Tooth Mousse Plus Research Articles

The Effectiveness of Remineralizing Agents on Dentinal Permeability.

The effectiveness of remineralizing agents in reducing dentine permeability by tubule occlusion using fluid filtration device functioning at 100 cmH2O (1.4 psi) pressure and SEM/EDX analysis were evaluated and compared. Seventy (n = 70) dentine discs of 1±0.2 mm width were prepared from sound permanent human molars. Fifty (n = 50) dentine discs were randomly divided into 5 groups (n = 10): Group 1: GC Tooth Mousse Plus (Recaldent GC Corporation Tokyo, Japan), Group 2: Clinpro™ White Varnish (3M ESPE, USA), Group 3: Duraphat® Varnish (Pharbil Waltrop GmbH, Germany), Group 4: Colgate Sensitive Pro-Relief™ dentifrice (Colgate Palmolive, Thailand), and Group 5: Biodentine™ (Septodont/UK). Dentine permeability was measured after treatment application at 10 minutes, artificial saliva immersion at 7 days, and citric acid challenge for 3 minutes. Data were analyzed by two-way repeated measures ANOVA. Dentine specimens (n = 20) were used for SEM/EDX analyses to obtain qualitative results on dentine morphology and surface deposits. Each treatment agent significantly reduced dentine permeability immediately after treatment application and created precipitates on treated dentine surfaces. All agents increased permeability values after 7 days of artificial saliva immersion except Clinpro White Varnish and Biodentine. Clinpro White Varnish exhibited significant resistance to acid challenge compared to others. Colgate Sensitive Pro-Relief dentifrice has a dual mechanism of action in reducing the dentine sensitivity.

Effect of Fluoride Recharging on Fluoride Release and Surface Properties of Orthodontic Bracket Adhesives

The aim of this study was to compare fluoride release and surface changes according to different orthodontic bracket adhesives the application of fluoride products. We used non-fluoridated composite resin Transbond fluoridated composite resins Blugloo and LightBond, resin-modified glass ionomer Rely X™ Luting 2, and conventional glass ionomer Fuji I®. Fluoride release of five orthodontic bracket adhesives and fluoride release ability after application of three fluoride products (1.23% acidulated phosphate fluoride gel, Tooth Mousse Plus®, Fluor Protector, and a toothbrush with sodium fluoride-containing toothpaste) were measured using a fluoride electrode that was connected to an ion analyzer. After 4 weeks of fluoride application, the surface roughness and surface morphology were examined using a surface roughness tester and field emission scanning electron microscopy. The amounts of fluoride release were observed not only on application of Tooth Mousse Plus® and Fluor Protector on resin-modified glass ionomer Rely X™ Luting 2 and Fuji I®, but also during tooth brushing using fluoride-containing toothpaste. After application of Tooth Mousse Plus®, except Transbond XT, the surface roughness increased, and all orthodontic adhesives showed a partial drop of micro-particle filler. On application of 1.23% acidulated phosphate fluoride gel on all orthodontic bracket adhesives, their surface roughness increased. To bond the orthodontic bracket, resin-modified glass ionomer Rely X™ Luting 2 and Fuji I® adhesives are highly recommended if the amount of fluoride release is considered to confer a preventative effect on dental caries, and among the fluoride products, Tooth Mousse Plus® and Fluor Protector are better than 1.23% acidulated phosphate fluoride gel, and these are expected to prevent dental caries even during tooth brushing with fluoride-containing toothpaste.

Comparison of the newer preventive therapies on remineralisation of enamel in vitro

