***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 purpose was to study differences in the  caries increment rate  as influenced by various sugars . The trial involved almost complete substitution of sucrose ( S ) by fructose ( F ) or xylitol ( X ) during a period of 2 years . There were no significant initial differences as to caries status between the prospect i ve sugar groups ; 35 subjects in the S-group , 38 in the F-group , and 52 in the X-group . During the entire study 10 subjects discontinued or were excluded . The clinical and radiographical observer error was reported and discussed . After 2 years the mean increment of decayed , missed and filled tooth surfaces was 7.2 in the S-group , 3.8 in the F-group , and 0.0 in the X-group . The weakness of the DMFS-index in not showing the development of new secondary caries and the increase in size of the lesions was overcome by expressing the caries activity in terms of indices showing the total quantitative and qualitative development . The results showed a massive reduction of the caries increment in relation to xylitol consumption . Fructose was found to be less cariogenic than sucrose . It was suggested that the non- and anticariogenic properties of xylitol principally depend on its lack of suitability for microbial metabolism and physico-chemical effects in plaque and saliva The aim of this study was to assess the modifying effect of oral hygiene , and the use of fluorides on  caries increment in children when frequency of meals , intake of sugars and prevalence of lactobacilli and S. mutans in the saliva were known . In 8- and 13-yr-olds it was possible to show that children with a low caries increment ( 0 - 2 surfaces ) had lower mean values for frequency of meals , daily sucrose consumption and prevalence of lactobacilli and S. mutans in the saliva than children with a high caries increment ( greater than or equal to 3 surfaces ) . There were higher mean values in the low caries-increment groups for toothbrushing frequency , use of fluori date d toothpaste and NaF-mouthrinse .  Gingival bleeding index ( GBI % ) was used as an objective measure of oral hygiene and revealed statistically significant differences between the two groups in both age groups ( P less than 0.05 , P less than 0.01 ) with the highest scores recorded in the high caries-increment groups . Using as discriminating variables number of meals/day , daily consumption of sucrose and other sugars and number of lactobacilli and S. mutans in the saliva , 77 % of the 8-yr-olds and 70 % of the 13-yr-olds were correctly classified with regard to net caries increment . If GBJ % , tooth-brushing frequency , use of fluori date d toothpaste and NaF-mouthrinse were included in the analysis another 4 % of the 8-yr-olds and 11 % of the 13-yr-olds could be correctly classified To characterize the extent and severity of coronal caries among older US adults and document their need for prevention interventions , we systematic ally review ed studies on coronal caries incidence , increment , and attack rate . We abstract ed six studies and calculated summary measures using a r and om-effects model ( 95 % confidence interval [ 95%CI ] ) . We tested for heterogeneity and identified associated factors by examining the correlation between outcome measures and baseline population risk and study characteristics . We re-calculated summary measures after adjusting outcomes that netted out examiner reversals . Incidence and increment varied significantly by study . Adjusting studies for netting out examiner reversals reduced heterogeneity significantly . Annual attack rate among adjusted North American studies was 1.4 surfaces per 100 surfaces ( 95%CI = 1.0–1.9 ) , or approximately 1 new carious surface per person per year . These rates are equal to or higher than those in children and indicate a need for caries-prevention services OBJECTIVE To assess the changes in levels of sugar consumption  and concommitant dental caries experience in Iraqi children in relation to United Nations Sanctions ( UNS ) on Iraq . METHODS Before and after UNS a selection of a r and om sample of school children aged 6 - 7 , 11 - 12 and 14 - 15 years of two urban socio-economic groups ( Urban 1 and Urban 2 ) and seven rural communities was done . A total sample of 3,015 and 2,977 individuals were dentally examined before and after UNS , using the WHO dmft/DMFT indices . RESULTS  Sugar consumption dropped from 50 kg/person/year before UNS to 12 kg/person/year after UNS . The dmft for 6 - 7 year old Urban 1 and Urban 2 children was respectively 6.5 and 8.8 before and 3.3 and 4.6 after UNS . For 6 - 7-year-old rural children the dmft was 1.9 before and 0.7 after UNS . For 11 - 12-year-old Urban 1 and Urban 2 children the respective DMFT was 5.4 and 8.7 before and 2.5 and 2.9 after UNS . The DMFT levels for 11 - 12-year-old rural children were 1.3 before and 0.5 after UNS . For 14 - 15-year-old children the DMFT for Urban 1 and Urban 2 children was 5.9 and 10.7 before and 2.7 and 2.9 after UNS , whereas in 14 - 15-year-old rural children it was 1.8 before and 0.9 after UNS . CONCLUSIONS Reductions in sugar availability due to sanctions was related to marked caries reductions in Iraqi children over a 5 year period The  dental health  of children in western countries has improved without a concomitant decrease in the mean sucrose consumption . Our aim was to analyse the association of long-term sucrose consumption with dental health in children representing the highest ( n = 33 , 18 boys ) and the lowest 5 percentiles ( n = 33 , 21 boys ) of sucrose intake , in a study where food consumption was prospect ively recorded from infancy to 10 years of age . The sum of decayed , missing and filled teeth in the primary ( dmft ) and permanent ( DMFT ) teeth was assessed .  Children ’s  sucrose intake in the high intake group was constantly higher than in their counterparts ( p < 0.001 ) , and already exceeded 10 % of energy intake ( E % ) at 2 years of age . The mean ± SD of the dmft + DMFT scores was higher in the high than in the low sucrose intake group ( 3.9 ± 3.9 and 1.9 ± 2.5 , respectively ; p = 0.032 ) . We conclude that a persistently  high sucrose intake increases the risk of dental caries in children OBJECTIVES As data on the association of sugar consumption and dental caries in the industrialized countries give mixed results , we prospect ively studied this association in 135 healthy Finnish children ( 71 boys , 64 girls ) . METHODS The dental health and oral hygiene of the children was first examined at the mean age ( + /-SD ) of 37.4 ( + /-2.1 ) months and again at 73.7 ( + /-2.6 ) months . On both occasions the parents were interviewed about the child 's sweet intake and toothbrushing habits , and sucrose consumption was analyzed using 4-day food diaries . RESULTS The proportion of children with caries experience , enamel and dentin lesions combined , increased from 16 % to 40 % . Daily sucrose intake of children who developed caries by 6 years of age , whether expressed as absolute ( g ) or as relative ( E% ) amounts , was already higher at 3 years of age than that of children who stayed caries-free ( P<0.05 and P<0.03 , respectively ) . Furthermore , children who used sweets more than once a week at 3 years of age , consumed more sucrose 3 years later ( P<0.01 ) than those who used sweets once a week or less . The proportion of children with a combination of a sweet intake more than once a week and visible plaque , increased ( P<0.05 ) during the follow-up . The risk ratio of children with the combined risk habit at 3 years of age to develop carious lesions by 6 years of age was 1.7 compared to the rest of the children ( 95 % confidence interval 0.9 - 3.0 ) . CONCLUSIONS We conclude that the manifestation of dental caries at 6 years of age seemed to be associated with a higher daily sucrose intake that had started already at 3 years of age . Moreover , a combination of sweet intake more than once a week and visible plaque at 3 years of age may be predictive of dental health 3 years later 
    Output:
    
The findings are relevant to minimizing caries risk throughout the life course