You will be presented with a collection of medical randomized controlled trial (RCT) reports addressing a shared clinical question -- for instance, the efficacy of a medical intervention on a disease or condition. Given the titles and abstracts of these reports, your task is to generate the conclusion of the systematic review article synthesizing the key findings. Your conclusion should be a few sentences long. In your response, include only the conclusion and no other text. The RCT reports are below.



Title 1:
A comparison of two chlorhexidine gel brushing regimens and a conventional toothpaste brushing regimen for the development of tooth staining over a 6-week period.
Abstract 1:
AIMS A single-centre , r and omized single-blind parallel study was undertaken to compare staining seen with three brushing regimens and to determine subject perception of side effects such as staining and effects on taste . METHODS This 6-week parallel study used 157 volunteers who were r and omized into one of three treatment groups : ( i ) brushing in the morning and evening with a normal dose of a 1 % chlorhexidine gel , ( ii ) brushing with a low dose of chlorhexidine gel in the evening and a whitening dentifrice in the morning , and ( iii ) brushing with a st and ard fluoride paste in the morning and evening . Following home usage of their allocated products , the study volunteers returned after 3 and 6 weeks to record the amount of stain present . After the 6-week period , subject perception of taste and stain acceptability was determined using a question naire . RESULTS After 6 weeks of use of the low-dose chlorhexidine gel and whitening dentifrice , significantly more stain was seen compared with the use of a st and ard dentifrice ( P<0.0001 ) . Similarly , significantly more stain was seen with use of the normal-dose chlorhexidine gel compared with the low-dose gel and whitening dentifrice ( P=0.0007 ) . Approximately 30 % of individuals on the low-dose chlorhexidine gel regimen found the amount of stain unacceptable and 10 % noted an effect on their taste perception . CONCLUSIONS The use of low dose of chlorhexidine gel at night and a whitening paste in the morning produced a significant amount of stain that 30 % of subjects considered unacceptable


Title 2:
Clinical study to compare the effectiveness of a test whitening toothpaste with a commercial whitening toothpaste at inhibiting dental stain.
Abstract 2:
AIMS A single centre , r and omised single-blind , three-way crossover study was performed , to compare the effect of an experimental test toothpaste with a commercially available whitening toothpaste and water control at inhibiting extrinsic stain promoted by repeated chlorhexidine/tea rinses . METHODS This study used 23 subjects . During the week before the study the subjects received a prophylaxis to remove all staining , plaque and calculus deposits . On the Monday of the following week subjects returned to the clinic to receive their rinses and to check their dentition was stain free . Under direct supervision at both 09:00 and 13:00 hours they rinsed with either a toothpaste slurry or water control that was repeated daily up to and including the following Thursday . Additionally from the Monday to the Thursday each subject rinsed with a 0.2 % chlorhexidine mouthrinse , immediately followed by a rinse with a warm black tea solution . This cycle was repeated hourly eight times throughout the day and on the following days until the Friday . Throughout this period volunteers omitted all other forms of oral hygiene except rinsing with the chlorhexidine mouthwash . On the Friday the level of stain on the teeth and dorsum of tongue was assessed using the Lobene stain index for both stain area and intensity . At the end of each trial period each subject received a thorough prophylaxis to remove all plaque , calculus and staining before starting the second and third period of the study . RESULTS As expected appreciable amounts of extrinsic stain accumulated on the teeth over each study period . The amount of stain following use of the toothpastes and water control was least with the experimental toothpaste , followed by water control and lastly the commercial whitening paste . For all sites combined there was evidence that the experimental paste was significantly superior to both the commercial paste and water control at reducing stain area ( p<0.001 ) , a product of stain area and intensity ( p<0.001 and 0.05 , respectively ) but not stain intensity ( p>0.05 ) . CONCLUSIONS In this stain-prevention model the use of an experimental paste showed a significant reduction in stain accumulation on the teeth compared with a ( placebo ) negative water control and a commercially available whitening paste . As such the experimental paste would be expected to be of benefit in controlling extrinsic dental staining