ObjectivesTo investigate in vitro the effect of MI Paste, MI Paste Plus and 2800ppm fluoride (F) toothpaste (TP) on the remineralisation of enamel subsurface lesions and to compare these to the effect of 1450ppm and 0ppm F toothpastes. MethodsEnamel subsurface lesions were created in bovine enamel slabs (n=120) which were assigned randomly to five groups; (1) 0ppm F TP, (2) 1450ppm F TP, (3) 2800ppm F TP, (4) 1450ppm F TP+MI Paste (Tooth Mousse-TM,10% w/v CPP-ACP) and (5) 1450ppm F TP+MI Paste Plus (Tooth Mousse Plus,10% w/v CPP-ACP, 900ppm F as 0.2% w/w sodium fluoride). The enamel slabs were subjected to a pH cycling regimen for 21days. Quantitative Light-induced Fluorescence (QLF) images were taken and analysed. Data analysis was carried out using one way ANOVA. ResultsIn all groups, both ΔF (percentage fluorescence loss) and ΔQ (ΔF times the area) values improved significantly within the same group after the treatment. In addition, the mean difference in ΔF of the non-fluoride control group was significantly lower than all other groups but not for the 2800ppm F− group. Whereas the mean difference in ΔQ of the non-fluoride control of group was significantly lower when compared with all other groups (p<0.05). ConclusionsBoth MI Paste and MI Paste Plus when used in conjunction with 1450ppm F did not show a significant increase in efficacy for the remineralisation of bovine enamel subsurface lesions in the model used in this study. Clinical significanceNewer preventive agents such as MI paste and MI paste plus are advocated as promoting remineralisation when used in addition to routine oral care. This in vitro study shows that they may have a limited value in promoting remineralisation over and above that of 1450ppm F toothpaste used twice a day.

Synergetic remineralization effectiveness of calcium, phosphate and fluoride based systems in primary teeth

ObjectiveTo assess remineralization of primary teeth enamel under the presence of fluoride, calcium and phosphorous ions using microhardness and surface roughness testing. DesignArtificial caries lesions were created in enamel surface of 144 human primary molars. Specimens were randomly assigned according to remineralizing agent into six groups: 1) Artificial saliva, 2) Fluoride varnish, 3) Clinpro™white varnish, 4) Relief, 5) Tooth Mousse Plus, 6) VanishXTTM. Surface micro-hardness and surface roughness were evaluated at baseline, after demineralization, after 2 and 4 weeks remineralization and after exposure to acid challenge. ResultsAll test groups showed superior results to the control. The surface micro-hardness of Clinpro™ group by 4 weeks remineralization showed statistically the highest value with the least softening as exposed to acid challenge. Concomitantly, by 4 weeks remineralization, Clinpro™ agent was able to regain enamel surface roughness incomparable to that of baseline value statistically the least of test groups. ConclusionCalcium-phosphate and fluoride remineralizing systems possess added remineralization potency in comparison to artificial saliva. Clinpro™ varnish showed the greatest remineralizing action and the least softening by acid challenge.

Assessment of Enamel Remineralisation After Treatment with Four Different Remineralising Agents: A Scanning Electron Microscopy (SEM) Study.

Decades of research has helped to increase our knowledge of dental caries and reduce its prevalence. However, according to World Oral Health report, dental caries still remains a major dental disease. Fluoride therapy has been utilised in a big way to halt caries progression, but has been met with limitations. This has paved the way for the development of newer preventive agents that can function as an adjunct to fluoride or independent of it. The purpose of the present study was to evaluate the ability of Casein Phosphopeptide-Amorphous Calcium Phosphate Fluoride (CPP ACPF), Bioactive Glass (BAG), fluoride enhanced Hydroxyapatite (HA) gel and self-assembling peptide P11-4 to remineralise artificial carious lesions in enamel in vitro using a 30 day pH cycling model through surface microhardness analysis and SEM. Sixty enamel samples were divided into five groups of 12 samples each. The control Group A consisted of intact enamel samples, Group B: CPP-ACPF (Tooth Mousse Plus), Group C: BAG (SHY- NM), Group D: fluoride enhanced HA gel (ReminPro) and Group E: Self-assembling peptide P11-4 (Curodont Protect). All groups excluding the control group were subjected to demineralisation following which four of these groups were remineralised using the four remineralising agents. The treated groups were subjected to pH cycling over a period of 30 days. This was followed by assessment of surface microhardness and SEM for qualitative evaluation of surface changes. The results were analysed by One-Way Analysis Of Variance (ANOVA). Multiple comparisons between groups were performed by paired t-test and post-hoc Tukey test. The results of the study revealed that remineralisation of enamel was the highest in samples of Group E (Self assembling peptide P11-4) followed by Group B (CPP-ACPF), Group C (BAG) and Group D (fluoride enhanced HA gel). There was a significant difference (p<0.05) in the remineralising ability between the self assembling peptide P11-4 group and BAG and fluoride enhanced HA gel group. Although no significant difference was observed between the self assembling peptide P11-4 and CPP-ACPF group, the self assembling peptide P11-4 remineralised the enamel lesions more effectively. SEM photomicrographs of the test groups demonstrated either amorphous crystals or particles scattered on the surface or lines of remineralisation along the prismatic borders. Self assembling peptide P11-4 demonstrated promising results by effectively and significantly remineralising the enamel lesions as compared to other test agents.

