***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 topical ketorolac tromethamine mouthrinse ( 0.1 % ) on gingival crevicular fluid ( GCF ) prostagl and in E2 ( PGE2 ) concentrations were investigated in a 6-week , r and omized , double-blind , placebo-controlled , parallel group , single center study of 42 patients with moderately advanced chronic adult periodontitis . Following screening , GCF was sample d from 6 sites per subject with filter paper strips and PGE2 levels measured using an enzyme immunoassay kit . Only those subjects with mouth median GCF PGE2 concentrations > 30 ng/ml entered the rinsing phase . Eligible subjects were allocated placebo rinse in the first 2-week period ( days 0 through 14 ) , either ketorolac rinse ( test group , n = 21 ) or placebo rinse ( control group , n = 21 ) in the second 2-week period ( days 14 through 28 ) , and placebo rinse in the third 2-week period ( days 28 through 42 ) . Full mouth median GCF PGE2 concentrations were calculated for each subject at days 0 , 14 , 28 , and 42 , and group means were compared . From day 0 to day 14 , no significant changes in GCF PGE2 concentrations were detected in either study group ( P > 0.05 ) . Utilizing mean GCF PGE2 concentrations at days 0 and 14 as covariates , no significant differences were observed in adjusted mean PGE2 levels at days 28 and 42 between the study groups ( ANCOVA , P > 0.05 ) . A statistically significant increase in GCF PGE2 levels was noted at days 28 and 42 in the placebo group ( P < 0.01 ) , but not in the ketorolac group ( P > 0.05 ) , when compared to baseline , however . GCF PGE2 levels were further studied in a subset of volunteers ( n = 11 ) during a 12-hour period following first rinsing with mouthrinse ( active or placebo ) at day 14 . GCF was sample d 0 , 2 , 4 , 6 , 8 , and 12 hours post-rinsing . Mean PGE2 levels were higher in the placebo subgroup than in the ketorolac subgroup , and increased gradually over the 12-hour period in both subgroups . These data indicate that 1 ) 14 days of rinsing with 0.1 % ketorolac mouthrinse controlled the elevation of GCF PGE2 observed in the placebo group but did not actually reduce GCF PGE2 concentrations and 2 ) changes in GCF PGE2 levels were not detectable in the 12-hour period following first rinsing with ketorolac BACKGROUND Plaque control is the main method for preventing periodontal diseases . Chlorhexidine digluconate mouthrinse is widely recognized as helping to maintain plaque control . Most of these mouthrinses contain alcohol , making them impractical for many patients , including those with oral mucosal hypersensitivity . Mouthrinses without alcohol might cause fewer side effects , but also be less efficient . In this study , we evaluated the efficacy of a 0.12 % chlorhexidine mouthrinse without alcohol against one with 11 % ethanol and a placebo . METHODS This a double-blind , parallel group study with 96 patients who tested 3 mouthrinses containing 1 ) chlorhexidine digluconate 0.12 % sodium fluoride 0.05 % , and ethanol 11 % ( group 1 ; CHX-A ) ; 2 ) the same solution without alcohol ( group 2 ; CHX-NA ) ; and a placebo ( group 3 ; P ) . Plaque and bleeding indexes were recorded in all patients prior to treatment and at 14 and 28 days . RESULTS There were significant differences in plaque , gingivitis , and papilla bleeding indexes in both chlorhexidine rinses compared to placebo , but no differences between the 2 CHX products . CONCLUSIONS In this study , the alcohol-free rinse was as effective as one containing alcohol in controlling plaque and reducing gingival inflammation . Therefore , it would seem that its use can be recommended in all patients , but especially in patients for whom the use of alcohol is contraindicated OBJECTIVE To compare measures of dry mouth following extended use of an alcohol-based mouthrinse ( LISTERINE Antiseptic [ LA ] ) and a non-alcohol-based mouthrinse ( Crest Pro-Health Rinse [ CPH ] ) on healthy adults with " normal " salivary flow . METHODS This single-site , r and omized , observer-blinded , parallel study compared unstimulated whole salivary flow and perceived dryness following daily use at weeks 4 and 12 versus baseline . Noninferiority , between-treatment flow comparisons ( 0.15 mL/min margin ) , and between-treatment comparisons of the mean Bluestone Mouthfeel Question naire ( BMQ ) visual analog scale scores were made using analysis