***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 effects of a stabilized 0.454 % stannous fluoride dentifrice , currently marketed as Crest Gum Care , on supragingival plaque , gingivitis , gingival bleeding and oral soft tissue condition were studied in 328 adult male and female subjects who completed a six-month , double blind clinical study . Following initial examinations , subjects presenting with a minimum of five gingival bleeding sites received a thorough dental prophylaxis and were instructed to brush at least twice a day for three months with a commercially available fluoride dentifrice , packaged in such a way as to blind its identity to the study subjects . This constituted the three-month pre-test period . At the end of this period , subjects were again examined , given a second oral prophylaxis , and r and omly assigned to brush with one of the following dentifrices : 1 ) stabilized 0.454 % stannous fluoride , 2 ) 0.243 % sodium fluoride control , or 3 ) one of three experimental dentifrices . Subjects were instructed to brush their teeth as they normally would , at least twice a day for one minute per brushing . Follow-up examinations after three and six months of dentifrice use evaluated supragingival plaque , gingivitis , gingival bleeding , extrinsic tooth stain and oral soft tissue status . After six months , the stabilized stannous fluoride dentifrice significantly reduced gingivitis and gingival bleeding by 20.5 % and 33.4 % compared to the sodium fluoride control group . However , the stabilized stannous fluoride dentifrice group was not significantly different from the control dentifrice group with respect to supragingival plaque scores . As expected , accumulation of extrinsic tooth stain was greater in the stabilized stannous fluoride group than the control group . No unexpected nor clinical ly significant oral soft tissue health effects were associated with the use of the test dentifrices . The results from this clinical study demonstrate that over a six-month period , twice-daily use of a dentifrice containing 0.454 % stabilized stannous fluoride significantly reduced gingivitis and gingival bleeding , relative to a 0.243 % sodium fluoride control dentifrice This double-blind parallel- design clinical study compared the efficacy of a stabilized stannous fluoride dentifrice ( Crest Plus Gum Care ) , baking soda and peroxide ( NaF ) dentifrice ( Mentadent ) , and essential oil mouthrinse ( Listerine ) to a conventional NaF dentifrice ( Crest ) for the control of plaque , gingivitis and gingival bleeding over six months . Following an initial baseline examination and stratification , subjects received a complete oral prophylaxis and were distributed assigned test products . Following three and six months , subjects re-visited the clinic for examinations . Evaluations at baseline and at 3 and 6 months included soft tissue status . Löe-Silness gingivitis/gingival bleeding , Silness-Löe plaque and dental stain . Results subsequent to six months of product use were as follows : At six months , the stabilized stannous fluoride dentifrice was observed to produce statistically significant 17.5 % reductions in gingivitis and 27.5 % reductions in gingival bleeding relative to the NaF dentifrice . The combination of sodium fluoride dentifrice and essential oil mouthrinse produced statistically significant reductions of 7.4 % in gingivitis and 10.8 % in plaque as compared with the NaF dentifrice . The stabilized stannous fluoride dentifrice produced statistically significant reductions in both gingivitis ( 10.8 % ) and gingival bleeding ( 23.0 % ) relative to the combination of sodium fluoride dentifrice and essential oil mouthrinse . The baking soda and peroxide ( NaF ) dentifrice did not provide reductions in gingivitis , plaque or gingival bleeding as compared with the conventional NaF dentifrice . The stabilized stannous fluoride dentifrice provided statistically significant reductions in gingivitis as compared with the baking soda and peroxide dentifrice following six months of use , and both the essential oil mouthrinse and stabilized stannous fluoride dentifrice provided statistically significant reductions in gingivitis as compared with the baking soda and peroxide dentifrice following three months of use . These results support : 1 ) the efficacy of stabilized stannous fluoride dentifrice and the combination of sodium fluoride dentifrice and essential oil mouthrinse for the prevention of gingivitis ; 2 ) the superior activity of stabilized stannous fluoride dentifrice as compared with a combination of sodium fluoride dentifrice and essential oil mouthrinse for the control of gingivitis and gingival bleeding ; and 3 ) the lack of efficacy for baking soda and peroxide dentifrice for the control of  plaque , gingivitis and gingival bleeding  as compared with conventional fluori date d dentifrice A primary patient