Remineralizing potential of a 60-s in vitro application of Tooth Mousse Plus.

No published studies exist on the remineralizing potential of Tooth Mousse Plus® (TMP) when applied for less than 3 min. To evaluate (i) the remineralizing potential of TMP on artificial carious lesions, when applied thrice daily for 60 s, and (ii) the benefit of using a fluoridated dentifrice prior to TMP application. Carious lesions, 120-200 μm deep, were produced by placing molars in demineralizing solution for 96 h, and sections 100-150 μm thick were then randomly assigned to four groups. Specimens were treated thrice daily with a non-fluoridated (Group A), or 1000 ppm F dentifrice (Group B), or TMP (Group C), or a 1000 ppm F dentifrice followed by TMP application (Group D), and then subjected to a 10-day pH cycling model. Lesion evaluation involved polarizing light microscopy and microradiography. Post-treatment maximum mineral content at the surface zone (Vmax ) was significantly increased and lesion depth (LD) significantly decreased in Group C, while only the Vmax increased in Group D. Increase in LD was observed in Group B; however, no significant differences were noted in percentage LD changes between groups B, C, and D (P > 0.05). TMP applied for 60 s significantly remineralized the artificial carious lesions. No additional benefit was evident when TMP was preceded by treatment with 1000 ppm F dentifrice.

Casein phosphopeptide-amorphous calcium phosphate products in caries prevention.

Data sourcesMedline, Embase, PreMedline and Cochrane Central Register of Controlled Trials.Study selectionClinical trials, investigating only clinical caries outcomes on participants of any age comparing the use of Tooth Mousse(®) or Tooth Mousse Plus(®) to a routine oral care regimen for the prevention of dental caries with or without comparison to additional preventive products. Studies that used other formulations of CCP-ACP were excluded. Trials using split-mouth design were also excluded. Only English language papers were considered.Data extraction and synthesisPapers were assessed independently by both authors using the Cochrane Collaboration tool for assessing risk of bias in randomised trials.1 Meta-analysis was not possible due to study heterogeneity.ResultsTwelve studies were available for the final review; three studies on caries prevention were assessed as having low risk of bias. The remaining nine studies, with high risk of bias, reported on treatment or regression of early carious lesions. Two RCTs reported no significant benefits in the use of Tooth Mousse(®) over brushing with a fluoride toothpaste, a third study demonstrated a statistically significant increase in enamel microhardness for the Tooth Mousse(®) group compared to control group but no difference to the group who had fluoride gel treatment. Overall the authors concluded that Tooth Mousse(®) performs no better than fluoride in the prevention of carious lesions.Seven of nine studies evaluated caries lesion severity in orthodontic patients, with four demonstrating statistically significant white spot regression. Two trials in non-orthodontic patients showed statistically significant remineralising potential of Tooth Mousse(®) over fluoride mouthrinse or the regular use of fluoride toothpaste in 14-30 days.ConclusionsThe authors found no evidence to support the use of Tooth Mousse(®) over brushing with a fluoride toothpaste for the prevention of early caries. ToothMousse(®) appeared to benefit regression of white spot lesions associated with orthodontic treatment but the evidence is limited. Effectiveness of Tooth Mousse(®) was not significantly increased by the addition of fluoride in Tooth Mousse Plus(®) and evidence is still lacking to support the use of one over another. High quality randomised clinical trials are needed before these products can be recommended for the prevention and treatment of early carious lesions in the general population.Source of fundingThe publication was funded by Colgate Palmolive, Australia.

