***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 Dental caries is one of the most common diseases affecting children in Saudi Arabia despite the availability of free dental services . School-based dental screening could be a potential intervention that impacts uptake of dental services , and subsequently , dental caries ’ levels . The purpose of this study is to evaluate the effectiveness of two alternative approaches for school-based dental screening in promoting dental attendance and reducing untreated dental caries among primary schoolchildren . Methods This is a cluster r and omised controlled trial comparing referral of screened-positive children to a specific treatment facility ( King Saud University Dental College ) against conventional referral ( information letter advising parents to take their child to a dentist ) .  A thous and and ten children in 16 schools in Riyadh , Saudi Arabia , will be recruited for the trial . Schools ( clusters ) will be r and omly selected and allocated to either group . Clinical assessment for dental caries will be conducted at baseline and after 12 months by dentists using the World Health Organisation ( WHO ) criteria . Data on sociodemographic , behavioural factors and children ’s dental visits will be collected through structured question naires at baseline and follow-up . The primary outcome is the change in number of teeth with untreated dental caries 12 months after referral . Secondary outcomes are the changes in the proportions of children having untreated caries and of those who visited the dentist over the trial period . Discussion This project should provide high level of evidence on the clinical benefits of school dental screening . The findings should potentially inform policies related to the continuation/implementation of school-based dental screening in Saudi Arabia . Trial registration Clinical Trials.gov , ID : NCT03345680 . Registered on 17 November 2017 OBJECTIVE To assess the impact of oral health promotion integrated with a health promoting school ( HPS ) initiative on the oral health outcomes of secondary school students . MATERIAL S AND METHOD Using an urban-rural stratified cluster r and omized approach , the intervention was applied to secondary school students in Arusha , Tanzania . In the urban , three control ( n = 315 ) and two intervention ( n = 214 ) schools performed oral clinical examination and question naires at baseline . In rural the corresponding figures at baseline were two ( n = 188 ) and three ( n = 360 ) schools . After 2 years , 374 and 358 students remained in the intervention and control arms . RESULTS Mean number of decayed teeth ( DT ) increased in the intervention ( mean score 1.0 vs 1.7 , p < 0.001 ) and control schools ( mean score 1.2 vs 1.7 , p < 0.001 ) . Mean number of teeth with plaque decreased significantly in intervention and control schools . No significant difference in caries increment and plaque decline scores was observed between groups . Mean number of teeth with bleeding decreased ( 0.5 vs 0.3 , p < 0.05 ) in intervention schools , whereas no change was observed in the control schools ( 0.4 vs 0.5 , p = 0.051 ) . Increment in mean number of DT between baseline and follow-up was largest and smallest in students who , respectively , deteriorated and improved their plaque and bleeding scores . CONCLUSION The intervention activities did not show any effect with respect to dental caries , calculus and plaque status among the students investigated . Compared with the control group , more favorable changes in the intervention group occurred with respect to bleeding on probing , suggesting a weak but positive effect on students ' oral hygiene status INTRODUCTION Many low-income parent/caregivers do not underst and the importance of cavity-free primary ( baby ) teeth and the chronic nature of dental caries ( tooth decay ) . As a consequence , dental preventive and treatment utilization is low even when children are screened in schools and referred for care . This study aims to test a referral letter and Dental Information Guide ( DIG ) design ed using the Common-Sense Model of Self-Regulation ( CSM ) framework to improve caregivers ' illness perception of dental caries and increase utilization of care by children with restorative dental needs . METHODS A multi-site r and omized controlled trial with caregivers of Kindergarten to 4th grade children in urban Ohio and rural Washington State will compare five arms : ( 1 ) CSM referral letter alone ; ( 2 ) CSM referral letter+DIG ; ( 3 ) reduced CSM referral letter alone ; ( 4 ) reduced CSM referral letter+DIG ; and ( 5 ) st and ard ( control ) referral . At baseline , children will be screened at school to determine restorative dental needs . If in need of treatment , caregivers will be r and omized to study arms and an intervention packet will be sent home . The primary outcome will be dental care based on a change in oral health status by clinical examination 7 months post-screening ( ICDAS sealant codes 1 and 2 ; restoration codes 3 - 8 ; extraction ) . Enrollment commenced summer 2015 with results in summer 2016 . CONCLUSION This study uses the CSM framework to develop and test behavioral interventions to increase dental utilization among low-income caregivers . If effective this simple intervention has broad applicability in clinical and community-based setting OBJECTIVES It has been suggested that changes in the distribution of dental caries mean that targeting high-risk groups can maximize the cost effectiveness of dental health programs . This study aim ed to assess the effectiveness of a targeted school-based dental screening program in terms of the proportion of children with dental care needs it identified . METHODS The target population was all children in junior and senior kindergarten and grade s 2 , 4 , 6 , and 8 who attended schools in four Ontario communities . The study was conducted in a r and om sample of 38 schools stratified according to caries risk .  