***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: OBJECTIVE To evaluate the oral health-related quality of life ( OHRQoL ) of children by dental caries and fluorosis status . METHODS A r and om sample of South Australian 8- to 13-year-old children was selected . Caries data were collected from school dental service records to group children by combined deciduous and permanent tooth caries experience . Children were examined for fluorosis using the Thylstrup and Fejerskov ( TF ) Index to form groups by fluorosis scores on maxillary central incisors . Occlusal traits were recorded using the Dental Aesthetic Index . Children and their parents completed the Child Perception Question naire ( CPQ ) and the Parental Perception Question naire ( PPQ ) and a global rating of oral health ( OH ) . OHRQoL indicators , rating OH as Excellent/Very good , and mean overall CPQ/PPQ scores were compared between groups by fluorosis scores and caries experience . Multivariate models were generated for both OH and CPQ/PPQ indicators . RESULTS Two hundred forty-two children ( 43.0 percent ) had 0 decayed , missing , and filled primary and permanent tooth surface ( dmfs/DMFS ) , while 170 ( 23.9 percent ) had 5 + dmfs/DMFS . The prevalence of TF scores 1 , 2 , and 3 were 14.5 , 9.5 , and 1.9 percent , respectively . The proportion of children/parents rating OH as Excellent/Very good was significantly associated with children 's caries experience . That proportion increased when fluorosis severity increased from a TF score of 0 to 2 , but decreased with a TF of 3 . Having low caries experience and better dental appearance were associated with parents ' perception of good OH . Having mild fluorosis and more acceptable appearance were significant factors for children 's perception of good OH . Caries and malocclusion were associated with lower OHRQoL , while having a TF score of 2 was associated with better OHRQoL in multivariate models for overall CPQ/PPQ scores . CONCLUSION Caries and less acceptable appearance showed a negative impact , while mild fluorosis had a positive impact on child and parental Two groups of children , initially in the first and second grade s , chewed , rinsed with , and swallowed an acidulated phosphate-fluoride tablet containing 1 mg of fluoride either once or twice a day in school . A control group of children followed the procedure once a day using a placebo tablet . An evaluation after six years of treatments showed that both the once-a-day and the twice-a-day procedures with fluoride tablets effectively reduced the incidence of dental caries A 6-yr double-blind study was undertaken to compare the caries inhibiting-effectiveness of ( a ) 1 mgF- tablets ( daily at school ) plus fortnightly rinsing at school with 1000 ppmF- ; ( b ) 1 mgF- tablets plus placebo rinsing ; and ( c ) placebo tablets plus 1000 ppmF- rinsing .  Participants were aged 4.5 - 5 yr at outset of the trial . At baseline , and annually thereafter , clinical caries and bitewing X-ray examinations were undertaken , hence ethical approval for a negative control was not feasible . Fissure sealant presence was also recorded . Initially , 192 children from predominantly low socio-economic background s were enrolled , and baseline analyses showed no significant differences between groups with respect to primary caries prevalence . After 6 yr , 112 children remained , by which time no significant differences were noted between DMFT and DMFS values for those in the active tablet/active rinse group , as compared to those in the placebo tablet/active rinse group . However , in relation to both indices , in permanent first molars , the effectiveness of the active tablet/placebo rinse regime appeared to be significantly poorer than the placebo tablet/active rinse programme . For the active tablet/active rinse group , the DMFT difference was significantly less than the active tablet/placebo rinse group ( 37.9 % ) , although for the DMFS difference , significance was not achieved . Similar trends were noted when DMFT and DMFS values for all permanent teeth were considered . The occlusal caries prevalence in permanent first molars followed the DMFT pattern , but differences between combined tablet/rinsing children and tablet-only children could be ascribed solely to the effectiveness of sealant presence . ( ABSTRACT TRUNCATED AT 250 WORDS OBJECTIVE To evaluate the caries-inhibiting effect of a fluoride drops program in two kindergartens in Chengdu , Sichuan Province , a fluoride-deficient area . METHODS For 3 years , participating children ingested in school 0.25 mg fluoride daily , in the form of drops for 2 to 3-year-olds and 0.5 mg for children age 3 years and older . These systemic fluoride supplements were made available for over 180 days each year and they were distributed by teachers who maintained attendance records . Annual examinations were conducted for 176 2-year-olds who had used the supplements in the kindergartens and 148 control children . After 3 years , 128 test and 112 control children remained in the study . RESULTS The results demonstrated a marked reduction in dental caries in the control group : test children had 2.21 decayed , missing , or filled teeth (DMFT)-versus 4.32 in the control group , a reduction rate of 48.84 % . The mean DMFT increments over the 3-year period were 1.76 and 3.92 , respectively . Over a 1- to 3-year period of supplement use , the group provided with the fluoride drops had consistently