GC Tooth Mousse Plus: A potential storage media for avulsed teeth

Context: Avulsion injury is a severe form of dental trauma. Due to the complexity of this injury, the neurovascular supply is severely compromised and usually results in the loss of pulp vitality. A variety of factors can influence the success of replantation especially the storage media and storage period. Casein phosphopeptides are derived from casein which accounts for 80% of the total protein in bovine milk. They can function as carriers for several minerals especially calcium and also have known to have antibacterial properties. Aim: The purpose of this study is to evaluate the efficacy of GC Tooth Mousse Plus in comparison with chilled Homogenous pasteurized whole milk as a storage media. Materials and Methods: Thirty healthy premolars that are extracted for orthodontic purpose will be divided into three groups: (1) Group A: Control (Saline), (2) Group B: Positive control (Chilled Homogenous milk), (3) Group C: Experimental (GC Tooth Mouse Plus). These groups were further divided into two subgroups, each indicating storage period of 30 min and 60 min. The periodontal ligament (PDL) cell viability will be checked using tryphan blue staining. Results: Data were analyzed using Student's t-test. Conclusion: GC Tooth Mousse Plus can be used as a storage media to prevent desiccation of PDL cells up to the duration of 60 min.

The effect of different fluoride application methods on the remineralization of initial carious lesions.

ObjectivesThe purpose of this study was to assess the effect of single and combined applications of fluoride on the amount of fluoride release, and the remineralization and physical properties of enamel.Materials and MethodsEach of four fluoride varnish and gel products (Fluor Protector, FP, Ivoclar Vivadent; Tooth Mousse Plus, TM, GC; 60 Second Gel, A, Germiphene; CavityShield, CS, 3M ESPE) and two fluoride solutions (2% sodium fluoride, N; 8% tin(ii) fluoride, S) were applied on bovine teeth using single and combined methods (10 per group), and then the amount of fluoride release was measured for 4 wk. The electron probe microanalysis and the Vickers microhardness measurements were conducted to assess the effect of fluoride application on the surface properties of bovine teeth.ResultsThe amount of fluoride release was higher in combined applications than in single application (p < 0.05). Microhardness values were higher after combined applications of N with FP, TM, and CS than single application of them, and these values were also higher after combined applications of S than single application of A (p < 0.05). Ca and P values were higher in combined applications of N with TM and CS than single application of them (p < 0.05). They were also increased after combined applications of the S with A than after single application (p < 0.05).ConclusionsCombined applications of fluoride could be used as a basis to design more effective methods of fluoride application to provide enhanced remineralization.

Bleaching Effects on Color, Chemical, and Mechanical Properties of White Spot Lesions.

The purpose of the study was to evaluate the effect of bleaching on teeth with white spot lesions. Carious lesions with standardized whiteness were produced on the buccal and lingual surfaces of human premolars by pH cycling. Specimens were subjected to four experimental conditions (n=20/group) as follows: group 1, control; group 2, caries formation followed by remineralization using fluoride-containing casein phosphopeptide-amorphous calcium phosphate (CPP-ACP; Tooth Mousse Plus, GC, Tokyo, Japan); group 3, caries formation followed by bleaching using 10% carbamide peroxide; and group 4, caries formation followed by both bleaching and remineralization. The CIE L(*)a(*)b(*) color values were measured with a spectroradiometer, the mineral content was measured with electron probe microanalysis (EPMA) on the cross-sectional surface of each specimen, and the Knoop hardness test was carried out along the EPMA scan line. Two-way analysis of variance was performed with Tukey post hoc comparison. The change in the CIE color values was not significantly different between the caries-formed (ΔE(*)=7.03) and the bleached enamel (ΔE(*)=7.60). Bleaching of the carious enamel extended the whiteness (ΔE(*)=3.38) without additional mineral loss (p<0.05). The remineralization treatment significantly increased the calcium (Ca), phosphate (P), and fluoride content of the subsurface lesion area (p<0.05). The cross-sectional microhardness values correlated well with the Ca and P content (R>0.80). Bleaching reduced the color disparities between sound and carious enamel without deteriorating the chemical and mechanical properties. The application of CPP-ACP paste enhanced mineral deposition in the subsurface lesion area of carious enamel.

Is there a place for Tooth Mousse in the prevention and treatment of early dental caries? A systematic review.

