***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 / AIMS A simple in vivo approach to examine early dental plaque formation in the human mouth and to determine the effects of common dietary and oral hygiene procedures on biofilm formation is reported . METHODS A custom design ed device that fits securely behind the teeth of the m and ibular arch provides a surface for microbial colonization . This device is prepared with denture acrylic and can be repeatedly used by the subject , exposing a large and constant surface area for microbial accumulation . RESULTS Large numbers of oral bacteria colonized the device by 2 h ; these increased significantly by 4 h ( P < 0.05 ) . Bacterial colonization increased significantly after rinsing with a sucrose solution ( P < 0.05 ) but remained unaffected after rinsing with water , a commercially available fluoride mouthrinse without antimicrobial agents , or brushing with a fluoride dentifrice ( P > 0.05 ) . Rinsing with mouthrinses formulated with chlorhexidine , cetylpyridinium chloride or triclosan/copolymer significantly inhibited colonization ( P < 0.05 ) . A dose-dependent inhibition was noted with chlorhexidine rinses ( P < 0.05 ) . Brushing with a triclosan/copolymer dentifrice significantly inhibited microbial colonization compared with a control ( P < 0.05 ) . CONCLUSION This simple approach was useful for examining the effects of common dietary and oral hygiene procedures . Significant biofilm inhibitory effects were noted with formulations that demonstrated efficacy in previous clinical studies BACKGROUND Due to the side effects of chlorhexidine digluconate ( CHX ) mouthrinsing , a spray has been proposed as an alternative method of CHX delivery to the oral cavity . The aim of this study was to investigate the plaque inhibitory effects of CHX , cetylpyridinium chloride ( CPC ) , and triclosan ( TRN ) delivered by sprays and mouthrinses . METHODS The study was an observer-masked , r and omized cross-over design balanced for carryover effects , involving 15 healthy volunteers in a 4-day plaque regrowth model . Products being tested ( 0.2 % CHX , 0.12 % CHX , 0.05 % CPC , and 0.03 % TRN ) were used both as sprays and mouthrinses . A saline solution served as a negative control . On day 1 , subjects received professional prophylaxis , suspended oral hygiene measures , and commenced using their allocated products . On day 5 , subjects were scored for disclosed plaque . RESULTS CHX sprays ( P<0.01 ) were the most effective sprays in preventing plaque regrowth , without significant differences between the two concentrations tested ( P>0.05 ) . TRN spray showed a significant inhibition of plaque regrowth in comparison to the negative control ( P<0.05 ) . CPC spray did not differ from saline spray ( P>0.05 ) . A similar trend of efficacy was detected for rinses . Although the effect on plaque regrowth observed with CHX rinses was superior to that of CHX sprays ( P<0.0003 ) , the latter did not cause side effects ( P>0.2 ) . CONCLUSIONS These findings , together with those from clinical trials , suggest that the CHX-containing sprays may represent an effective alternative to CHX rinses when mechanical oral hygiene has to be avoided in restricted areas . On the contrary , the TRN and CPC sprays showed little or no plaque inhibitory effects BACKGROUND AND AIMS Cetylpyridinium chloride ( CPC ) mouth rinses have moderate plaque inhibitory activity when used alone but rarely have shown adjunctive benefits to tooth brushing with toothpaste . Several explanations for this apparent anomaly can be proferred , including loss of antiseptic activity due to interactions with toothpaste ingredients . The aim of this study was to measure the effect of toothpaste on the plaque inhibitory properties of a CPC mouth rinse using paired rinses of CPC , toothpaste slurry ( TP ) and water ( W ) . METHODS The study was a single blind , r and omised , seven-treatment , cross over design balanced for residual effects , involving 21 healthy , dentate subjects . The paired rinses were : W-CPC , CPC-W , TP-CPC , CPC-TP , W-TP , TP-W and W-W. Rinsing with solutions or slurries was done for 60 s twice per day . On day 1 , subjects were rendered plaque free , suspended tooth cleaning and commenced the allocated rinse regimen . On day 5 , plaque was scored by index . A 2(1/2 ) day wash out of normal oral hygiene was allowed between each regimen . RESULTS The order from lowest to highest plaque scores was as follows : W-CPC = CPC-W < CPC-TP < TP-CPC < or = W-TP < TP-W < W-W. Several differences in pairs of treatments were statistically significant , the most relevant of which were significantly less plaque with W-CPC compared to TP-CPC , TP-W and W-TP , and significantly more plaque with W-W compared to all other regimens except TP-W. CONCLUSIONS Toothpaste , whilst possessing some plaque inhibitory activity , when used immediately before a CPC mouth rinse adversely affected the plaque inhibitory action of this antiseptic . This in part may explain the reported lack of adjunctive benefits of CPC rinses to normal oral hygiene practice s and supports the suggestion , made for chlorhexidine rinses , that their use should follow toothpaste by at least 60 min PURPOSE To evaluate the effects of a novel mouthrinse containing 0.07 % high bioavailable cetylpyridinium chloride ( Crest Pro-Health Rinse ) on the development of gingivitis and plaque versus a placebo control over a period of 6 months . METHODS This was a r and omized , 6-month , placebo-controlled , parallel groups , double blind , single center clinical trial . One hundred thirty-nine generally healthy adults with mild-to-moderate gingivitis were enrolled in the study . Subjects were given Modified Gingival Index ( MGI ) , Gingival Bleeding Index ( GBI ) and Modified Quigley-Hein Plaque Index ( MQH ) examinations followed by a dental prophylaxis . Subjects were then r and omly assigned to either the cetylpyridinium chloride ( CPC ) rinse or placebo rinse and instructed to begin rinsing twice a day with 20 ml of their assigned mouthrinse for 30 seconds after brushing their teeth . Subjects were assessed for MGI , GBI and MQH scores after 3 and 6 months of product use . Oral hard and soft tissue examinations were also performed at all visits . RESULTS 124 subjects were evaluable at Month 3 and 119 at Month 6 . After 6 months , subjects rinsing with the CPC rinse showed 15.4 % less gingival inflammation , 33.3 % less gingival bleeding , and 15.8 % less plaque relative to the placebo group . All reductions were highly statistically significantly different ( P < 0.01 ) . Results were similar at 3 months . Both treatments were well-tolerated . CLINICAL SIGNIFICANCE This study demonstrates that the Crest Pro-Health 0.07 % CPC mouthrinse provided significant antiplaque and antigingivitis benefits when used twice daily for 6 months as an adjunct to toothbrushing PURPOSE To evaluate the effects of two experimental cetylpyridinium chloride ( CPC ) mouthrinses containing 0.075 % and 0.10 % CPC on the development of gingivitis and plaque versus a placebo control over a period of 6 months . METHODS This was a r and omized , single center , parallel group , double blind , positive and placebo controlled clinical trial . A 0.12 % chlorhexidine rinse served as the positive control for validation of the methodology . At the beginning of the trial , 366 subjects were balanced and r and omly assigned to treatment groups . Subjects received a dental prophylaxis and began rinsing twice a day with 15 ml of their assigned mouthwash for 30 seconds after brushing their teeth . Subjects were assessed for gingivitis and gingival bleeding by the Löe-Silness Gingival Index method and plaque by the Turesky modification of Quigley Hein Plaque Index at baseline and after 3 and 6 months of product use . Oral soft tissue health was also assessed . RESULTS After 3 and 6 months , subjects rinsing with either 0.075 % or 0.10 % CPC had significantly ( P < 0.0001 ) less gingivitis , gingival bleeding , and plaque , on average , than those on placebo . The 6-month mean reductions in gingivitis , gingival bleeding , and plaque for the 0.075 % and 0.10 % CPC rinses versus placebo were 23 % , 30 % and 17 % , and 20 % , 27 % and 19 % , respectively . There was no statistically significant difference in efficacy between the two CPC mouthrinses . Reductions at 3 months were similar to those seen at 6 months . Significant benefits