***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 Several studies have recently demonstrated that a post-treatment communication to explain the importance of an oral hygiene can improve the orthodontic patients ’ compliance over a period of 66 days . The main goal of this study is to evaluate the effects of a structured follow-up communication after orthodontic appliance application on oral hygiene compliance after 30–40 days . Methods Eighty-four orthodontic participants enrolled from patients who were beginning fixed orthodontic treatment at the Orthodontic Department , Gaslini Hospital , Genova , between July and October 2014 were r and omly assigned to one of three trial arms . Before the bonding , all patients underwent a session of oral hygiene aim ed at obtaining an plaque index of “ zero . ” At the following orthodontic appointment , the plaque index was calculated for each patient in order to assess oral hygiene compliance . The first group served as control and did not receive any post-procedure communication , the second group received a structured text message giving reassurance , and the third group received a structured telephone call . Participants were blinded to group assignment and were not made aware that the text message or the telephone call was part of the study . ( The research protocol was approved by the Italian Comitato Etico Regionale della Liguria-sezione 3^ c/o IRCCS-Istituto G. Gaslini 845/2014 , and it is not registered in the trial ’s register . ) Results Thirty patients were r and omly assigned to the control group , 28 participants to the text message group , and 26 to the telephone group . Participants who received a post-treatment communication  reported higher level of oral hygiene compliance than participants in the control group . The plaque index was 0.3 ( interquartile range ( Iqr ) , 0.60 ) and 0.75 ( Iqr , 1.30 ) , respectively , with a significant difference ( P = 0.0205 ) . Conclusions A follow-up procedure after orthodontic treatment may be an effective tool to increase oral hygiene compliance also over a short period OBJECTIVE Text messaging is useful for promoting numerous health-related behaviors . The Text2Floss Study examines the feasibility and utility of a 7-day text messaging intervention to improve oral health knowledge and behavior in mothers of young children . METHODS Mothers were recruited from a private practice and a community clinic . Of 156 mothers enrolled , 129 r and omized into text ( n = 60 ) and  control groups ( n = 69 ) completed the trial . Participants in the text group received text messages for 7 days , asking about flossing and presenting oral health information .  Oral health behaviors and knowledge were surveyed pre- and post-intervention . RESULTS At baseline , there were no differences between text and control group mothers in knowledge and behaviors ( P > 0.10 ) . Post-intervention , text group mothers flossed more ( P = 0.01 ) , had higher total ( P = 0.0006 ) and specific ( P < 0.05 ) knowledge , and tried to improve their child 's oral health behaviors ( P = 0.03 ) and decrease their soda and sugary snacks ( P = 0.05 ) more than control mothers . Text messages were accepted and perceived as useful . CONCLUSIONS Mothers receiving text messages improved their own oral health behaviors and knowledge as well as their behaviors regarding their children 's oral health .  Text messaging represents a viable method to improve oral health behaviors and knowledge . Its high acceptance may make it useful for preventing oral disease OBJECTIVE To determine if text message reminders regarding oral hygiene compliance have an influence on the level of compliance within an orthodontic population . MATERIAL S AND METHODS In this prospect i ve , r and omized , controlled clinical trial , 42 orthodontic patients were assigned to a text message or control group . Parents of patients assigned to the text message group received a reminder text message one weekday each week .  Oral hygiene compliance was measured using bleeding index ( BI ) , modified gingival index ( MGI ) , and plaque index ( PI ) , and visual examination of white spot lesion ( WSL ) development at baseline ( T0 ) , two appointments after baseline ( T1 ) , and four appointments after baseline ( T2 ) . RESULTS BI , MGI , and PI scores were significantly lower in the text message group than in the control group at T2 . CONCLUSION A text message reminder system is effective for improving oral hygiene compliance in orthodontic patients BACKGROUND Rising concern over the poor level of blood-pressure ( BP ) control among hypertensive patients has prompted search es for novel ways of managing hypertension . The objectives of this study were to develop and pilot-test a home BP tele-management system that actively engages patients in the process of care . METHODS Phase 1 involved a series of focus-group