***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: There is ample evidence documenting that simultaneous use of several fluoride application techniques results in an enhanced cariostatic effect . A formula is presented which estimates the combined cariostatic efficacy of such multiple usage . For simultaneously applied topical fluorides , the formula seems to overestimate the combined efficacy . Both higher frequency of use and higher concentration result in increased topical fluoride efficacy . Within narrower limits , higher concentrations of fluoride in water or salt also enhance efficacy . The rapid and substantial decline of caries prevalence in some highly industrialized countries may , in part , be attributed to multiple fluoride usage , but other factors must also have exerted a beneficial effect Although the efficacy of school-based preventive programmes is well established , their effectiveness under conditions prevailing in the community require further exploration . A longitudinal study was conducted to assess the community effectiveness of two school-based caries preventive programmes .  A group of 150 primary school pupils , 10 - 15 years old were r and omly selected from each of three primary schools ( Dagbreek , Vergesig , De Villiers ) in the Bol and town of Robertson . The sample comprised 75 10 - 12 year-olds and 25 in each of the 13 , 14 and 15 year age groups . The 75 ( 10 - 12 year-olds ) constituted the experimental cohort , which was to be followed up over a period of 3 years and compared to the 13 - 15 year-olds , the control or baseline cohort . The experimental cohort in Vergesig was exposed to a daily toothbrushing programme with a fluoride dentifrice , the Dagbreek children were exposed to the same regimen plus a weekly 0.2 per cent fluoride rinse and the De Villiers cohort acted as a control group for contamination and co-intervention . The DMFT index ( WHO , 1987 ) was used as a caries measure . Dagbreek showed a reduction of 0.96 DMFT ( 14.2 per cent ) and Vergesig of 1.85 DMFT ( 24.5 per cent ) . The difference is attributed to a higher baseline DMFT at Vergesig . The weekly fluoride rinse did not confer any additional benefit . Although the caries reduction was lower than that generally found in clinical trials , the two intervention programmes were cost-effective Abstract A clinical trial was conducted in a non-fluori date d water , high-caries community in which school children ( average age = 13.04yr ) were r and omly assigned to one of four groups subjected to two different fluoride procedures . Clinical and radiographic examinations were conducted at baseline , 12 , 24 and 36 months . After 12 months , there was a small but significant rinse effect and a small gel effect which fell short of significance . The effects were additive , and subjects who received both forms of fluoride treatment experienced a 19 per cent reduction in decayed + filled ( DF ) surface increment . The pattern of incremental findings at the end of 24 months was similar to that at 12 months . Both gel and rinse effects were significant and of similar size ; subjects receiving both treatments experienced a 31 per cent reduction in DF surface increment . The incremental findings after 24–36 months 2 yr and 1 yr were similar . The effects were reduced relative to those seen at 24 months ; the gel effect was still statistically significant , but the rinse effect was not . Possible mechanisms underlying the treatment effects include deposition of CaF 2 and fluorapatite , and suppression of microbial flora UNLABELLED The piped water of Kuopio , Finl and , was fluori date d in 1959 . Owing to strong opposition by different civic groups , water fluoridation was stopped at the end of 1992 . OBJECTIVES The aim of this study was to examine the consequences of the discontinuation on dental health . METHODS In 1992 and 1995 , independent r and om sample s of all children aged 6 , 9 , 12 and 15 years were drawn from Kuopio and Jyväskylä , a nearby low fluoride town whose distribution of demographic and socio-economic characteristics was fairly similar to Kuopio 's . The total number of subjects examined was 550 in 1992 and 1198 in 1995 . Caries was registered clinical ly and radiographically by the same two calibrated dentists in both towns . RESULTS In 1992 , the mean DMFS values were lower in the fluori date d town for the two older age groups , the percentage differences for 12- and 15-year-olds being 37 % and 29 % , respectively . For the two younger age groups no meaningful differences could be found . In 1995 , the only difference with possible clinical significance was found in the 15-year-olds in favor of the fluori date d town ( 18 % ) . In 1995 , a decline in caries was seen in the two older age groups in the nonfluori date d town . In spite of discontinued water fluoridation , no indication of an increasing trend of caries could be found in Kuopio . The mean numbers of fluoride varnish and sealant applications decreased sharply in both towns between 1992 and 1995 . In spite of that caries declined . CONCLUSIONS These findings suggest that the decline of caries has little to do with professional preventive measures performed in dental clinics Many dental research ers