BackgroundIt is important for Dental Professionals to consider the evidence for the effectiveness of the preventive strategies used to maintain good oral health and reduce the risk of caries in their patients. Whilst many of the traditional preventive activities, including the recommendation and use of fluoride products and the placement of fissure sealants have a wealth of clinical evidence to support their use, some of the newer preventive agents have a more limited evidence base. In order to investigate the level of scientific support behind one such technology, a systematic literature review was carried out to assess the effectiveness of Tooth Mousse® (MI Paste®) and Tooth Mousse Plus® (MI Paste Plus®) in the prevention and treatment of early dental caries.MethodsA broad search strategy using Medline via OvidSP and EMBASE was performed in order to capture all published studies to related Casein Phosphopeptide-Amorphous Calcium Phosphate. In addition to the above searches the terms “CPP ACP” and “casein phosphopeptide amorphous calcium phosphate” were searched using PREMEDLINE and the Cochrane Central Register of Controlled Trials. Inclusion criteria were clinical trials of participants of any age, comparing the use of Tooth Mousse® (MI Paste®) or Tooth Mousse Plus® (MI Paste Plus®) to a routine oral care regimen and reporting recognised clinical outcome measures for early caries lesions. Only research studies in English were selected.Results7576 articles were identified, but the majority were duplicates. Once these were removed 172 articles were inspected and the focus on ‘CPP-ACP formulations of Tooth Mousse® (MI Paste®) and Tooth Mousse Plus® (MI Paste Plus®) resulted in 29 articles being selected, and of these 12 studies met the inclusion criteria and were considered acceptable for the systematic review.DiscussionThe overall findings of this review did not show any significant benefits of using Tooth Mousse® (MI Paste®) products over brushing with a fluoride toothpaste for the prevention of early dental caries. With regard to the regression of white spot lesions in orthodontic patients there is a tendency towards a benefit for the use of Tooth Mousse® (MI Paste®) but the quality of evidence is limited. There is a lack of evidence to support the use of Tooth Mousse Plus® (MI Paste Plus®) over Tooth Mousse® (MI Paste®) at this time.ConclusionThis review suggests that further well-designed randomized controlled trials are required prior to the widespread recommendation of Tooth Mousse® products for the prevention and treatment of early dental caries in the general population.Electronic supplementary materialThe online version of this article (doi:10.1186/s12903-015-0095-6) contains supplementary material, which is available to authorized users.

A Polarized Light Microscopic Study to Comparatively evaluate Four Remineralizing Agents on Enamel viz CPP-ACPF, ReminPro, SHY-NM and Colgate Strong Teeth.

ABSTRACTAim: To compare and evaluate the remineralizing potential of four commercially available products namely SHY-NM, GC Tooth Mousse Plus, ReminPro and Colgate strong teeth on demineralized human teeth.Materials and methods: The study included 50 extracted premolars having 3 × 3 mm window prepared on the middle third of the tooth, which was then subjected to demineralization for 48 hours at 37°C. Teeth were randomly selected and grouped into five study groups of 10 teeth in each. Each group was treated with respective remineralizing agent and sectioned using hard-tissue microtome. Each section obtained was visualized under polarized light microscope and analyzed using Image J software.Results: The statistically evaluated results revealed that SHY-NM has the most remineralizing potential followed by ReminPro, GC Tooth Mousse Plus and fluoridated toothpaste.Conclusion: Based on the study, the SHY-NM was superior to the GC Tooth Mousse Plus, ReminPro and Colgate strong teeth on demineralized human teeth.How to cite this article: Rajan R, Krishnan R, Bhaskaran B, Kumar SV. A Polarized Light Microscopic Study to Comparatively evaluate Four Remineralizing Agents on Enamel viz CPP-ACPF, ReminPro, SHY-NM and Colgate Strong Teeth. Int J Clin Pediatr Dent 2015;8(1):42-47.

Clinical Evaluation of Enamel Demineralization during Orthodontic Treatment: An in vivo Study using GC Tooth Mousse Plus

Clinical Evaluation of Enamel Demineralization during Orthodontic Treatment: An in vivo Study using GC Tooth Mousse Plus

