***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: AIM Oral health is a reflection of general health and significantly influences the quality of life . Dental caries is one of the most common chronic diseases of childhood which may adversely affect physical , mental and social growth of children . Oral hygiene methods can effectively prevent oral and dental diseases , and oral hygiene education plays an important role in this regard . The aim of the present study was then to assess the effect of oral hygiene education on the oral and dental health  of 6-year-olds . MATERIAL S AND METHODS A hundred and sixty 6-year-old children from 4 pre-school centers were divided into two groups , case and control , in this cluster r and omised controlled trail . The children in the case group received oral and dental education in one session . The parents of the case group were also instructed in one session . The children and parents of the control group did not receive any instructions .  Plaque index ( PI ) : Turesky-Gilmore-Glickman ; gingival index ( GI ) : Loe & Silness ; at a ) baseline , b ) 1.5 and c ) 6 months after the first examination . Data were analysed by repeated measure ANOVA . RESULTS PI : A significant difference was found between the baseline examination and the first follow-up ( p < 0.01 ) , and between the baseline examination and the second follow-up ( p < 0.001 ) . GI : Although values in the case group were lower , no statistically significant difference was found between the two groups and within each group ( p > 0.05 ) . Regarding the number of brushing times , a statistically significant difference was found between the first and the second follow-ups of the study groups ( p > 0.05 ) . The brushing type and the application of other hygienic measures did not show any difference ( p > 0.05 ) . CONCLUSION Within the limitations of the present study it may be concluded that oral hygiene instruction to 6-year-old children and their parents improves their dental health Background School based oral health education through traditional lecturing has been found successful only in improving oral health knowledge , while has low effectiveness in oral hygiene and gingival health . The aim of this study was to evaluate the effectiveness of experiential learning ( EL ) oral health education to traditional lecturing ( TL ) , on enhancing oral health knowledge , attitude and behavior as well as oral hygiene , gingival health and caries of 10-year-old children . Methods Eighty-four children were recruited for the EL and 100 for the TL group from 3 locations in Greece . Data regarding oral health knowledge , attitude and behavior were collected via question naires . Data regarding dental plaque , gingivitis and caries were collected by clinical examination . The evaluation using question naires and clinical examination was assessed at baseline and 6 and 18 months afterwards . Two calibrated pediatric dentists examined the students using a periodontal probe and artificial light .  Modified hygiene index ( HI ) was used for dental plaque recording , the simplified gingival index ( GI-S ) was used for gingivitis and DMFT , based on BASCD criteria , for dental caries . Based on a dedicated manual , the teacher applied in the classroom the oral health educational program using EL . Results EL group had statistically significant better hygiene than the TL at 6 months ( p < 0.05 ) . Within the same group , both groups had enhanced oral health knowledge at 6 and 18 months ( p < 0.05 ) and improved oral health behavior ( p > 0.05 ) and attitude ( p > 0.05 ) at 6 months in comparison to baseline . Conclusion EL program was found more successful than TL in oral hygiene improvement . Both oral health education programs improved the oral health knowledge , attitude and behavior of children . Trial registration Clinical Trials.gov ( NCT02320162 ) OBJECTIVES The aim of this study was to evaluate the effect of a 6-year oral health education programme in primary schoolchildren . METHODS This programme was part of the Signal-T and mobiel project , a longitudinal collaborative project combining the registration of oral health data and oral health promotion . The intervention group comprised 3291 children with a mean age of 7.1 years ( SD 0.43 ) at the start of the programme . Every year these children were examined clinical ly and a question naire , to be filled in by the parents , was administered to assess oral health behaviour . These children received an oral health education programme which consisted of a yearly 1-h instruction . Data collected using the same question naire and clinical examination in 676 12-year-old children were included as control group . The sample s were obtained using stratified cluster sampling . The effect of the interventional programme was assessed by measuring differences in caries prevalence and incidence , levels of dental care and reported oral health behaviour . RESULTS Mean DMFT/S