***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 
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    Input: Sound evidence on the effectiveness of fluoride varnishes ( FV ) to reduce caries incidence  in preschool children is lacking . Objective : To assess whether the application of FV  in preschool children at 6-month intervals decreases the incidence of caries and produces any adverse effects . Methods : A r and omized , examiner- and patient-blind , placebo-controlled , parallel-group design , clinical trial , comprising 1- to 4-year-old children , 100 in each group ( FV or placebo varnish , PV ) , was conducted in Rio de Janeiro , Brazil . Two trained pediatric dentists performed the clinical examinations ( kappa = 0.85 ) . Dental caries was recorded at the d2 ( cavitated enamel ) and d3 ( dentine ) levels using the International Caries Diagnosis and Assessment System . Results : At baseline , the mean age of the participants was 2.4 years ( SD 0.9 ) and the mean d3mfs was 0.8 ( SD 1.9 ) . Most of the children brushed their teeth with fluoride toothpaste and consumed fluori date d tap water . After 24 months , 89 and 92 children of the test and the control groups were analyzed , respectively . A total of 32 ( 35.9 % ) children in the FV group and 43 ( 46.7 % ) in the PV group presented new dentine caries lesions ( χ2 test ; p = 0.14 ) , showing relative and absolute risk reductions of 23 % ( 95 % CI : -9.5 to 45.9 ) and 11 % ( 95 % CI : -3.5 to 25.0 ) . The mean caries increment differences between the test and control groups were -0.8 ( 95 % CI : -2.0 to 0.4 ) at the d2 level and -0.7 ( 95 % CI : -1.9 to 0.4 ) at the d3 level . Only 2 minor complaints regarding the intervention were reported . Conclusion : Although safe and well accepted , twice-yearly professional FV application , during 2 years , did not result in a significant decrease in caries incidence Objectives We tested a dental health program in remote Aboriginal communities of Australia 's Northern Territory , hypothesizing that it would reduce dental caries in preschool children . Methods In this 2-year , prospect i ve , cluster-r and omized , concurrent controlled , open trial of the dental health program compared to no such program , 30 communities were allocated at r and om to intervention and control groups . All residents aged 18–47 months were invited to participate . Twice per year for 2 years in the 15 intervention communities , fluoride varnish was applied to children 's teeth , water consumption and daily tooth cleaning with toothpaste were advocated , dental health was promoted in community setting s , and primary health care workers were trained in preventive dental care . Data from dental examinations at baseline and after 2 years were used to compute net dental caries increment per child ( d3mfs ) . A multi-level statistical model compared d3mfs between intervention and control groups with adjustment for the clustered r and omization design ; four other models used additional variables for adjustment . Results At baseline , 666 children were examined ; 543 of them ( 82 % ) were re-examined 2 years later . The adjusted d3mfs increment was significantly lower in the intervention group compared to the control group by an average of 3.0 surfaces per child ( 95 % CI = 1.2 , 4.9 ) , a prevented fraction of 31 % . Adjustment for additional variables yielded caries reductions ranging from 2.3 to 3.5 surfaces per child and prevented fractions of 24–36 % . Conclusions These results corroborate findings from other studies where fluoride varnish was efficacious in preventing dental caries in young children Early childhood caries , a serious health problem among young children , can be prevented with effective intervention . The aim of this study was to evaluate the efficacy of oral health education and a fluoride varnish in the prevention of caries in children under the age of 3 years . For this single-blind r and omized parallel group 1-year clinical trial in Shiraz , 300 children aged 12 - 24 months with sound primary teeth were selected and r and omly divided into three groups ( n = 100 ) : ( 1 ) control : no preventive intervention ; ( 2 ) oral health counseling , and ( 3 ) oral health counseling and fluoride varnish at baseline and 6 months later . At baseline and 4 , 8 and 12 months after the intervention , caries risk reduction was recorded as the primary outcome . The mothers ' knowledge and performance regarding oral health in children was used as a secondary outcome . A total of 260 children ( mean age : 20.49 ± 7.33 months ) completed the study . Compared to group 1 , caries risk reduction in group 2 was 28 % ( 95 % CI : -39.05 to -17.45 ) and 31 % in group 3 ( 95 % CI : -41.88 to -21.73 ) . However , there was no significant difference between groups 2 and 3 ( 95 % CI : -8.58 to 1.47 ) . In all groups , mothers ' knowledge and performance at baseline were low ; however , they increased significantly in follow-up appointments in groups 2 and 3 ( p < 0.001 ) . Oral health education  increased mothers ' knowledge and performance regarding oral health in children . Oral health counseling alone or associated with the use of fluoride varnish reduced the caries incidence in young children We conducted a parallel group r and omized controlled trial of children initially aged 2 to 3 y who were caries free , to prevent the children becoming caries active over the subsequent 36 mo . The setting was 22 dental practice s in Northern Irel and , and children were r and omly assigned by a clinical trials unit ( CTU ) ( using computer-generated r and om numbers , with allocation concealed from the dental practice until each child was recruited ) to the intervention ( 22,600-ppm fluoride varnish , toothbrush , 50-mL tube of 1,450 ppm fluoride toothpaste , and st and ardized , evidence -based prevention advice ) or advice-only control at 6-monthly intervals . The primary outcome measure was conversion from caries-free to caries-active states . Secondary outcome measures were number of decayed , missing , or filled teeth ( dmfs ) in caries-active children , number of episodes of pain , and number of extracted teeth . Adverse reactions were recorded . Calibrated external examiners , blinded to the child ’s