Remineralizing potential of various agents on dental erosion

AimThe purpose of this study is to compare the effect of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP, Tooth Mousse) containing and casein phosphopeptide-amorphous calcium phosphate with fluoride (CPP-ACPF, Tooth Mousse Plus) containing pastes on dental erosion. Materials and methodsThirty permanent non-carious premolars indicated for orthodontic extraction were included in this study and were sectioned in mesiodistal direction vertically. After immersion in the carbonated drink for 14 min, samples were treated with various remineralizing pastes which were CPP-ACP containing paste (Tooth Mousse) and CPP-ACPF containing paste (Tooth Mousse Plus) according to the manufacturer's instructions. Vickers Microhardness was recorded at baseline, after exposure to erosive drink and after treatment with remineralizing pastes. Data obtained was statistically analysed using Student t-test with a level of significance set at p < 0.05. ResultsCPP-ACP (Tooth Mousse) and CPP-ACP with fluoride (Tooth Mousse Plus) resulted in 30.52% and 38.98% increase in post-erosion microhardness values respectively. The remineralizing potential of CPP-ACP with fluoride containing paste (Tooth Mousse Plus) was significantly better than that of CPP-ACP containing paste (Tooth Mousse) (p < 0.05). ConclusionCasein phosphopeptide-amorphous calcium phosphate with fluoride (CPP-ACPF, Tooth Mousse Plus) can be recommended to be used in preventing erosive tooth wear from acidic beverages.

The Effect of Remineralisation Treatments on Demineralised Dentine, an In Vitro Study

This in vitro study evaluated the effect of commercially available remineralising products on demineralised dentine. Demineralised dentine was stored in pooled saliva or treated with Tooth Mousse, Tooth Mousse Plus, Gel-Kam or NeutraFluor 5000, for 7 days at room temperature. Dentine slices were microhardness tested, and assessed using scanning electron microscopy (SEM) and energy dispersive and Raman spectroscopy. Demineralisation decreased dentine microhardness and was increased following storage in saliva. However, Tooth Mousse and NeutraFluor 5000 treatment significantly increased (p<0.05) microhardness. SEM analyses showed that following demineralisation, dentine tubule openings were more clearly defined and treatment with saliva did not alter this surface appearance. Dentine tubules appeared to be occluded following treatment. With the exception of fluoride, few significant differences in elemental content between Tooth Mousse, Tooth Mousse Plus and NeutraFluor5000 were observed. All products significantly increased (p<0.001) fluoride levels compared with control, demineralised and saliva stored specimens. The increase in surface fluoride levels was significantly higher for Gel-Kam andNeutraFluor5000 (p<0.001). Raman spectrometry indicated that fluoride was being incorporated into apatite crystals following treatment with Tooth Mousse Plus, NeutraFluor 5000 and Gel-Kam.

Remineralizing efficacy of different calcium-phosphate and fluoride based delivery vehicles on artificial caries like enamel lesions

ObjectivesTo assess enamel remineralization of different calcium-phosphate and fluoride delivery systems. MethodsArtificial caries lesions were created on 115 extracted human molars. Specimens were assigned according to remineralizing agent into five groups: G1: Control (artificial saliva), G2: Clinpro™ white varnish, G3: Relief, G4: Tooth Mousse Plus, G5: Vanish™XT. Surface micro-hardness (SMH), surface roughness (Ra) and surface topography by scanning electron microscope (SEM) were evaluated at baseline, after demineralization, after 2 and 4 weeks remineralization and after acid challenge. ResultsDemineralized enamel showed the lowest SMH. By 2 weeks remineralization, SMH were ranked as follows: G2 (282.14±6.82)>G3 (269.37±7.25)>G5 (263.00±6.49)=G4 (251.83±8.26)>G1 (226.5±9.34). However, 4 weeks remineralization showed the following: G2 (304.09±6.65)>G3 (293.1±5.24)=G4 (285±7.29)>G5 (272.43±4.89)>G1 (233.33±9.12). By exposure to acid challenge, groups presented order of: G2 (279.71±5.99)=G3 (275.51±5.59)>G4 (262.29±6.65)>G5 (245.43±6.43)>G1 (190.27±8). Surface roughness showed the following mattress after 2 weeks remineralization: G1 (0.2488±0.0016)=G2 (0.2487±0.0007)=G3 (0.2476±0.0006)>G4 (0.2442±0.0004)>G5 (0.2396±0.0009). After 4 weeks remineralization: G1 (0.2469±0.0017)>G4 (0.244±0.0004)>G5 (0.2413±0.0008)=G3 (0.2405±0.0007)=G2 (0.2399±0.0006). After acid challenge; G1 (0.2582±0.0027)>G5 (0.2556±0.0007)>G4 (0.2484±0.0009)>G3 (0.2463±0.0007)>G2 (0.2443±0.0004). SEM revealed mineralized coating on the surfaces which resists dissolution by acid challenge at variable degrees according to remineralization regimen applied. ConclusionsRemineralizing agents containing different calcium-phosphate formulas and fluoride have increased remineralization potential compared to artificial saliva. Clinpro™ varnish presented the highest remineralization tendency with greatest resistance for acid challenge. Clinical significanceThis in vitro study imitated the application of different calcium phosphorous and fluoride based delivery vehicles to enamel tooth surfaces in the mouth. The new therapeutic techniques based on different calcium phosphate formulas containing fluoride provide a new avenue for remineralization of non-cavitated and early carious lesions.

