***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: OBJECTIVE To determine which  child-rearing practice s are associated with nursing caries . DESIGN Cross-sectional study . SETTING Hospital-based general pediatric clinic . PARTICIPANTS Sequential sample of 110 healthy children aged 18 to 36 months . OUTCOME MEASURES  Feeding practice s of children , limit- setting issues , and familial dental health were determined by maternal interview .  Nursing caries were diagnosed by dental examination . RESULTS Nursing caries were found in 22 ( 20 % ) of the children . Ninety percent of children with and without caries were bottle-feeding at 12 and 18 months of age . Ninety-one percent of children with caries and 84 % without were still drinking a nighttime bottle at 18 months ( P = .33 ) . The mothers of children with caries were found to have fewer years of education , 8.9 vs 10.8 years ( P = .02 ) , and were more likely to have eight or more cavities , 55 % vs 19 % ( P = .002 ) . More infants in the caries group had been breast-fed , 72 % vs 46 % ( P = .02 ) , although length of breast-feeding was similar , 5.4 vs 6.7 months . Fewer children with caries drank fluori date d tap water , 27 % vs 54 % ( P = .05 ) , but there were no differences in topical fluoride use , dental hygiene practice s , or visits to the dentist . CONCLUSIONS These findings fail to substantiate a straightforward relationship between child-rearing practice s and nursing caries and suggest that well- design ed prospect i ve studies are needed to clarify the etiology of early caries A ten-year longitudinal prospect i ve study compared the effect of fluoride on dentition of 1,500 children from infancy through age 10 years . In Kalamazoo , Mich , and Oneida , NY , parallel groups were given a fluoride-vitamin supplement from infancy and from age 4 and compared with fluori date d water and control groups . Incidence of new caries activity in both deciduous and permanent teeth was measured by mean number of new decayed and filled teeth , as well as percentage of children with no caries throughout the periods studied . Prevalence of caries was also studied in six-year molars . The results indicate a consistent ( and , for selected groups , a statistically significant ) diminution in caries activity for both deciduous and permanent teeth for groups ranked from greatest retardation of caries to least : infant fluoride group , water fluoride group , age 4 fluoride group , and controls As part of an educational program in preventive dentistry for family medicine residents , we evaluated changes in systemic fluoride prescribing habits related to newly acquired knowledge . Residents , unaware of the study , were r and omly assigned to one of two groups and shown a videotape describing preventive dental techniques . We supplemented the tape viewed by one group with specific instructions explaining the implementation of the information in patient care .  Residents in both groups demonstrated the ability to learn and maintain their level of knowledge during a three-month period . Daily chart audits , however , revealed no substantial increase in correct prescribing of systemic fluoride  to pediatric patients for either group . Only subsequent individual monitoring and reinforcement achieved the desired behavior . The acquisition of new knowledge by resident physicians under these circumstances did not lead to its application in daily patient care . This result parallels reported difficulties in altering physician behavior by continuing medical education , and suggests that residency programs are an appropriate setting to initiate improved physician performance in response to acquired knowledge The aim was to study the effect of substitution of invert sugar for sucrose , in combination with fluoride varnish ( Duraphat ) treatment twice a year , on caries development in preschool children . One hundred and eighty-seven 4-years-olds were divided r and omly into four sugar groups : ( 1 ) sucrose ( S ) , ( 2 ) sucrose-Duraphat ( SD ) , ( 3 ) invert sugar ( I ) , and ( 4 ) invert sugar-Duraphat ( ID ) . All families were asked to buy beverages , biscuits , breakfast cereals , marmalade , ice cream , jam , ketchup , sweets and table sugar , totally 32 different food items , sweetened with invert sugar or sucrose . The substitution was , thus , restricted to a number of sugar-rich between-meal products . The study was carried out double-blind for 2 years . The children of those parents who did not want to participate in the sugar groups were divided r and omly into one of the following two groups : ( 5 ) Duraphat ( D ) , and control ( C ) . Because of lack of cooperation , only 114 of the 187 children ( 61 % ) were considered to have completed the study . The mean caries increment , including initial lesions , was 3.86 dmfs in the combined groups S and SD ( n = 63 ) and 3.10 dmfs in the combined groups I and ID ( n = 51 ) during the 2 years ( p = 0.34 ) . The corresponding values for the 2nd year only were 1.84 and 0.67 dmfs , respectively ( p = 0.09 ) . The mean caries increment was 2.86 dmfs in group D ( n = 113 ) and 4.10 dmfs ( p = 0.08 ) in group C ( n = 93 ) . If initial caries lesions were excluded from the index , the difference between groups D and C was significant ( p = 0.008 ) . ( ABSTRACT TRUNCATED AT 250 WORDS OBJECTIVES This study sought to measure the effect of a community health education program on reported infants ' bottle-feeding practice s and infants ' toothbrushing behavior  , with or without distribution of toothpaste and toothbrushes . METHODS In this quasi-experimental comparison group design study conducted in mother and child health centers in Jerusalem , parents of 727 children were surveyed by telephone at baseline and six months later . The cohort of infants was aged 6 - 12 months at baseline . The program group received structured health education . The control group received no organized educational intervention . Within the program and control groups , half of the centers were r and omly given toothpaste and toothbrushes . RESULTS Parents ' reports revealed a secular 32.5 percent increase in toothbrushing for infants with no intervention , 45.1 percent for infants only receiving toothpaste and toothbrushes , 43.7 percent for infants only receiving the health education program , and a 60.4 percent increase for infants receiving health education together with toothpaste and toothbrushes ( chi-square , P = .0002 ) . Modification of bottle-drinking practice s , in this program , was unsuccessful . CONCLUSION The free distribution of toothpaste and toothbrushes , together with an oral health education program , is recommended as a potentially practical and effective method of promoting early oral hygiene practice OBJECTIVE To evaluate the caries-inhibiting effect of a fluoride drops program in two kindergartens in Chengdu , Sichuan Province , a fluoride-deficient area . METHODS For 3 years , participating children ingested in school 0.25 mg fluoride daily , in the form of drops for 2 to 3-year-olds and 0.5 mg for children age 3 years and older . These systemic fluoride supplements were made available for over 180 days each year and they were distributed by teachers who maintained attendance records . Annual examinations were conducted for 176 2-year-olds who had used the supplements in the kindergartens and 148 control children . After 3 years , 128 test and 112 control children remained in the study . RESULTS The results demonstrated a marked reduction in dental caries in the control group : test children had 2.21 decayed , missing , or filled teeth (DMFT)-versus 4.32 in the control group , a reduction rate of 48.84 % . The mean DMFT increments over the 3-year period were 1.76 and 3.92 , respectively . Over a 1- to 3-year period of supplement use , the group provided with the fluoride drops had consistently lower caries prevalence than the control group . The differences were statistically significant . CONCLUSIONS This treatment regimen demonstrated an effective caries-inhibiting effect BACKGROUND The aim of this study was to evaluate the effect of fluoride varnish on enamel caries progression in the primary dentition . METHODS One hundred forty-two children in Head Start schools ( 3 to 5 years old ) were r and omized into the varnish and control groups . Children in the varnish group received fluoride varnish ( Duraphat , Colgate-Palmolive Co. ) at baseline and after four months , and children in the control group received no professional fluoride applications . Two calibrated examiners performed the examinations at baseline and at nine months . RESULTS At nine months , the authors found that in the control group , 37.8 percent of active enamel lesions on occlusal , buccal and lingual surfaces became inactive , 3.6 percent progressed and 36.9 percent did not change . In the varnish group , 81.2 percent became inactive , 2.4 percent progressed and 8.2 percent did not change . The difference between the groups was statistically significant ( P < .0001 ) . The mean decayed surfaces , or ds , value in the varnish group was significantly lower after nine months than it was at baseline ( P < .0001 ) . When enamel lesions were included in the data analysis ( along with dentinal lesions ) , the decayed with initial enamel lesions , missing and filled surfaces , or dEmfs , values ; decayed with initial enamel lesions , missing and filled teeth , or dEmft , values ; and decayed surfaces with initial enamel lesions , or dEs , values