study group , assessed the status of the children at baseline and after 3 y. In total , 1,248 children ( 624 r and omized to each group ) were recruited , and 1,096 ( 549 intervention , 547 control ) were included in the final analyses . Eighty-seven percent of intervention and 86 % of control children attended every 6-mo visit ( P = 0.77 ) . A total of 187 ( 34 % ) in the intervention group converted to caries active compared to 213 ( 39 % ) in the control group ( odds ratio , 0.81 ; 95 % confidence interval , 0.64–1.04 ; P = 0.11 ) . Mean dmfs of those with caries in the intervention group was 7.2 compared to 9.6 in the control group ( P = 0.007 ) . There was no significant difference in the number of episodes of pain between groups ( P = 0.81 ) or in the number of teeth extracted in caries-active children ( P = 0.95 ) . Ten children in the intervention group had adverse reactions of a minor nature . This well-conducted trial failed to demonstrate that the intervention kept children caries free , but there was evidence that once children get caries , it slowed down its progression ( EudraCT No : 2009 - 010725 - 39 ; IS RCT N : IS RCT N36180119 ) Objective : We aim ed to evaluate the efficacy of oral hygiene instruction , fluoride varnish and casein phosphopeptide-amorphous calcium phosphate ( CPP-ACP ) for remineralizing white spot lesions ( WSL ) , and the effect of these on the dmft index in primary teeth . Subjects and Methods : In this 1-year , r and omized clinical trial , 140 children aged 12 - 36 months with WSL in the anterior maxillary teeth were selected and r and omly divided into 4 groups of 35 children each . Group 1 ( control ) received no preventive intervention . In group 2 , there was oral hygiene and dietary counseling . In group 3 , there was oral hygiene and the application of fluoride varnish at 4 , 8 and 12 months after baseline . In group 4 , there was oral hygiene and tooth mousse was applied by the parents twice a day over a 12-month period . At baseline and 4 , 8 and 12 months after the intervention , the size of WSL in millimeters and the dmft index were recorded . One hundred and twenty-two children completed the study . Data were analyzed using the repeated- measures ANOVA test . Results : In group 1 , the mean percent WSL area and dmft index values had increased significantly at 12 months after baseline ( p < 0.001 ) . The interventions led to significant decreases in the size of the WSL ; the greatest reduction was in group 4 ( 63 % ) followed by group 3 ( 51 % ) and group 2 ( 10 % ) after 12 months . The smallest increase in the dmft index was in group 4 ( 0.17 ) , followed by groups 3 ( 0.3 ) and 2 ( 0.42 ) . However , there were no significant differences between the groups ( p < 0.001 ) . Conclusions : Oral hygiene along with four fluoride varnish applications or constant CPP-ACP during the 12- month period reduced the size of WSL in the anterior primary teeth and caused a small increase in dmft index values OBJECTIVE To measure the effectiveness of fluoride varnish ( FV ) ( Duraflor ) , 5 % sodium fluoride , Pharmascience Inc. , Montréal , QC , Canada ) and caregiver counseling in preventing early childhood caries ( ECC ) in Aboriginal children in a 2-year community-r and omized controlled trial . METHODS Twenty First Nations communities in the Sioux Lookout Zone ( SLZ ) , Northwest Ontario , Canada were r and omized to two study groups . All caregivers received oral health counseling , while children in one group received FV twice per year and the controls received no varnish . A total of 1275 , 6 months to 5-year-old children from the SLZ communities were enrolled . In addition , a convenience sample of 150 primarily non-Aboriginal children of the same age were recruited from the neighboring community of Thunder Bay and used as comparisons . Longitudinal examinations for the dmft/s indices were conducted by calibrated hygienists in 2003 , 2004 and 2005 . RESULTS Aboriginal children living in the SLZ or in Thunder Bay had significantly higher caries prevalence and severity than non-Aboriginal children in Thunder Bay .  FV treatment conferred an 18 % reduction in the 2-year mean ' net ' dmfs increment for Aboriginal children and a 25 % reduction for all children , using cluster analysis to adjust for the intra-cluster correlation among children in the same community . Adjusted odds ratio for caries incidence was 1.96 times higher in the controls than in the FV group ( 95 % CI = 1.08 - 3.56 ; P = 0.027 ) . For those caries-free at baseline , the number ( of children ) needed to treat ( NNT ) equaled 7.4 . CONCLUSIONS Findings support the use of FV at least twice per year , in conjunction with caregiver counseling , to prevent ECC , reduce caries increment and oral health inequalities between young Aboriginal and non-Aboriginal children The authors tested the effectiveness of a community-based , tribally delivered oral health promotion ( OHP ) intervention ( INT ) at reducing caries increment in Navajo children attending Head Start . In a 3-y cluster-r and omized trial , we developed an OHP INT with Navajo input that was delivered by trained Navajo lay health workers to children attending 52 Navajo Head Start classrooms ( 26 INT , 26 usual care [ UC ] ) . The INT was design ed as a highly personalized set of oral health – focused interactions ( 5 for children and 4 for parents ) , along with 4 fluoride varnish applications delivered in Head Start during academic years of 2011 to 2012 and 2012 to 2013 . The authors evaluated INT impact on decayed , missing , and filled tooth surfaces ( dmfs ) increment compared with UC . Other outcomes included caries prevalence and caregiver oral health – related knowledge and behaviors . Modified intention-to-treat and per- protocol analyses were conducted . The authors enrolled 1,016 caregiver-child dyads .  Baseline mean dmfs/caries prevalence equaled 19.9/86.5 % for the INT group and 22.8/90.1 % for the UC group , respectively . INT adherence was 53 % ( i.e. , ≥3 child OHP events , ≥1 caregiver OHP events , and ≥3 fluoride varnish ) . After 3 y , dmfs increased in both groups ( + 12.9 INT vs. + 10.8 UC ; P = 0.2 
    Output:
    
We conclude that FV showed a modest and uncertain anticaries effect  in preschoolers .