values , although higher in the control group , were not significantly different . The reported frequency of brushing was the same in both groups . Significant differences in favour of the intervention group were found in the number of between-meal snacks ( P < 0.001 ) and the proper use of topical fluorides ( P < 0.05 ) . Children in the control group showed a significantly lower proportion of filled teeth than those in the intervention group ( P < 0.01 ) , with a care index of 73 % versus 80 % . CONCLUSION In conclusion , the implemented minimal school-based oral health education programme did not result in a significant reduction of the caries prevalence measured . The programme has been effective in improving reported dietary habits and the proper use of topical fluorides and result ed in a higher care index OBJECTIVE The aim of this study is to assess the impact of three different health education methods among preschoolers . STUDY DESIGN The study group included 100 preschoolers of the same socio-economic status r and omly selected and divided into four groups . Debris index ( DI-S ) was recorded for all children followed by the dental health education . Group A received dental health education from the Dentist ; Group B from the class teacher trained by the Dentist and Group C from the dental residents dressed mimicking cartoon characters . Group D acted as the control group . Post-intervention evaluation program was carried out after 3 months . Data were analyzed by Chi-square test , paired t-test and analysis of variance ( ANOVA ) appropriately using the SPSS Version 17.1 . RESULTS Comparison of pre- and post-intervention data showed that there was a statistically significant improvement in the ( DI-S ) scores in all groups except the control group . Group C showed a significant improvement compared to the other Groups A , B , and D ( P<0.04 ) . CONCLUSION Drama as a method of health education can have a bigger impact on the oral health attitude and practice s of the preschoolers . These modes can serve to reinforce as well as improve the oral health practice s among pre-school children Background Oral health education ( OHE ) in schools has largely been imparted by dental professionals . Considering the substantial cost of this expert-led approach , the strategies relying on teachers , peer-leaders and learners themselves have also been utilized . However the evidence for comparative effectiveness of these strategies is lacking in the dental literature . The present study was conducted to compare the effectiveness of dentist-led , teacher-led , peer-led and self-learning strategies of oral health education . Methods A two-year cluster r and omized controlled trial following a parallel design was conducted . It involved five groups of adolescents aged 10 - 11 years at the start of the study . The trial involved process as well as four outcome evaluations . The present paper discusses the findings of the study pertaining to the baseline and final outcome evaluation , both comprising of a  self-administered  question naire , a structured interview and clinical oral examination . The data were analyzed using Generalized Estimating Equations . Results All the three educator-led strategies of OHE had statistically higher mean oral health knowledge ( OHK ) , oral health behavior ( OHB ) , oral hygiene status ( OHS ) and combined knowledge , behavior and oral hygiene status ( KBS ) scores than the self-learning and control groups ( p<0.001 ) . The mean OHK , OHS and KBS scores of the three educator-led strategies did not differ significantly . The peer-led strategy was , however , found to have a significantly better OHB score than the respective score of the teacher-led strategy ( p<0.05 ) . The self-learning group had significantly higher OHB score than the control group ( p<0.05 ) but the OHK , OHS and KBS scores of the two groups were not significantly different . Conclusions The dentist-led , teacher-led and peer-led strategies of oral health education are equally effective in improving the oral health knowledge and oral hygiene status of adolescents  . The peer-led strategy , however , is almost as effective as the dentist-led strategy and comparatively more effective than the teacher-led and self-learning strategies in improving their oral health behavior . Trail registration S RCT The aim of our study was to compare the changes in children 's oral health-related behavior , knowledge , and attitudes obtained using an oral health-promotion approach , a risk- strategy and promotion approach , and reference area , and to report changes in the behavior of children between the experimental and the control groups of a r and omized clinical trial ( RCT ) . The study population consisted of all fifth and sixth grade rs who started the 2001 - 2002 school year in Pori , Finl and ( n = 1,691 ) , where the RCT and program of oral health promotion were implemented for 3.4 yr . Children with at least one