Clinical Evaluation of Enamel Demineralization during Orthodontic Treatment: An in vivo Study using GC Tooth Mousse Plus

Aims and objectives: Fixed orthodontic treatment makes oral hygiene procedures difficult and may result in enamel demine ralization. Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) with fluorides (GC Tooth Mousse Plus) reduces the incidence of enamel demineralization. The objective of this study was to evaluate the effects of GC Tooth Mousse Plus application, on enamel demineralization in patients undergoing orthodontic treatment. Methodology: Thirty subjects seeking orthodontic treatment were selected from patients visiting Department of Orthodontics in AB Shetty Memorial Institute of Dental Sciences, Mangalore. The subjects were divided into test and control group, and scanning electron microscopic (SEM) evaluation was done to compare level of surface roughness on samples of both the groups. Results: No white spot lesion was clinically appreciable in either test or control group. After extracting the teeth, SEM ima ges of surface of the teeth was graded and statistically eva luated with Pearson’s Chi-square and likelihood ratio test. The results were significant with p-value below 0.001 which indicated increased surface roughness in controls compared to the test group patients.

Comparison of Effect of Fluoride Varnish, Fluoride-releasing Composite, and Casein Phosphopeptide-amorphous Calcium Phosphate Fluoride on Demineralization around Brackets: An in vivo Study

Introduction: White spot lesions are a major problem in orthodontic patients as they compromise esthetics. They are the result of decalcification of enamel that occurs around brackets. This in vivo study was conducted to evaluate the effect of three different forms of topical fluoride on enamel demineralization adjacent to bonded brackets. Materials and methods: A total of 24 patients who needed extraction of at least two premolars for orthodontic reasons were selected. In each patient, one premolar was the test tooth and the other was the control. Brackets were bonded but only the test teeth received topical fluoride, that is, Transbond PLUS Color Change Adhesive, bifluoride12, GC Tooth Mousse Plus. The premolars were extracted after 80 to 90 days, and buccolingual sections 50 to 70 μm in thickness were evaluated with polarized light microscopy. The mean depth of demineralization in each lesion was measured using the software Image Pro Plus. Results: The difference between the values of the depth of demineralization in the experimental and control samples of all groups was found to be statistically significant (p < 0.05). There was a 43.3% reduction in the lesion depth in the transbond plus group. There was a 67.4% reduction in the lesion depth in the GC tooth mousse group. There was a 70% reduction in the lesion depth in the bifluoride varnish group. Conclusion: Enamel demineralization around brackets is signi­ ficantly reduced by all the three materials used in this study. The highest amount of lesion depth reduction was seen in the Bifluoride varnish group. Transbond plus, was the least effective among the three materials used.

The Erosivity Potential Of Common Pediatric Over-The-Counter Medications And Its Reduction By Remineralising Agents