Universal screening was implemented in these schools . The parents of all children identified as having dental care needs were sent a short question naire to document the sociodemographic and family characteristics of these children . Children with needs were divided into two groups : those who would and who would not have been identified had the targeted program been implemented . The characteristics of the two groups were compared . RESULTS Overall , 21.0 percent of the target population were identified as needing dental care , with 7.4 percent needing urgent care . The targeted program would have identified 43.5 percent of those with dental care needs and 58.0 percent of those with urgent needs . There were substantial differences across the four communities in the proportions identified by the targeted program . Identification rates were lowest when the difference in prevalence of need between the high- and low-risk groups was small and where the low-risk group was large in relation to the high-risk group . The targeted program was more effective at identifying children from disadvantaged background s. Of those with needs who lived in households receiving government income support , 59.0 percent of those with needs and 80.1 percent of those with urgent needs would be identified . CONCLUSIONS The targeted program was most effective at identifying children with dental care needs from disadvantaged background s. However , any improvements in cost effectiveness achieved by targeting must be balanced against inequities in access to public health care re sources Objective To obtain consensus amongst a sample of primary care dentists in the North West of Engl and on a set of clinical criteria that should trigger referral following school dental screening . Design Delphi process . Setting Primary dental care , Engl and 2002 Method Primary care dentists in the North West of Engl and were r and omly selected to complete a two round ' Delphi exercise ' that included 10 potential referral criteria . The dentists were invited to express their level of support for the inclusion of each referral criterion . Main outcome measures Level of agreement for each referral criterion . Acceptance of any criterion was that the interquartile range should be no more than 3 scale points with the lower value being no less than 7 . Results Eighty-eight dentists , ( 72.7 % ) , completed the Delphi exercise . Six referral criteria met with the groups ' approval : Child with caries in permanent dentitionChild with darkened/discoloured permanent incisorsChild aged 9 - 10 years with overjet greater than 10 mmChild over six years with either gross plaque , calculus or swollen gumsChild with evidence of sepsisChild registered with a GDP with caries in permanent dentition . Conclusion It is possible for a representative sample of primary care dentists in the North West to agree referral criteria following school dental screening Background Recent studies have cast doubt on the effectiveness and efficiency of school based dental screening programmes in improving dental attendance or improving dental health . In 2002 the National Dental Inspection Programme was introduced in Scotl and which categorises children by their dental health and informs parents of the findings via a personalised letter home and encourages dental registration . In addition , epidemiological data for local and national planning purpose s is collected . This replaced an earlier school screening system in Lothian where a generic letter urging registration was sent to children who were identified as not being registered with a dentist . The objective of this study is to compare dental registration s rates among unregistered children in these two school inspection systems with a system where letters were sent home but no dental inspection was carried out . Methods The study was design ed as a single blinded , cluster r and omised , controlled trial involving 12,765 12–13-year-old children attending all 65 state Secondary schools in Lothian and Fife during the academic year 2003/4.After stratifying for school size and range of social deprivation , schools were r and omly allocated to one of four groups:1 . ' Traditional ' inspection , letter to unregistered children only,2 . Letter sent home to unregistered children only , no inspection,3 . National Dental Inspection Programme , letter to all children,4 . Control group in which the children were neither inspected nor sent a letter .  