motivation for oral hygiene is effective cleaning . Dentifrice serves this function by including ingredients such as abrasives , surfactants , and specialized cleaning ingredients such as anticalculus agents . This introductory article aims to introduce professionals , educators , and research ers on the rationale behind the development of an improved cleaning dentifrice formulation , Crest Multicare Advanced Cleaning . This new dentifrice is based upon the application of an improved tartar control/cleaning ingredient that is a polymeric adjunct of a pyrophosphate anion commonly applied in tartar control and stain control whitening dentifrices . The polypyrophosphate anion , also referred to as sodium hexametaphosphate , produces superior activity and substantivity on oral surfaces as compared to both pyrophosphate and some other commonly used dental cleaning ingredients and cleaning/conditioning adjuncts . The increased activity and substantivity translate into significant improvements in the prevention of dental stains and supragingival calculus and in the non-abrasive removal of dental stains . This article describes the structure of polypyrophosphate as compared to the parent pyrophosphate molecule , the rationale for its improved chemistry , and , in particular , its tartar control chemistry . In addition , the fundamental mechanisms of calculus formation and inhibition are review ed . Lastly , a preliminary clinical study evaluating the improved efficacy of a polypyrophosphate dentifrice is described where the tartar control activity of the polypyrophosphate dentifrice is shown to be superior to that of a clinical ly established and marketed industry st and ard pyrophosphate dentifrice BACKGROUND AND AIMS R and omised , blind , controlled experimental gingivitis and home-use study protocol s are used to evaluate the efficacy of oral hygiene products . The present method ological study combined the two clinical trial design s to compare the preventive and therapeutic potentials of two toothpastes . MATERIAL AND METHODS The study was a parallel group , r and omised , double-blind design , initially involving 73 healthy dentate subjects . A 21-day experimental gingivitis protocol was combined with a 6-week ( 42 days ) home-use protocol . At baseline , modified gingival index ( MGI ) , gingival index ( GI ) and gingival bleeding ( GB ) were recorded . A dental prophylaxis was then performed . Subjects were allocated to either control fluoride or stannous fluoride toothpaste based on gender and GI . During the first 21-day period , subjects applied the allocated toothpaste , for 1 min twice a day , to a group of teeth in a plastic shield and brushed the remaining teeth with the same paste . From day 21 the shield was not placed , and subjects brushed all teeth with the toothpaste for 1 min twice per day up to day 42 . MGI , GB and a plaque index ( PI ) were recorded on days 21 and 42 . RESULTS Sixty-nine and 67 subjects completed to days 21 and 42 , respectively . For shielded teeth , PI , MGI and GB increased to day 21 and then after ceasing the use of the shield decreased to day 42 . At day 21 , PI favoured the stannous fluoride toothpaste , but differences did not achieve statistical significance for any parameter at days 21 or 42 . For unshielded teeth , there were no significant differences between the toothpastes for any parameter at either time point . CONCLUSION : The feasibility of combining two gingivitis clinical trial method ologies appears proven , and data on both the preventive and therapeutic chemical and mechanical efficacy of toothpastes can be obtained through such protocol s. Specifically from the present study and consistent with some other reports , the plaque inhibitory properties of the stannous fluoride product are limited and do not always translate into an antiplaque/antigingivitis effect The effects of stabilized 0.454 % stannous fluoride dentifrices on  supragingival plaque , gingival inflammation and gingival bleeding  were studied in 549 adult male and female subjects who completed a six-month , double blind clinical study . Following an oral prophylaxis , subjects were r and omly assigned to brush with one of the following dentifrices : 1 ) 0.454 % SnF2 stabilized with 2.08 % sodium gluconate , 2 ) 0.454 % SnF2 stabilized with 4.16 % sodium gluconate , 3 ) an experimental dentifrice , or 4 ) 0.243 % NaF control dentifrice . Follow-up examinations were conducted at 3 and 6 months . Compared to the control dentifrice at 6 months , stannous fluoride dentifrices stabilized with 2.08 % or 4.16 % sodium gluconate significantly reduced gingivitis by 18.8 % and 18.0 % , respectively . There were no statistically significant differences between the two stabilized SnF2 groups with respect to their beneficial effects on gingival health . Gingival bleeding was also reduced , relative to the control dentifrice , for