***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 objective of this research was to evaluate the anticaries effectiveness of a low-dose ( 500 ppm F , low-NaF ) sodium fluoride dentifrice , a high-dose ( 2,800 ppm F , high-NaF ) sodium fluoride dentifrice and an experimental 0.454 % stabilized stannous fluoride ( 1,100 ppm F ) with sodium hexametaphosphate ( SnF2-HMP ) dentifrice , each relative to a st and ard 1,100 ppm F sodium fluoride positive control dentifrice . Subjects ( n = 955 , with ∼239 per group ) with a mean age of 10.6 ( ∼9–12 years ) were r and omly assigned to one of four dentifrice treatments . Two calibrated examiners independently measured visual-tactile caries as DMFS that was supplemented with a radiographic examination at baseline , 12 months and 24 months for each subject . Generally similar results were independently observed by both examiners at the conclusion of the 2-year study period . Considering all subjects that attended at least 60 % of the supervised brushing sessions , statistically significantly less caries was observed in the high-NaF group compared to the control group . Similarly , statistically significantly less caries was observed in the SnF2-HMP group as compared to the control group . Differences in caries increments between the low-NaF and control groups were not statistically significant . One of the examiners observed these same statistically significant differences after 1 year . In conclusion , the results of this clinical trial indicated that while no difference in caries increments was observed between the low-NaF and control groups , both the high-NaF and the SnF2-HMP groups experienced significantly fewer lesions than the control group Background Extensive caries in children can result in a referral for tooth extraction under General Anaesthesia ( GA ) . While there are guidelines for the use of GA within paediatric dentistry this process is ultimately dependent upon the decision making of the treating dentist . This decision can be influenced locally by the availability of services and their waiting list . GA services for paediatric extraction s ( DGA ) have developed from different historical positions , including community dental services , maxillofacial services and paediatric led specialist services . Methods This article explores the differences between DGA services provided by 6 r and omly selected hospitals across the North West of Engl and . 456 patients who attended a routine DGA appointment in each hospital over a period of two months from 2012 to 2013 gave consent to allow access to their clinical notes  and completed a question naire ( 93 % consent rate ) . Data were entered onto SPSS and appropriate statistical tests undertaken . Results Differences between hospitals included the clinic structure , patient characteristics and the treatment provided . There was a significant difference in the number of previous child DGAs experienced within the family , ranging from 33 % to 59 % across hospitals . Hospital 1 attendees differed in a number of ways to other areas but notably in the stability of life time residency with 20 % of patients having previously lived in another area and with just 58 % of parents stating their child regularly attended the dentist ( compared to an average of 9 % and 81 % respectively across other hospitals ) . Conclusion Findings suggest services throughout the region face different obstacles in providing support and treatment for young children referred for DGA . There are , however common practice s such as preventative treatment , which could impact on caries experience and subsequent DGA referral , a particular issue given the high DGA repeat rate observed . For many children a DGA may be their first dental experience . It is therefore vital to engage with both child and family at this stage , attempt to initiate a pattern of dental attendance and to ensure this experience does not create an on-going cycle of poor dental behaviour and health The purpose of this study was to compare the effectiveness of toothbrushing followed by fluoride rinsing , fluoride gel brushing , or fluoride gel dentifrice brushing alone in controlling the demineralization that often follows orthodontic treatment . Seventy-eight consecutive adolescent patients undergoing orthodontic care were divided into 3 groups : group 1 ( control ) used a low-potency , high-frequency fluoride rinse ; group 2 used a high-potency , high-frequency fluoride brush-on gel ; and group 3 used a high-potency , high-frequency fluoride gel dentifrice . When pretreatment