meetings with patients and primary care providers to guide the system 's development . In Phase 2 , 33 diabetic patients with uncontrolled ambulatory hypertension were enrolled in a 4-month pilot study , using a before- and -after design to assess its effectiveness in lowering BP , its acceptability to users , and the reliability of home BP measurements . RESULTS The system , developed using commodity hardware , comprised a Bluetooth-enabled home BP monitor , a mobile phone to receive and transmit data , a central server for data processing , a fax-back system to send physicians ' reports , and a  BP alerting system . In the pilot study , 24-h ambulatory BP fell by 11/5 ( + /-13/7 SD ) mm Hg ( both P < .001 ) , and BP control improved significantly . Substantially more home readings were received by the server than expected , based on the preset monitoring schedule . Of 42 BP alerts sent to patients , almost half ( n = 20 ) were due to low BP . Physicians received no critical BP alerts . Patients perceived the system as acceptable and effective . CONCLUSIONS The encouraging results of this study provide a strong rationale for a long-term , r and omized , clinical trial to determine whether this home BP tele-management system improves BP control in the community among patients with uncontrolled hypertension Background The grading of recommendation , assessment , development and evaluation ( GRADE ) approach is widely implemented in health technology assessment and guideline development organisations throughout the world . GRADE provides a transparent approach to reaching judgements about the quality of evidence on the effects of a health care intervention , but is complex and therefore challenging to apply in a consistent manner . Methods We developed a checklist to guide the research er to extract the data required to make a GRADE assessment . We applied the checklist to 29 meta-analyses of r and omised controlled trials on the effectiveness of health care interventions . Two review ers used the checklist for each paper and used these data to rate the quality of evidence for a particular outcome . Results For most ( 70 % ) checklist items , there was good agreement between review ers . The main problems were for items relating to indirectness where considerable judgement is required . Conclusions There was consistent agreement between review ers on most items in the checklist . The use of this checklist may be an aid to improving the consistency and reproducibility of GRADE assessment s , particularly for inexperienced users or in rapid review s without the re sources to conduct assessment s by two research ers independently AIM The aims of this study were to discover the knowledge of and attitudes towards dental health of a group of regularly attending mothers of young children at high-risk of caries , and to evaluate their toothbrushing techniques .  METHOD As part of the baseline examination of a r and omised controlled trial to test the influence of dental health counselling on the caries increment of at-risk pre-school children , 268 mothers of 334 children completed a question naire enquiring about their dental health knowledge and attitudes , and were also observed brushing their children 's teeth . RESULTS Although most mothers ( 71 % ) knew that they should brush their children 's teeth twice a day using a small toothbrush ( 94 % ) only 52 % knew that they should use only a small pea-sized amount of paste , and only 3 % knew the recommended level of fluoride in toothpaste for these at-risk children . 40 % of the children insisted on brushing their own teeth and 40 % of the mothers brushed their children 's teeth inadequately . Although three-quarters of the mothers knew that sugary foods and drinks should be consumed only at mealtimes , only 7 % knew the four foods and drinks supplying most sugar to a child 's diet . Although three-quarters of mothers thought that dental decay in milk teeth was very important , only half wanted their children 's carious teeth restored . CONCLUSION Knowledge , attitudes and behaviour about dental health among these regularly attending mothers of at-risk , pre-school children were superficial . Their attitudes to dental health of primary teeth were equivocal and their demonstrated brushing behaviour on the part of their children was inadequate INTRODUCTION Fixed orthodontic treatment is frequently associated with increased plaque accumulation leading to gingivitis and white spot lesions ( WSLs ) . AIM This study evaluated the role of text message reminder on oral hygiene of orthodontic patients . MATERIAL S AND METHODS A total of 60 patients under fixed orthodontic treatment were r and omly divided into two equal groups as control group and study ( text message ) group . Text message group received reminders about oral hygiene , while the control group did not receive any messages .  