of covariance . RESULTS Measures of dry mouth were comparable between mouthrinses , as demonstrated by both noninferiority of LA versus CPH flow ( P < .001 ) and no significant differences between groups in the BMQ measures at 4 or 12 weeks . CONCLUSIONS Extended use of an alcohol-based mouthrinse is no more likely to cause reduction in salivary flow or perceived dryness in individuals with normal salivary flow compared with a non-alcohol-based mouthrinse ( CPH ) OBJECTIVES To evaluate the efficacy of two alcohol-free antimicrobial mouthrinses in reducing  plaque and gingivitis  compared to an alcohol-containing rinse and toothbrushing alone . METHODS One hundred and sixty healthy volunteers were enrolled in the r and omized controlled trial . Participants were r and omly and equally assigned to four groups : ( i ) toothbrushing + rinsing ( 0.06 % CHX + 0.025 % NaF , alcohol-containing rinse , positive control ) ; ( ii ) toothbrushing + rinsing ( 0.06 % CHX + 0.025 % NaF , alcohol-free experimental rinse ) ; ( iii ) toothbrushing + rinsing ( 0.06 % CHX + 0.03 % CPC + 0.025 % NaF , alcohol-free experimental rinse ) ; ( iv ) toothbrushing alone ( negative control ) . At baseline , Quigley-Hein plaque index ( QHI ) , modified proximal plaque index ( MPPI ) , and papillary bleeding index ( PBI ) were recorded . All subjects brushed their teeth as usual during the study . Additionally , groups 1 - 3 rinsed twice daily . Eight weeks after baseline , indices were recorded again . anova with Bonferroni adjustment served for statistical analysis . RESULTS One hundred and fifty-five participants were included into final analysis ( i : n = 39 , 2 : n = 39 , 3 : n = 37 , 4 : n = 40 ) . Experimental rinses ( ii , iii ) reduced QHI and MPPI to a higher extent than the negative control ( iv ) , whereas no significant difference to the positive control was found . QHI : ( i ) 36.6 % , ( ii ) 32.3 % , ( iii ) 36.8 % , ( iv ) 21.6 % ; MPPI : ( i ) 11.9 % , ( ii ) 12.2 % , ( iii ) 13.6 % , ( iv ) 3.5 % . For PBI , no statistically significant difference was found between groups : ( i ) 80.2 % , ( ii ) 77.8 % , ( iii ) 76.5 % and ( iv ) 78.8 % . CONCLUSIONS With respect to QHI and MPPI , toothbrushing in combination with any rinse was more effective than toothbrushing alone . No statistically significant differences were found between the alcohol-free and the alcohol-containing control rinses BACKGROUND Non-alcoholic chlorhexidine mouthwashes are equally effective and have fewer potential risks than hydroalcoholic solutions . Nowadays , other active ingredients are added to these mouthwashes in an attempt to improve their effectiveness and reduce side effects . Following an experimental gingivitis model , this study examined three non-alcoholic commercial mouthwashes having 0.12 % chlorhexidine digluconate ( CHX ) in common . METHODS Using a double masked , cross-over design , 30 subjects underwent three consecutive experimental phases with  three mouthwashes : CHX , CHX + 0.05 % sodium fluoride ( CHXNaF ) , and CHX + 0.05 % cetylpyridinium chloride ( CHX-CPC ) . In each one of these 21-day phases , the subjects discontinued all oral hygiene measures and were treated exclusively with the experimental mouthwash r and omly assigned ( an oral rinse twice a day ) . Each experimental phase was preceded by a 14-day washout period . Levels of gingivitis , dental plaque , supragingival calculus , and dental staining were assessed at baseline and end ( day 21 ) of experimental phases . RESULTS The evolution of gingival and dental staining indices did not show statistically significant differences between the treatments . Differences were noticed in the plaque index ( P = 0.0002 ) , with CHX-NaF the treatment with the greatest increase . Differences were also observed in the supragingival calculus index ( P = 0.0136 ) , with CHX-CPC showing a smaller increase . Tongue staining was more frequent with CHX-CPC ( P = 0.0141 ) . CONCLUSION In non-alcoholic 0.12 % chlorhexidine mouthwashes , the addition of other active ingredients does not produce beneficial effects , but may even reduce the antiplaque effectiveness or increase tongue staining 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 , 
    Output:
    
Staining was time associated ; the longer the study , the higher its reported incidence and severity .
The most frequently reported adverse effect was teeth staining .