Dental Registration status was compared at baseline and 3 months post inspection . Results The registration levels in both the ' Traditional ' screening and the NDIP inspection groups rose 3 months post inspection ( 14 % and 15.8 % respectively ) but were not significantly different from one another or the control group which rose by 15.8 % ( p > 0.05 ) . The group who were sent a letter home but were not inspected also has a rise in registration levels of 18.1 % which was not significantly different from either of the groups who were inspected or the control group ( p > 0.05 ) . The only significant predictors of registration were previous registration ( p < 0.05 ) and within those who previously registered , the length of time since last registration ( P < 0.001 ) . Conclusion Neither of the two dental inspection methods nor a letter home to unregistered children result ed in a significant rise in registration rates in 12–13-year-olds compared to a control group of children who received no intervention Background Poor response rates can jeopardise the validity of the findings of epidemiological surveys . The aim of this study was to undertake a r and omised controlled trial to determine the effectiveness of different strategies for maximizing parental consent rates for dental health surveys of young children . Methods The trial took place within the 2007/2008 NHS Epidemiological Dental Health Survey of 5-year-old children in the North West of Engl and . Schools were r and omised to one of five interventions : multiple letters to parents ; promoting the research by providing additional information to parents and children ; a financial incentive to the school ; a financial incentive to the school administrator plus direct mailing to parents ; and a control intervention comprising of usual practice , that is a single letter home to parents via the children . Results A total of 335 schools ( 11,088 children ) were recruited . The mean percentage consent rates ranged from 47 % ( financial incentive to school administrator plus direct mailing ) to 63 % ( multiple letters ) . Pair-wise comparisons indicated that the multiple letter group had a statistically significantly greater consent rate than the financial incentive to the school administrator plus direct mailing group and promoting the research by providing additional information group , but was not statistically significantly different from the financial incentive to the school group and the control group . Conclusions There was little evidence to show that any of the five interventions made a significant difference to consent rates when compared to the control group . Financial incentives to schools were less effective than multiple reminder letters to parents . Trials should be built into surveys to test different interventions , in different context s to exp and the evidence base for improving consent rates in health surveillance programmes Objective To determine dental attendance and treatment outcomes following two models of dental screening . Design An observational prospect i ve cohort study . Setting Infant , primary and junior schools in the North West of Engl and .Subjects Children aged six to nine years at the start of the study . Interventions Subjects received a screening examination according to either a ' Traditional model ' or ' New model ' of school dental screeningMain outcome measures Attendance at a dentist within four months of the intervention and treatment received by children referred via the ' New model  ' with caries in their permanent teeth . Results In the ' New model ' of school dental screening 46 % of screened positive and 41 % of screened negative children attended a dentist during the study period . Some 44 % of children referred with caries in permanent teeth attended a dentist and 53 % of those attending received treatment for the referred condition . Larger proportions of children from disadvantaged background s were screened positive but higher proportions of children from more affluent background s attended the dentist and subsequently received treatment . Conclusion School dental screening has a minimal impact on dental attendance and only a small proportion of screened positive children receive appropriate treatment . The programme fails to reduce inequalities in utilisation of dental services One-hundred and twenty-five families in the Medicaid Early Periodic Screening , Diagnosis and Treatment Program were assigned to one of five treatments to encourage parents to obtain health care service following the dental screening of their children : ( a ) a control procedure , in which parents were given a dentist 's name ; ( b ) a multiple contact procedure , in which parents received a postcard and two telephone call reminders ; ( c ) a problem-solve procedure , in which a social worker aide conducted a brief session with 
    Output:
    
We found very low certainty evidence that was insufficient to allow us to draw conclusions about whether there is a role for traditional school dental screening in improving dental attendance .
For criteria -based screening , we found low-certainty evidence that it may improve dental attendance when compared to no screening .
However , when compared to traditional screening there was no evidence of a difference in dental attendance ( very low-certainty evidence ) .We found low-certainty evidence to conclude that personalised or specific referral letters improve dental attendance when compared to non-specific counterparts .
We also found low-certainty evidence that screening supplemented with motivation ( oral health education and offer of free treatment ) improves dental attendance in comparison to screening alone .
We did not find any trials addressing cost-effectiveness and adverse effects of school dental screening