Title 3:
A clinical comparison of antibacterial mouthrinses: effects of chlorhexidine, phenolics, and sanguinarine on dental plaque and gingivitis.
Abstract 3:
This study compared the clinical efficacy of three mouthrinses containing either 0.12 % chlorhexidine , phenolic compounds , or sanguinarine , which were used unsupervised , in a placebo-controlled , double-blind study of 6 months ' duration . The study was conducted according to ADA clinical guidelines for evaluation of antigingivitis agents and was completed by 481 adults . Following baseline exams and a prophylaxis , subjects were r and omly divided into treatment groups matched for age , gender , and gingivitis severity , and were instructed to use the rinses in accordance with manufacturer 's directions . Followup examinations evaluated supragingival plaque , gingivitis , and gingival bleeding . Compared to placebo at 6 months , the group rinsing with 0.12 % chlorhexidine had significantly less gingivitis ( 31 % reduction ) , gingival bleeding ( 39 % reduction ) , and plaque ( 49 % reduction ) and was significantly better than any of the other treatment groups ( P less than 0.05 ) . Both the phenolic and sanguinarine groups showed moderate , yet significant , reductions in plaque compared to placebo ( 24 % and 12 % respectively ) yet were significantly less effective than the 0.12 % chlorhexidine rinse ( P less than 0.05 ) . However , neither the phenolic nor sanguinarine rinses were significantly different than placebo in their effects on gingivitis or gingival bleeding . These results support previous published results on the superiority of 0.12 % chlorhexidine when used in conjunction with professional care and as an adjunct to routine oral hygiene practice


Title 4:
The effect of 0.12% chlorhexidine dentifrice gel on plaque accumulation: a 3-day non-brushing model.
Abstract 4:
BACKGROUND Maintaining an adequate low level of plaque through daily tooth brushing is often not feasible . Effective chemotherapeutic agents as an adjunct to mechanical plaque control would therefore be valuable . Chlorhexidine ( CHX ) mouthwash has proved to be an effective inhibitor of plaque accumulation . AIM The purpose of the present study was to assess the effect of application of 0.12 % CHX dentifrice gel on de novo plaque accumulation . MATERIAL AND METHODS The study was design ed as a single blind , r and omized three-arm parallel clinical trial . At the beginning of the test period all volunteers received a thorough professional oral prophylaxis . Subjects were r and omly assigned to one of three regimens . During a 3-day non-brushing period , subjects abstained from all forms of mechanical oral hygiene . One regimen ( test group ) used 0.12 % chlorhexidine dentifrice gel ( CHX-DGel , Perio . Aid ) applied in a fluoride gel tray , the benchmark control group used a regular dentifrice applied in a fluoride gel tray ( RegD , Everclean HEMA ) . The positive control group rinsed with a 0.12 % chlorhexidine mouthwash ( CHX-MW , Perio . Aid ) . The Quigley and Hein plaque index ( PI ) from all subjects was assessed after 3 days of de novo plaque accumulation . Subsequently , all subjects received a question naire to evaluate their attitude , appreciation and perception towards the products used employing a Visual Analogue Scale scores . After the experimental period , habitual oral hygiene procedures were resumed . RESULTS Ninety-six systemically healthy subjects completed the study . After 3 days , the full-mouth PI for the CHX-DGel regimen was 1.87 compared with 1.93 for the RegD regimen and 1.55 for the CHX-MW regimen . The two dentifrices ( CHX-DGel and RegD ) were significantly less effective as the CHX-MW ( P=0.0006 ) . No significant difference between scores of the dentifrices was found . CONCLUSION Within the limitations of the present 3-day non-brushing study design , it can be concluded that application of 0.12 % CHX dentifrice gel is not significantly different from application of regular dentifrice on plaque accumulation . Use of a 0.12 % CHX mouthwash is significantly more effective . CHX-DGel appears a poor alternative for a dentifrice . It is not an effective inhibitor of plaque growth and does not possess fluoride


Title 5:
The effect of a dentifrice containing chlorhexidine and zinc on plaque, gingivitis, calculus and tooth staining.
Abstract 5:
In this 6 months r and omized , stratified double-blind parallel study , plaque , gingivitis , calculus formation and tooth staining were assessed in 208 participants . The participants either used a 0.12 % chlorhexidine rinse and a gum care dentifrice ( positive control ) or a placebo rinse and the gum care dentifrice ( control ) or the placebo rinse and an experimental dentifrice containing 0.4 % chlorhexidine and 0.34 % Zn2 + ( experimental group ) . After 6 months product use , all groups had less plaque , less gingivitis and all developed calculus and tooth staining . For the positive control group and for the experimental group , significant reductions in plaque and gingivitis ( gingival index and number of bleeding sites ) were seen compared with the control group . Significantly more calculus developed in the positive control group , while the experimental group was not different from the control group . Finally , tooth staining was significantly higher for the groups using chlorhexidine containing products compared with the control group . The experimental dentifrice users however did develop significantly less staining compared with the positive control . It is concluded that the experimental dentifrice will contribute to a significant improvement in oral hygiene with less staining compared with using a 0.12 % chlorhexidine rinse