were observed with chlorhexidine , thereby validating the study . CLINICAL SIGNIFICANCE This study clearly demonstrates that CPC mouthrinses formulated to deliver therapeutic benefits when used twice daily can significantly prevent the development of gingivitis , gingival bleeding , and plaque over a 6-month period A double-blind crossover trial on the effect of cetylpyridinium chloride 0.05 per cent ( Merocet ) on plaque To evaluate the relative efficacy of a non-degradable osmotic slow-release dosage form containing 6.6 mg cetylpyridinium chloride ( MOTS [ Mucosal Oral Therapeutic System ] CPC ) to inhibit new plaque formation and gingivitis , a single-blind , r and omised , parallel group pilot study was set up . 52 healthy volunteers were assigned to receive one of the following treatments for 18 days of non-brushing : holding 1 MOTS CPC 2 x daily for 2 h intra-orally , or rinsing 30 s with 15 ml Peridex 2 x daily , or dissolve Cepacol ( each 1.6 mg CPC ) lozenges 2 x daily unsupervised . Before the test period , the subjects received a thorough tooth cleaning followed by tooth polishing 1 x a week for 3 weeks to achieve clinical gingival health . After the start of therapy , the subjects were examined at day 4 , 7 ( + /- 2 ) , 14 ( + /- 2 ) and 18 ( 2 + /- ) . Relative efficacy was assessed by the modified Navy plaque index , the Quigley and Hein index , the planimetric plaque index , as well as the papillary marginal gingival index . There was an increase in both plaque formation and gingivitis over the 18 + /- 2 day period of nonbrushing for all subjects in the study . Peridex was the most effective in inhibiting plaque and gingivitis formation over that period of time . There was no difference between MOTS CPC and Cepacol at any time point in plaque accumulation and gingivitis intensity . Peridex was considered more convenient than MOTS CPC . Cepacol result ed in more staining at 18 days than MOTS CPC and Peridex The effect of a degradable controlled release system containing cetylpyridinium chloride ( CPC ) on plaque accumulation and gingivitis was evaluated when applied on the anterior teeth of volunteers ( 16 - 17 years ) over 4 weeks . At baseline , plaque index ( PI ) and gingival index ( GI ) of the Ramfjord teeth were measured in the experimental and placebo groups , including 23 and 21 participants respectively . Following scaling and root planning , the participants were instructed to brush , using one brush stroke , the film-forming solution on the buccal surface of the maxillary and m and ibular incisors , 1 x a day before bedtime . The applied active solution contained 9 mg of CPC ( approximately 80 mg of 11 % CPC solution ) , while the placebo solution was identical in formation , but without the active agent . After 4 weeks , in the CPC-applied group , the recorded PI scores were 0.52 ( + /- 0.56 ) in the anterior area and 1.31 ( + /- 0.80 ) in the posterior area , whereas the corresponding areas in the placebo group reached 1.25 ( + /- 0.74 ) and 1.51 ( + /- 1.00 ) , respectively . The PI = 0 frequency in the buccal anterior surfaces after 4 weeks was 54.6 % ( + /- 38.7 % ) in the experimental group as compared with 21.9 % ( + /- 29.0 % ) in the placebo group ( p = 0.005 ) . In contrast to the anterior teeth , there was no significant difference between groups with respect to the PI scores in the non-applied posterior teeth . It may be postulated that the impressive 58 % inhibition of plaque accumulation at the site of application is the result of an increase of the substantivity of the CPC due to its incorporation in the film-forming degradable controlled release system The purpose of this single blind clinical study was to determine the effects of two commerical mouthwashes ( one containing cetylpyridinium chloride and domiphen bromide and the other containing only cetlypridinium chloride ) on existing plaque accumulations . A second purpose was to determine if a residual effect could be 
    Output:
    
The existing evidence supports that CPC containing mouth rinses , when used as adjuncts to either supervised or unsupervised oral hygiene , provide a small but significant additional benefit in reducing plaque accumulation and gingival inflammation