active caries lesion were r and omly assigned to experimental ( n = 250 ) and control ( n = 247 ) groups . Children in Rauma ( n = 807 ) acted as the reference . Changes in children 's self-reported behavior , knowledge , and attitudes were compared between groups . The subjects in the oral health-promotion group and in the risk- strategy and promotion group in Pori tended to show greater improvement in most of their oral health-related behaviors than those in the reference group , and children in the RCT experimental group showed greater improvement in most of their oral health-related behaviors than those in the RCT control group . Children can be helped to improve their oral health-related behavior by intervention , including oral hygiene and dietary counseling , or by implementing a multilevel-approach oral health-promotion program Non-r and omised studies of the effects of interventions are critical to many areas of healthcare evaluation , but their results may be biased . It is therefore important to underst and and appraise their strengths and weaknesses . We developed ROBINS-I ( “ Risk Of Bias In Non-r and omised Studies - of Interventions ” ) , a new tool for evaluating risk of bias in estimates of the comparative effectiveness ( harm or benefit ) of interventions from studies that did not use r and omisation  to allocate units ( individuals or clusters of individuals ) to comparison groups . The tool will be particularly useful to those undertaking systematic review s that include non-r and omised studies The purpose of the study was to assess the outcome of school‐based oral health education ( OHE ) and a sugar‐free chewing gum program on the oral health status of children in terms of reduced caries increment and gingival bleeding over a period of 2 years . Nine primary schools r and omly chosen from one district were divided into three groups : OHE group ( Group E ) , sugar‐free chewing gum in addition to OHE group ( Group G ) , and the control group ( Group C ) . All children of grade 1 ( aged 6–7 years ) were recruited ( n = 1342 ) . After 2 years , 1143 children remained in the study group at follow‐up . The overall drop‐out rate was about 15 % . Data on dental caries and gingival bleeding were collected by clinical examination . The results showed that the mean increment of DMFS in Group G was 42 % lower than in groups E and C ( P < 0.05 ) . The mean increments in F‐S were higher in Groups G and E than in Group C ( P < 0.01 ) . The gingival bleeding scores were statistically significant among the three groups . Compared to Group C , the mean increment in bleeding scores of Group G was 71 % lower ( P < 0.01 ) and in Group E 42 % lower ( P < 0.05 ) . The school‐based OHE programs had some positive effect improving children 's oral hygiene ; in certain circumstances children may benefit from using polyol‐containing chewing gum in terms of reduced dental caries OBJECTIVES To assess the outcome of oral health promotion in schoolchildren over a 3-year period in Yichang City , Hubei , China . METHODS In a cluster r and omized controlled trial , the concept of the World Health Organization Health Promoting Schools Project was applied to primary schoolchildren . Seven intervention schools and eight control schools were r and omly selected from one district by stratified cluster sampling . The study was conducted as a 3-year follow-up study . After 3 years , 661 children remained in the intervention group and 697 children in the control group . Data on dental caries , plaque accumulation , and sulcus bleeding were collected by clinical examination , while behavioural data were gathered by self-administered question naires . RESULTS The 3-year net mean DMFS increment score was 0.22 in the intervention schools and 0.35 in the control schools ( P < 0.013 ) . A statistically significant difference in mean plaque ( P < 0.013 ) and sulcus bleeding ( P < 0.005 ) increment scores after 3 years was found between the two groups . Statistically significant higher scores were observed in restorations received and sealants placed , and a lower score in untreated dental caries , in children from the intervention group than the control group after 3 years ( P < 0.01 ) . In addition , more children in the intervention schools adopted regular oral health behavioural practice s such as brushing their teeth at least twice a day , visiting the dentist within the past calendar year , and using fluoride toothpaste . CONCLUSION The study suggests that the school-based oral health promotion was an effective way to reduce 
    Output:
    
Oral health-related knowledge improved in children .
Oral health-related practice behaviors such as frequency and duration of brushing improved .
Use of fluori date d toothpaste was increased .
Plaque scores and gingival bleeding scores reduced .
Conclusion : School dental health education had a positive impact on the oral health status , knowledge , and practice behavior of children .