both stabilized SnF2 dentifrices . However , these differences were not statistically significant at p=0.05 . The stabilized SnF2 dentifrices were not significantly different from the control dentifrice in their effects on supragingival plaque . No significant differences in adverse oral soft tissue effects were observed between the test and control groups . As expected , accumulation of extrinsic tooth stain increased in the stabilized SnF2 groups . However , the difficulty in removing accumulated dental stain was similar between the control and stabilized SnF2 dentifrices . Since use of SnF2 dentifrices has been reported to produce tooth stain , gingivitis examinations were done with and without custom-made tooth covers to evaluate the potential for examiner bias . Comparable gingivitis and gingival bleeding benefits were observed when the evaluations were conducted with or without the tooth covers . Results from this study support that 0.454 % stabilized stannous fluoride dentifrices can provide an important adjunct to the prevention and control of gingivitis when used in combination with regular personal oral hygiene procedures and professional care PURPOSE S To compare the oral malodor protection efficacy of a 0.454 % stannous fluoride dentifrice versus a negative control ( 0.243 % sodium fluoride ) using a sulfide monitor ( halimeter ) as the measurement . A secondary objective was to assess the effects of tongue brushing . METHODS This was a four-treatment , five-period , examiner-blinded , crossover , r and omized study . Healthy subjects who met the entrance criteria were enrolled into the study . A 5-day acclimation period , in which subjects brushed twice daily in their customary manner with a st and ard sodium fluoride dentifrice , occurred prior to baseline . After baseline halimeter measurements , subjects were r and omly assigned to one of four treatments ( SnF2 dentifrice groups , with or without tongue brushing ; negative control dentifrice groups , with or without tongue brushing ) based on baseline halimeter scores , age , and gender . Test products were used three times a day . Breath measurements were taken 24 hours after baseline ( after three product uses ) . Subjects then brushed again with the product treatment . Final breath measurements were taken 4 hours later , 28 hours after baseline . A 5-day washout separated each treatment period . RESULTS 33 subjects were enrolled and completed the study . The adjusted mean volatile sulfur compound ( VSC ) levels were significantly lower in the SnF2 groups than the NaF groups , at both 24 ( P < 0.01 ) and 28 ( P < 0.001 ) hours post baseline time points . Tongue brushing did not provide additional statistically significant breath benefits when compared to toothbrushing alone . Both dentifrices were well tolerated This r and omized and controlled , examiner blind , parallel group study was undertaken to evaluate the efficacy of three commercial dentifrices on breath malodor . A total of 384 healthy adult subjects with oral malodor were r and omized to one of four brushing groups , using either an antimicrobial dentifrice containing 0.45 % stannous fluoride , an antitartar dentifrice containing 0.243 % sodium fluoride and 5 % pyrophosphate , an antimicrobial dentifrice containing 0.24 % sodium fluoride and 0.30 % triclosan/copolymer , or bottled distilled water which served as the negative experimental control . Breath quality was evaluated over a five-day period by second-person organoleptic grading and measurement of volatile sulfur levels . Following treatment , adjusted mean organoleptic scores and volatile sulfur levels were lowest for the stannous fluoride dentifrice group , with this group exhibiting superior breath quality compared to the negative control at three hours after a single brushing , and again at all cumulative use time points . While all test dentifrices showed some activity , only stannous fluoride had a second-person breath benefit . Breath effects for the other two dentifrices were limited to reductions in volatile sulfur levels at hours 99 and 104 for the antitartar sodium fluoride pyrophosphate dentifrice , and at hour 99 only for 
    Output:
    
Risk of bias was high for the studies on dental calculus , halitosis , and stain , and varied for the dental plaque and gingivitis studies .
Significant reductions in dental calculus and in halitosis were reported for the SnF2 dentifrice ; no differences in stain reduction were noted .
Conclusions The present review found that stabilized SnF2 toothpaste had a positive effect on the reduction of dental calculus build-up , dental plaque , gingivitis , stain and halitosis .
A tendency towards a more pronounced effect than using toothpastes not containing SnF2 was found .
Clinical relevance Adding a SnF2 toothpaste to the daily oral care routine is an easy strategy that may have multiple oral health benefits