Title 6:
Studies on the effect of toothpaste rinses on plaque regrowth. (I). Influence of surfactants on chlorhexidine efficacy.
Abstract 6:
A number of compounds have been added to toothpastes to inhibit plaque regrowth . The inclusion of cationic antiseptics , such as chlorhexidine , poses formulation difficulties because of interactions with other ingredients particularly anionic detergents . More recently , Triclosan/zinc citrate formulations have been shown effective plaque inhibitors . The aim of this study was to compare a commercially available 0.2 % Triclosan/0.5 % zinc citrate toothpaste with a number of experimental 0.5 % chlorhexidine/detergent toothpastes for effects on plaque regrowth over 4 days . Subjects rendered plaque free at each baseline rinsed twice a day with toothpaste slurries and disclosed plaque was scored at the end of each period . All toothpastes significantly reduced plaque by comparison with a control toothpaste , but were significantly less effective than a 0.2 % chlorhexidine rinse . Some significant differences in favour of one chlorhexidine toothpaste were noted but these were small in magnitude . Whether the plaque inhibition obtained with Triclosan/zinc citrate toothpaste was greater than would be expected from other commercially available preparations can not be determined from this study and is the subject of a further investigation


Title 7:
Inhibition of "de novo" plaque formation with 0.12% chlorhexidine spray compared to 0.2% spray and 0.2% chlorhexidine mouthwash.
Abstract 7:
BACKGROUND Chlorhexidine ( CHX ) is widely accepted as the most effective product in the control of supragingival plaque . It is available in different delivery devices . The aim of this study was to test whether 0.12 % CHX spray was as effective as 0.2 % CHX spray and 0.2 % CHX mouthwash in a 3-day " de novo " plaque formation model . METHODS Ninety volunteers were enrolled into a single-blind , r and omized , three-group parallel study . They received a thorough dental prophylaxis prior to the test period . Subjects were divided r and omly into three equal groups . They were requested to refrain from all forms of mechanical oral hygiene and instructed to use only their assigned product during the 3-day experimental period . After 3 days , the plaque growth was assessed using the Quigley and Hein plaque index ( Q&H PI ) at six sites per tooth . RESULTS After 3 days , the CHX mouthwash group had a mean Q&H PI of 1.17 compared to 1.41 for the 0.2 % CHX spray and 1.49 for the 0.12 % CHX spray . The difference between the mouthwash and the two sprays was statistically significant , whereas the two sprays did not differ significantly from each other . CONCLUSIONS Within the limitations of this 3-day " de novo " plaque formation study , the two sprays were not as effective as the mouthwash in plaque inhibition . No significant difference was found between the two sprays . To achieve the same effectiveness as a mouthwash , a higher dose ( number of puffs ) of CHX spray may be necessary


Title 8:
Unchanged plaque inhibiting effect of chlorhexidine in human subjects after two years of continuous use.
Abstract 8:
Abstract Immediately after the end of a long-term study of the effects of chlorhexidinecontaining dentifrices , 21 subjects , nine from the experimental and 12 from the placebo group , participated in a short-term experiment to test whether the plaque-inhibitory effect of chlorhexidine in these individuals had been altered . During a period of 1 week without mechanical oral hygiene , all subjects employed 10 ml of a 0.2 per cent aqueous solution of chlorhexidine as a mouthrinse twice a day . The results showed that the previous use of chlorhexidine-containing dentifrices for 2 yr apparently had not influenced the plaqueinhibiting capacity of the drug
Chlorhexidine mouthwash , however , showed a significantly more tooth discoloration than the CHX DF/gel .
Chlorhexidine gel can be successfully formulated and will inhibit plaque growth to some degree , but not to the same extent , as a CHX MW .
When CHX DF/gel is used in a non-brushing model , it is significantly less effective in plaque inhibition compared to CHX MW .
The only brushing study also with a long follow-up showed that there is no significant difference between CHX DF and CHX MW .
However , as a corollary , significantly more tooth discoloration was observed with the CHX MW .
Altogether , the data show that when daily oral hygiene can not be performed , CHX MW is the first product of choice