were significantly lower in the varnish group after nine months than they were at baseline ( P < .0001 ) . CONCLUSIONS These results suggest that fluoride varnish applications may be an effective measure in reversing active pit- and -fissure enamel lesions in the primary dentition . CLINICAL IMPLICATION S Fluoride varnishes are safe , easy to apply and well-accepted by patients . This study shows that fluoride varnish may offer an efficient , nonsurgical alternative for the treatment of decay in children Results of a 1981 survey of r and omly selected primary care physicians with pediatric patients were compared with the results of a similar survey conducted in 1978 . In general , the 1981 survey respondents were more knowledgeable on the subject of fluoride and dental caries , had more positive attitudes about the effectiveness of fluoride supplementation , were more likely to prescribe fluoride supplements , and more closely followed the current guidelines for appropriate use of fluoride supplements . An intensive , multifaceted educational program on fluoride and childhood dental caries sponsored by the Wayne State University School of Medicine , Detroit , which started shortly after the first survey , may have contributed to these changes Abstract 705 children took part in a controlled trial in which they were given the vitamin A and D drops routinely supplied by Swedish child-welfare centres with or without a supplement of sodium fluoride . The children were examined by a dentist each year from the age of one to the age of six ( longer in some cases ) . At the third , fourth , fifth , and sixth examinations the mean number of decayed teeth was around 50 % lower in the fluoride group . It is recommended that fluoride be given in vitamin drops where the local fluoride content of drinking-water is below 0.6 p.p.m . Such a scheme could be voluntary . Other advantages would be simplicity and cheapness Summary A clinical study was conducted which included815 children between 18 and 39 months of age residing in three different fluoride-deficient communities . The children received chewable tablets containing vitamins , vitamins plus fluoride , or fluoride alone and were examined for dental caries initially and at 6 month intervals . The findings during the first two years of the 5 year study indicate that a significant reduction in the incidence of dental caries of about 37 per cent was observed after six months in the children ingesting either the fluoride or vitamin-fluoride supplements . This degree of protection increased to about 55 and 63 per cent , respectively , after the children had used the supplement for one and two years . No differences in efficacy were observed between the fluoride and vitamin-fluoride preparations . No toxicity related to the use of fluoride was encountered OBJECTIVE The aim of this two-year community demonstration trial was to study the caries inhibitory effects of semiannual applications of a fluoride varnish in preschool children . METHODS Twenty-four public dental health clinics in the county of Hall and , Sweden , with 5,137 preschool children , 4 and 5 years of age , were matched and equally allocated to a fluoride varnish group ( n = 2,535 ) and a reference group ( n = 2,602 ) . The children in the fluoride varnish group were treated every six months with topical applications of a silane fluoride varnish , Fluor Protector ( 0.1 % F ) , while no fluoride varnish was used in the reference group . Both groups received a basic preventive program at annual checkups consisting of dietary counseling and instructions to parents to brush their children 's teeth at least once daily with fluori date d dentifrice .  Caries data were collected by clinical examinations at baseline and after one and two years . RESULTS Caries prevalence at baseline did not differ significantly between the groups . After two years , the mean caries incidence was low and no statistical difference was found in the total number of carious and filled surfaces ( dfs ) between the two groups . However , the incidence of approximal lesions ( dfsa ) was significantly lower ( P < .05 ) in the fluoride varnish group than the reference group . Children 
    Output:
    
Evidence for the effectiveness of traditionally recommended primary care clinician interventions ( screening , referral , counseling ) to prevent dental caries in preschool children is lacking .
There is fair evidence for the effectiveness of two fluoride-based interventions ( fluoride supplementation and varnish ) applicable in primary care practice .
However , there is also fair evidence indicating that physicians ' consideration of fluoride exposure is incomplete , thus increasing the risk for fluorosis among those prescribed supplements