Oral hygiene of both the groups was evaluated at baseline , 2 , and 3 months using plaque indices ( PIs ) along with WSL status . Data were statistically analyzed using Statistical Package for the Social Sciences ( SPSS ) statistical software , version 19 , with chi-square test and t-test . RESULTS At the baseline , plaque score was higher in the study group over control group ( p > 0.038 ) , whereas it was decreased after 3 months in the test group ( p > 0.001 ) . For WSL , there was no significant difference at baseline , but it was significantly lower in study group ( p > 0.003 ) . CONCLUSION Oral hygiene status improved with text message reminder Objective To investigate the effect of using mobile applications active reminders to improve oral hygiene in comparison to verbal oral hygiene instructions . Design Two-arm parallel r and omised controlled trial . Setting orthodontic clinics at two branches of a university hospitals of the college of dentistry of Riyadh Colleges of Dentistry and Pharmacy , Riyadh , Saudi Arabia . Participants Forty-four 12-year-old and older subjects . Method Subjects undergoing orthodontic treatment with fixed appliances were r and omly assigned to one of two groups using simple r and omisation . Group I : subjects received a mobile application that sends active reminders of oral hygiene three times a day ( n = 22 ) . Group II : subjects received verbal oral hygiene instructions verbally during their routine orthodontic visits ( n = 22 ) . Two primary outcomes were assessed using plaque index ( PI ) and gingival index ( GI ) for Ramfjord teeth to evaluate the level of oral hygiene at baseline and after 4 weeks . Results Mean differences for PI and GI for group I were reduced from T1 to T2 ( P < 0.05 , P < 0.05 ) but did not significantly change for group II ( P > 0.05 , P > 0.05 ) . Both PI and GI significantly reduced for group I compared to group II between T1 and T2 ( P < 0.05 , P < 0.05 ) . Conclusions PI and GI all significantly decreased after 4 weeks of using active reminders of oral hygiene instructions on mobile application compared to verbal oral hygiene instructions . The study was registered at clinical trials.gov with number : NCT03109769 OBJECTIVE To investigate whether text message reminders regarding oral hygiene have an effect on plaque removal in orthodontic patients . MATERIAL S AND METHODS In this r and omized , controlled clinical trial , 50 orthodontic patients were assigned to either a text message or control group . Patients in the text message group received 12 text messages over the course of 4 weeks and one text message for 8 weeks thereafter . Photos were taken at baseline ( T0 ) , at 4 weeks after baseline ( T1 ) , and at 12 weeks after baseline ( T2 ) . For each subject , photos of eight teeth were taken and then the area of the tooth and amount of plaque were measured using planimetry . RESULTS There was a statistically significant difference in plaque coverage between baseline and both T1 and T2 in the text message group as measured using planimetry . This was demonstrated by comparing the average measurements of the control group and the treatment group . CONCLUSION This study demonstrated that the use of automated text message reminders sent from an orthodontic office was effective in improving oral hygiene compliance in orthodontic patients Objectives This study aims to determine the effectiveness of a messaging app ( WeChat ) in improving patients ’ compliance and reducing the duration of orthodontic treatment ( DOT ) . Material s and methods A r and omized controlled trial was performed in a dental hospital and a clinic from August 2012 to May 2015 . Orthodontic patients were included at the beginning of treatment . Patients with multiphase treatment or braceless technique were excluded . Participants were r and omized to WeChat group ( received regular reminders and educational messages ) or control group ( received conventional management ) and were followed up until the treatment was completed . Primary outcome measure was DOT . Others were late and failed attendance , bracket bond failure , and oral hygiene condition . Results One hundred twelve patients in each group participated and completed the trial . DOT in WeChat group were 7.3 weeks shorter ( P = 0.007 ) . There were less failed attendance ( 3.1 vs. 10.9 % , P < 0.001 ) 
    Output:
    
The pooled SMD for the dental plaque index ( n = 10 studies ) was -9.43 ( 95 % CI -14.36 to -4.495 ; I2 = 99 % , p < 0.001 ) , and that of gingival bleeding ( n = 7 studies ) was -8.54 ( 95 % CI -13.16 to -3.91 ; I2 = 99 % , p < 0.001 ) , indicating significant improvement in dental plaque control and gingival bleeding for groups that received the mobile health ( mHealth ) strategy .
CONCLUSION mHealth can be used as an adjunct component in managing gingivitis , acquiring oral health knowledge and improving oral hygiene