levels of demineralization were subtracted from posttreatment values , both gel groups displayed a significant difference ( P < .05 ) in smooth surface demineralization sites when compared to controls . Reversal of white-spot lesions occurred in 15 % of sites that exhibited pathology as a result of the fluoride and preventive regimen . These results indicate that a daily use of a 5000-ppm fluoride gel along with toothbrushing with a fluoride paste or brushing twice daily with a 5000-ppm fluoride dentifrice alone provides greater protection beyond that of tooth-brushing with a fluoride paste ( 1000 ppm ) and rinsing with a 0.05 % sodium fluoride rinse This study evaluated the dose-response relationship between four increasing levels of fluoride from 1000 to 2500 ppm F as sodium monofluorophosphate ( MFP ) and three-year dental caries increments , as measured by DMFS , DMFT , and DFS-A on 4424 schoolchildren . The results indicated consistent linear decreases in all three dental indices as the dose level increased to 2500 ppm F MFP , with slopes ( average reductions ) of 0.32 in DMFS for an increase of 1000 ppm F , 0.13 in DMFT , and 0.17 in DFS-A when all children were evaluated , p < 0.03 for each index . For children 11 years and older at baseline , the slopes quadrupled , p < 0.01 for each index . Age and baseline DMFS were shown to be the most important covariates to control for in the statistical models . No differences in adverse reactions , or other safety problems , were observed at the different dose levels In this double-blind caries study , 1160 Taiwanese children ( ages 8 - 15 ) completed a program using a test dentifrice containing 1.243 percent sodium fluoride and soluble pyrophosphates , or a control dentifrice without these agents . The average reduction of new carious tooth surfaces was 39 percent with the sodium fluoride dentifrice Conventional caries trials last from 24 to 36 months . This study evaluated whether the previously established difference in efficacy between 1000- and 2500-ppm-fluoride dentifrices could be detected after 12 months . Caries was assessed by clinical visual assessment ( CVA-simplified version of Dundee Selectable Threshold Method - DSTM ) ,  bitewing radiography , and Fiber Optic Transillumination ( FOTI ) . Changes in status for individual surfaces were classified by means of pre-prepared matrices as 0 ( unchanged ) , + 1 ( initiation or progression ) , or -1 ( regression ) and summed for each subject to yield an event score . Mean group event scores were calculated for each product . DSTM at the D1 [ enamel and dentin ] threshold showed significant inter-group differences in mean event scores ( p < 0.003 ) and D1MFS increment ( < 0.007 ) at 12 months ; these were confirmed at 24 months by traditional increment analysis ( CVA & FOTI at the D3 ( dentin only ) threshold + radiography , p < 0.03 ) . This study confirms the validity of an abbreviated trial protocol INTRODUCTION Dental caries , specifically decalcified white-spot lesions ( WSL ) , is a well-known side-effect of orthodontic treatment . The incidence of labial incipient caries lesions and its relationship with various patient and treatment variables was investigated in patients treated with comprehensive orthodontics .  METHODS R and omly selected orthodontic patient records ( n = 350 ) were examined to determine incipient caries lesion development . Labial surfaces on pretreatment and posttreatment photographs were scored with a st and ardized scoring system . Independent variables were collected by chart abstract ion . RESULTS The incidence of patients who developed at least 1 new WSL during treatment was 72.9 % , and this incidence was 2.3 % for cavitated lesions . Treatment duration was significantly associated with new WSL development ( P = 0.03 ) . Development of WSL and cavitated lesions increased ( both , P < 0.00 ) despite increased attention to oral hygiene during treatment . Sex , age , extraction therapy , and various fluoridation sources were not associated with WSL development , but initial oral-hygiene score was moderately associated ( P < 0.06 ) . CONCLUSIONS The incidence of WSL in patients treated with comprehensive orthodontics  was significantly high , and the preventive therapy provided appeared to be ineffective . This widespread problem is alarming and warrants significant attention from both patients and providers that should result in greatly increased emphasis on effective caries prevention There is a lack of clinical studies comparing dentifrices with high fluoride ( F ) concentration . The aim was to evaluate a dentifrice containing 5,000 ppm F compared to a dentifrice containing 1,450 ppm F in caries-active adolescents .  