have been expressing the response to treatment with anticariogenic agents  in terms of per cent reduction of caries incidence . Although they have found it desirable from time to time to calculate confidence limits and certain probabilities associated with true per cent reduction in caries incidence , they have not done so because they did not have access to any analytical tool for this purpose . Procedures for calculating confidence intervals associated with a single mean or difference between two means from normal distributions are commonly discussed in statistical texts , but a procedure for calculating a confidence interval associated with the ratio of two means from non-normal distributions with unequal variances is rarely considered . It is the purpose of this paper to make available to the research ers such a procedure . The procedure is based on asymptotic theory , which has application in our problems , since clinical comparisons of control and experimental regimens produce large sets of data 376 three-year old children were divided into four experimental groups and exposed to different combinations of preventive programs for a period of two years . All the groups were given the same basic prophylactic information . Additionally Group I received fluoride tablets ( FLUDENT ) for daily sucking twice a day plus a placebo dentifrice free of fluoride . Group II was given a fluoride dentifrice containing 0.025 % F , ( ACTA ) . Group III was given a placebo dentifrice plus fluoride varnish ( Duraphat ) twice a year . Group IV a fluoride dentifrice containing 0.025 % F ( ACTA ) plus fluoride varnish ( Duraphat ) twice a year . No statistically significant difference in caries increment during the two experimental years was found between the groups . A tendency to lower caries increment was found in Group IV , i.e. in the children using the low fluoride dentifrice and treated twice a year with fluoride varnish 751 14- and 15-year old children completed a 3-year , double-blind , caries preventive program . The effects of daily , supervised toothbrushing with an 0.76 % sodium monofluorophosphate dentifrice , rinsing with a 0.05 % sodium fluoride mouthrinse , and the combined effects of the two treatments were investigated . Both the dentifrice and mouthrinse reduced the incidence of dental caries , but their combined use at the same time had no greater effect than either used alone The study groups using a dentifrice and mouthrinse both containing fluorides , a dentifrice containing stannous fluoride and a mouthrinse containing sodium fluoride , or a mouthrinse containing sodium fluoride with a placebo dentifrice had a 20.7 % to 29.0 % lower DMF increment than the control group after 30 months . These differences were significant . The study groups using a dentifrice containing amine fluorides and a placebo mouthrinse , a mouthrinse containing amine fluorides and a placebo dentifrice , or a dentifrice containing stannous fluoride and a placebo mouthrinse had a 13.6 % to 22.4 % lower DMF increment than the control group . These differences were not statistically significant . There was no significant difference in effectiveness against caries between the use of the organic or inorganic fluoride products The purpose of this study was to evaluate the separate effect of fluoride dentifrice , fluoride mouthrinsing and fluoride varnish on approximal dental caries . All 252 13 - 14-yr-old children at an elementary school were selected at r and om and divided among four groups for a 3-yr longitudinal study . Group 1 received a fluoride dentifrice for home care and a fluoride mouthrinse once a week . Group 2 received a fluoride dentifrice for home care and a placebo mouthrinse once a week . Group 3 received a fluoride dentifrice for home care and a fluoride varnish once every 3 months . Group 4 received a placebo dentifrice for home care and a fluoride rinse once a week . Fluoride rinsing did not give any additional effect compared with placebo-rinsing when a fluoride dentifrice was used for home care . Fluoride varnish gave a significant caries reduction compared with fluoride rinsing A study to test the efficacy of two amine fluoride products in reducing the extent of  plaque and the  degree of gingivitis  was conducted with 6th- grade school children in Pensacola , Florida . The treatment regimens consisted of a daily supervised mouthrinse at school and the ad libitum home use of a dentifrice . Examinations were conducted at 12-week and 20-week intervals after the treatment had begun . There was no recognizable difference between the plaque and gingival reductions achieved with the use of the amine fluoride dentifrice or mouthrinse when compared either with their inorganic counterparts or with placebo treatment This report describes a clinical study carried out to compare the  cariesinhibiting effect of the unsupervised home use of a sodium-monofluorophosphate-calcium-carbonate-based toothpaste formulation 
    Output:
    
No other combinations of TFT were consistently superior to a single TFT .
REVIEW ER 'S CONCLUSIONS Topical fluorides ( mouthrinses , gels , or varnishes ) used in addition to fluoride toothpaste achieve a modest reduction in caries compared to toothpaste used alone .