of sixteen 7– to 9–year – old patients ( 32 teeth ) were treated with the air – motor and with Carisolv , respectively . Patients replied to a pre– and a postoperative question naire . Complete caries removal ( CCR ) was accomplished in all air – motor sessions . It was not achieved within the time limit of 15 min in 6 ( 37.5 % ) Carisolv sessions . Air  – motor CCR time ranged between 6 and 18 s ( mean : 11.81 s )  . Carisolv CCR time , where accomplished within 15 min , ranged between 6 min 46 s and 13 min 57 s ( mean : 6 min 51 s ) . Preoperatively , the majority of the children reported disliking the drilling , and that they would visit the dentist more often and prefer sitting in the chair longer if they could avoid it . Postoperatively , the majority of the children reported disliking the taste of Carisolv  , estimated Carisolv to have taken longer , would not recommend it to their friends , and preferred the air – motor . In conclusion , Carisolv , although a step forward in terms of solution volume required , is not in a position to replace rotary instruments for caries removal : it did not remove decay completely in one third of our sample ; it was much slower than the air – motor ; it had a chlorine taste/odor our patients disliked Prevalence , characteristics and consequences of dental anxiety in a r and omly selected sample of 645 Danish adults were explored in telephone interviews . Participation rate was 88 % . Demographics , fear of specific procedures , negative dentist contacts , general fear tendency , treatment utilization and perceived oral conditions were explored by level of dental anxiety using a modified Dental Anxiety Scale ( DAS ) . A Seattle fear survey item and a summary item from the Dental Fear Survey ( DFS ) were also included for fear description comparisons . Correlation between these indices ( DAS-DFS : rs = 0.72 ; DAS-Seattle item : rs = 0.68 ) aided semantic validation of DAS anxiety intensity levels . Extreme dental anxiety ( DAS > or = 15 ) was found in 4.2 % of the sample and 6 % reported moderate anxiety ( DAS scores 14 - 12 ) . Bivariate ( B ) and logistic regression ( L ) odds ratios ( OR ) showed that high dental anxiety was associated with gender , education and income , but not with age . Extreme dental anxiety for dentate subjects was characterized by fear of drilling ( ORL = 38.7 ) , negative dentist contacts ( ORL = 9.3 ) , general fear tendency ( ORL = 3.4 ) , avoidance of treatment ( ORL = 16.8 ) and increased oral symptoms ( ORB = 4.4 ) . Moderate dental anxiety was also related to drilling ( ORL = 22.3 ) , but with less avoidance due to anxiety ( ORL = 6.8 ) compared with low fear subjects AIM To evaluate and compare the efficacy of chemo mechanical ( carie care ) caries removal method with rotary and h and excavation by assessing the amount of time taken , the pain response experienced by the children and the amount of residual caries left out . STUDY DESIGN Twenty patients between the age groups of 5 - 7 years were selected and caries removal was done by airotor h and instruments and cariecare gel . The efficacy , time taken and pain threshold was evaluated during caries removal . RESULTS significant results were obtained when inter group comparison were made . CONCLUSION it was concluded that cariecare was efficient in caries removal and can be used as an alternative for the airotor in management of dental caries especially in children BACKGROUND Conventional methods of caries removal are commonly associated with pain , fear and discomfort . Chemomechanical methods were introduced to instill a positive dental attitude . Agents like GK-101 , Caridex , Carisolv did not prove effective alternatives owing to their high cost , need of special instruments and taste of chlorine . A new chemomechanical agent , Papacarie ® , has been introduced to overcome these deficiencies . OBJECTIVE This study was aim ed to compare the effectiveness and tolerance of Papacárie ® with the conventional method . METHOD 25 children with at least two primary teeth with broad cavitated occlusal or cervical lesion were selected . One carious tooth from each patient was r and omly treated with each of Papacarie ® and conventional drilling method , one after the other . Time taken for caries excavation , child 's pain perception , change in anxiety levels , microbial flora and child 's preference of treatment were recorded separately for both the methods . RESULT Although the mean time taken for caries removal by the Papacarie ® method was slightly longer ( P≯0.05 ) but it led to reduction in pain and anxiety ( p<0.05 ) . The viable bacterial counts were significantly reduced by either of the two methods ( P < 0 � 0001 ) . More patients preferred Papacarie ® over conventional method of treatment ( P<0.05 ) . CONCLUSION Papacárie ® method seems to be a better alternative to conventional method of caries removal The aim of this study was to evaluate the efficacy , comfort and efficiency of removing dentin caries using only h and instruments . The Carisolv ™ system for caries removal consisting of a solvent gel and a set of specially design ed h and instruments ( chemo – mechanical ) was compared to the use of conventional spoon excavators ( mechanical ) . This was a clinical r and omised controlled trial where the two techniques were compared in the same individual . The outcome variables were : complete caries removal ; pain during caries removal ; anaesthesia requested by the patient during caries removal ; time taken to remove caries .  Sixty – six individuals , each with a pair of similar cavities in permanent teeth were selected . After caries removal , a ‘ blinded ’ evaluator assessed the clinical status of the cavity , with the use of a probe . The times for caries removal  of the chemo – mechanical and mechanical methods were respectively : 9.2±3.8 and 8.6±3.8 min ( p>0.05 ) . There were 4 cavities arguably presenting signs of caries after cavity preparation in the 66 cavities treated with the mechanical method and 7 in the 66 chemo – mechanical cavities ( p>0,05 ) . Some pain/discomfort was reported by 21 ( 32 % ) participants when the chemo – mechanical method was used , compared with 43 ( 65 % ) when the mechanical method was used ( p<0.05 ) . During the chemo – mechanical and the mechanical treatment , 2 ( 3 % ) and 5 ( 8 % ) patients , respectively , requested local anaesthesia ( p>0.05 ) . The chemo – mechanical method appeared to be more comfortable for most patients 
    Output:
    
This review showed that Carie-care ™  reduces pain during caries treatment but requires a longer time for effective treatment than conventional methods .
Local anesthesia was not required in the Chemo-mechanical caries removal ( CMCR ) group .
In addition , dental anxiety decreased compared to the control group , and co-operation was more positive .