lower caries prevalence than the control group . The differences were statistically significant . CONCLUSIONS This treatment regimen demonstrated an effective caries-inhibiting effect Abstract 705 children took part in a controlled trial in which they were given the vitamin A and D drops routinely supplied by Swedish child-welfare centres with or without a supplement of sodium fluoride . The children were examined by a dentist each year from the age of one to the age of six ( longer in some cases ) . At the third , fourth , fifth , and sixth examinations the mean number of decayed teeth was around 50 % lower in the fluoride group . It is recommended that fluoride be given in vitamin drops where the local fluoride content of drinking-water is below 0.6 p.p.m . Such a scheme could be voluntary . Other advantages would be simplicity and cheapness Summary A clinical study was conducted which included815 children between 18 and 39 months of age residing in three different fluoride-deficient communities . The children received chewable tablets containing vitamins , vitamins plus fluoride , or fluoride alone and were examined for dental caries initially and at 6 month intervals . The findings during the first two years of the 5 year study indicate that a significant reduction in the incidence of dental caries of about 37 per cent was observed after six months in the children ingesting either the fluoride or vitamin-fluoride supplements . This degree of protection increased to about 55 and 63 per cent , respectively , after the children had used the supplement for one and two years . No differences in efficacy were observed between the fluoride and vitamin-fluoride preparations . No toxicity related to the use of fluoride was encountered Two groups of children initially in the first and second grade s chewed , rinsed with , and swallowed an acidulated phosphate-fluoride tablet containing 1 mg of fluoride either once or twice a day in school . A control group of children followed the procedure once a day using a placebo tablet . An interim evaluation after 55 months showed that the children receiving two fluoride tablets daily had a significant reduction in incremental caries on early erupting teeth , which received primarily topical exposure to the fluoride , as well as on late erupting teeth , which received mainly preeruptive , systemic exposure . The findings also suggested that the use of a single fluoride table daily may reduce dental caries , although the presence of a benefit was less definitive than it was for the two-tablet procedure 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 Incremental caries scores were determined after 30 months in this study involving elementary school children who use acidulated phosphate-fluoride tablets  containing 1 mg of fluoride either once or twice a day . Two groups of children initially in the first and second grade s chewed , rinsed with , and swallowed an acidulated phosphate-fluoride tablet either once or twice a day in school . A control group of children followed the procedure once a day using a placebo tablet . An interim evaluation after 30 months showed that the children receiving two fluoride tablets daily had a significant reduction in incremental caries on teeth that were present on the base-line examination and that , thus , were exposed only posteruptively to the fluoride Caries reduction and cost benefit after 3 years of sucking  fluoride tablets daily at school . A double-blind Children who received a chewable , acidulated phosphatefluoride tablet daily for two school years had a two to one advantage in caries reduction in the teeth erupting during the course of the study when compared to a control group This r and omized , double-blind study tested the caries-preventive efficacy of prenatal fluoride supplementation in 798 children followed until age 5 . Initially , 1,400 women in the first trimester of pregnancy residing in communities served by fluoride-deficient drinking water were r and omly assigned to one of two groups . During the last 6 months of pregnancy the treatment group received 1 mg fluoride daily in the form of a tablet and the control group received a placebo . Both treatment and control subjects were encouraged to use postnatal dietary fluoride supplements .  Caries was measured in children at age 3 and 5 while fluorosis was assessed at age 5 . Caries activity was very low in both study groups : 92 % of children remained caries-free in the treatment group and 91 % remained caries-free in the placebo group . Fluorosis was observed in 26 subjects , all classified as very mild . Overall , there were no statistically significant differences in the study groups with respect to caries and fluorosis in deciduous teeth . The study had sufficient power to detect an absolute risk reduction of 5.1 % while only a 1.5 % reduction was observed . These findings do not support the hypothesis that prenatal fluoride has a strong caries-preventive effect 
    Output:
    
All of the five included studies that evaluated the association between use of fluoride supplements and dental fluorosis found that use of the supplements increased the risk of mild-to-moderate fluorosis .
CONCLUSIONS There is weak and inconsistent evidence that the use of fluoride supplements prevents dental caries in primary teeth .
There is evidence that such supplements prevent caries in permanent teeth .
Mild-to-moderate dental fluorosis is a significant side effect .