The design was a 2-year , single-blind r and omized controlled trial and 211 adolescents of 279 ( 76 % ) completed the trial . The subjects were divided into two groups and were given one of the assigned F dentifrices for daily unsupervised toothbrushing : ( 1 ) Duraphat 5,000 ppm F and ( 2 ) Pepsodent Superfluor 1,450 ppm F , both as NaF. The outcome variables were caries incidence and progression of proximal and occlusal caries . The subjects were asked to fill in a question naire to evaluate their compliance and they were divided into two subgroups : subgroup A , excellent compliance , and subgroup B , poor compliance . The latter group ( 28 % ) comprised the subjects who did not brush twice a day or did not use the dentifrice regularly . Adolescents using 5,000 ppm F toothpaste had significantly lower progression of caries compared to those using 1,450 ppm F toothpaste ( A : p < 0.01 , B : p < 0.001 ) , with a prevented fraction of 40 % . Subjects using 5,000 ppm F toothpaste had significantly lower caries incidence for compliance B compared to those using 1,450 ppm F toothpaste ( p < 0.05 ) ; the prevented fraction was 42 % . This may indicate that 5,000 ppm F toothpaste has a greater impact on individuals who do not use toothpaste regularly or do not brush twice a day . Thus , 5,000 ppm F toothpaste appears to be an important vehicle for caries prevention and treatment of adolescents with a high caries risk A three-year double blind clinical caries trial was undertaken to compare the anticaries efficacy of three types of active agent , namely sodium fluoride ( NaF ) , sodium monofluorophosphate ( SMFP ) and the combination of NaF plus sodium trimetaphosphate ( TMP ) , using two fluoride levels ( 1000 ppm F and 1500 ppm F ) . The prime objective of the study was to determine whether there was any difference in the anticaries efficacy between NaF and SMFP . The second objective was to assess the effect on caries protection of the incorporation of TMP into a NaF dentifrice formulation . The study was carried out to FDI protocol and involved 4,294 children aged 11 - 12 years at outset . These participants had been selected from a pool of 6,212 potential subjects on the basis of caries experience and dental eruption pattern . They were stratified by sex , examiner , presence of calculus and caries , and allocated at r and om to one of the six toothpastes under study . Clinical examinations were carried out at baseline and thereafter annually for 3 years . Bitewing radiographs of a subset of children were taken at baseline and at the end of the study . The outcome measure for the study , DMFS increment , was defined as the increase in caries over three years , taking into account changes occurring on individual tooth surfaces . After three years , clinical -only data for 3,517 children were available for the calculation of caries indices . The mean three-year DMFS increment for subjects using a dentifrice containing NaF alone was 6.4 per cent lower than for those using a dentifrice containing SMFP . The difference between the NaF+TMP users and the SMFP users was 8.1 percent . ( ABSTRACT TRUNCATED AT 250 WORDS OBJECTIVE To evaluate the effectiveness of daily tooth brushing with high-fluoride toothpaste on  white spot lesion ( WSL ) formation in adolescents during treatment with fixed orthodontic appliances ( FOA ) . MATERIAL S AND METHODS Four hundred and twenty-four healthy 11- to 16-year-old patients , referred to five Orthodontic Specialist Clinics , were r and omized to use either toothpaste containing 5000 ppm fluoride or regular toothpaste with 1450 ppm fluoride . To be eligible for inclusion , the patients had to be scheduled for bimaxillary treatment with FOA for an expected duration of at least 1 year . The primary and secondary outcome measures were prevalence and incidence of WSL , as registered from digital photos of the maxillary incisors , canines , and premolars taken before onset and immediately after debonding . The photos were evaluated separately by two blinded and calibrated clinicians using a 4-step score . A r and om sample of 50 cases was reassessed to check intra- and interexaminer reliability ( Kappa = 0.70 ; 0 
    Output:
    
Further research is required on the use of population - or community-based interventions using such products and currently , the evidence for dentifrices containing more than 2,900 ppm is weaker than for those containing 2,800 ppm or less