Aim: The exposure of children’s teeth to acidic medications poses a risk for dental erosion, yet the erosivity of paediatric medications has scarcely been reported. The present study investigated the erosive potential of paediatric over-the-counter (OTC) medications, and assessed the change of the erosive potential in the presence of remineralising agents. Methods: A range of paediatric OTC medications and commercially available drinks was examined for pH and titratable acidity (TA). Detailed testings of pH and TA were investigated on representative drinks after addition of remineralising agents: Tooth Mousse® (TM), Tooth Mousse Plus® (TMP), ClinproTM, 1.23% neutral sodium fluoride (NaF), and artificial saliva (AS). Results: Paediatric OTC medications exhibited pH values of less than 5.5, which were comparable to commercial fruit juices and carbonated soft drinks. The TA values of OTC medications were similar to commerical fruit juices and carbonated soft drinks and ranged between 0.9 mL to 25.9 mL/ 20 mL of 0.1 M sodium hydroxide. In contrast, most dairy products, baby formulas, and bottled water had near-neutral pH (6.3-7.4) and low TA values of less than 1.3 mL/ 20 mL. The addition of TM, TMP, neutral NaF, and AS to the paediatric OTC medication increased the pH significantly compared to the control (Phosphate-buffered saline, PBS; p<0.001). The addition of TM, TMP, neutral NaF, and AS decreased the TA for paediatric OTC medication compared to the control (PBS; p<0.001-p<0.05), but not consistently. Conclusions: Paediatric OTC medications have erosive potential comparable to commercially available drinks. The erosive parameters (pH and TA) of paediatric OTC medications can be modified by the addition of TM, TMP, neutral NaF and artificial saliva, but not ClinproTM.

Efficacy Of Tooth Mousse: Authors' Reply

We appreciate Associate Professor Evans having taken the time to provide his personal views on Tooth Mousse and to also comment on the Therapeutic Guidelines, a publication authored by an expert group which is then examined closely before being endorsed by other authorities. While not immediately relevant to our recent ADJ paper,1 it is noteworthy that the interest in this area of CPP-ACP technology is reflected in significant publications – and not only for caries prevention but for other discrete clinical applications, including desensitizing dentine and reversing white spot lesions (applications for which there is evidence from randomized clinical trials). The clinical use of CPP-ACP technology is supported by a large body of literature including a number of systematic reviews. A 2009 meta-analysis identified more than 120 journal articles on CPP-ACP technology, which included animal model studies, in situ clinical studies, and randomized clinical trials, many of which were on the use of Tooth Mousse/MI Paste. A 2012 textbook chapter authored from our group identified that by the end of 2010, nine clinical trials of Tooth Mousse had been conducted across a range of locations around the globe which had shown regression of white spot lesions. Other studies have shown benefits in terms of caries reversal, caries prevention and altered plaque ecology in patients undergoing fixed orthodontic treatment,2-7 results which are consistent with our current understanding of the various mechanisms by which Tooth Mousse affects the ionic and microbial aspects of the oral environment in young children – and which is the context within which the sentence about Tooth Mousse and caries prevention referred to is placed within our ADJ paper.1 The finer points of discussion around what effects one sees in terms of caries prevention with Tooth Mousse in children we have made in the accompanying response to Associate Professor Kilpatrick wherein we explain the components of the Logan clinical trials which showed benefits, and the large positive effects of parallel interventions. There is considerable interest around the globe in the potential for caries prevention from using Tooth Mousse in young children and in older children its fluoride-containing relative Tooth Mousse Plus. We certainly stand by our views that there are benefits to using Tooth Mousse in young children, but stress that one should not depend entirely on the daily use of one agent, be that fluoride toothpaste or Tooth Mousse, to control early childhood caries – rather a much broader approach to prevention is needed where the benefits of several positive interventions are combined – as was the case the group of Logan studies which we cited. We expect that over time more will be learnt about the benefits or not of combining various preventive approaches. Certainly there is evidence from clinical trials of benefits of Tooth Mousse even in patients who are already using fluoride toothpastes and who are receiving supervised fluoride mouthrinses,8 and published literature showing that Tooth Mousse with fluoride is superior to fluoride alone. From time to time we see trials on various preventive agents including Tooth Mousse presented at meetings or published with suboptimal or negative results because of what we would regard as incorrect application protocols. For example, in the Thai study mentioned by Associate Professor Evans, the investigators treated the Tooth Mousse crème like fluoride toothpaste and the subjects used 0.4 gram once per day, which is suboptimal because in a high risk group they should have been using at least 1 gram twice daily after brushing with a fluoride toothpaste. Our final caveat to add to the comments of Associate Professor Evans is the need for readers to look carefully at the finer details of the protocol used for any trial of a preventive product and consider what confounding effects could be occurring. An excellent example is seen in the Thai study mentioned, where the two groups are not equally matched for caries risk factors. The authors of that paper state in their discussion that the children in the Tooth Mousse group fell asleep significantly more often on the bottle than the control group, which would have placed them at greater risk of caries development.