- Why patients may be at risk or high risk for caries
- What to do for patients at risk for caries
- MI Paste, MI Paste Plus
- MI Paste One
Michelle Strange: A Tale of Two Hygienists presents this week’s TIPisode: Quick and easy tips to keep you up to date and presented by the experts in the profession. Now, get ready for your unofficial TIPisode.
Dr. Pamela Maragliano-Muniz: Hey, everyone. I’m Dr. Pam Maragliano-Muniz. You may know me from DentistryIQ.com or DACE, Dental Academy of CE, or you may have heard me lecture about tooth decay over the years. I’m a dental hygienist, and I’m a prosthodontist. I own a practice in Salem, Massachusetts. And, when I think about a lot of my patients, many of them are at a high risk for developing cavities or caries.
Why would they be at a high risk? Well, if they have a lot of gingival recession, deep pits or fissures, if they grew up without any access to fluoride as they were growing up, patients that are 60 years of age or older, patients that have a diet that’s high in carbohydrates or acids, something like that, and patients that have poor oral hygiene.
I also have a lot of high-risk patients. These guys have xerostomia, my smokers, patients that have really heavily restored mouths whether they have partial dentures or bridges or a lot of crowns or fillings, patients that have orthodontics, and also patients that have a cavity now. If a person has a cavity now, statistically speaking, they are at a very high risk of developing cavities over the course of the next three years.
Another group of patients that I consider to be at high risk are patients that have early cavities. So the types of cavities that you may find on a radiograph but they’re too small to fill. Or maybe a little dark spot on a tooth or a white spot on a tooth. Something like that. Those patients are all at risk for developing cavities. So what do we do for them?
Well, obviously if it’s an oral hygiene problem or a diet problem or some sort of behavioral problem, I will always consider some sort of behavioral management, but I also want to keep the oral cavity as healthy as I can. And, for that, I always reach for products that contain recaldent. So you might be familiar with MI Paste or MI Paste Plus, and you may know that recaldent is amorphous calcium phosphate bound by a casein phosphopeptide. What does that mean? Basically means that it’s a calcium and phosphate is stabilized by a protein [sic]. In fact, it’s a milk-based protein.
So many people may understand that MI Paste, MI Paste Plus is — both of them are contraindicated for patients that have a true milk allergy, but they are safe for patients that have lactose intolerance. These products are great for children, great for pregnant patients, and obviously great for high risk patients.
Now, it’s the casein phosphopeptide that actually makes this product different from other products that are out there. Other materials that contain formulations of calcium phosphate are dependent upon the presence of an adequate amount of protein that occurs naturally in saliva. So, in cases where there’s just not enough salivary quality or quantity, the other products might not be as efficacious as the different MI products.
Now, one product I’d like to talk about in particular is MI Paste One. I’m not sure if you’re familiar with it. MI Paste One is a brush on version of MI Paste. One criticism that MI Paste users would have was that sometimes patients had a hard time with the extra step of adding the paste after brushing and flossing, and with MI Paste One, that extra step is eliminated. It’s a brush on paste. It contains 1100 parts per million sodium fluoride, also contains recaldent. There is a mild abrasive — there has to be an abrasive in a paste to be considered a toothpaste — but the RDA is extremely low. It’s at 64.
Now, one thing that’s very cool about this paste is that it additionally contains potassium nitrate. So this product has similar benefits as MI Paste Plus, better compliance for patients — it comes in a great mild mint flavor, so it’s not too strong especially for patients that have dry mouth — and it also has a neutral pH, which is great for patients that tend to have more of an acidic oral environment. A neutral pH product is exceptionally important for implant patients. And, if you have patients that suffer from dentinal hypersensitivity, potassium nitrate is a perfect addition to a toothpaste.
Now, let’s talk a little bit about recaldent and why recaldent is so special. As I mentioned, recaldent is amorphous calcium phosphate-casein phosphopeptide, and it has a synergistic property with fluoride. It promotes the incorporation of fluoride into plaque and subsurface enamel, which has a greater benefit than when fluoride alone is acting by itself. It also will buffer plaque acid. When using MI Paste products, plaque levels are elevated for 48 hours. That’s just MI Paste, just the paste that doesn’t even contain fluoride. But, when using something like MI Paste Plus or MI Paste One, pH levels are elevated for 96 hours. Imagine that. A nice, neutral oral pH, cariogenic bacteria isn’t allowed to thrive, and the oral environment stays in balance.
So this product alone will buffer plaque acid for upwards of 96 hours. It contains fluoride, so it will also inhibit demineralization and promote remineralization. Another favorable property of recaldent is that it acts as a prebiotic. Recaldent suppresses the growth of strep mutans and encourages the growth of beneficial bacteria.
So, if you’ve ever heard me speak about tooth decay, I always talk about the three major principles within the oral environment that have to be in balance to promote health. One is maintaining bacteria levels. Don’t let that biofilm thrive. The second property is oral pH. Oral pH, ideally, should stay around neutral for the better part of the day. If the oral pH is too low or acidic, cariogenic bacteria will thrive and greatly increase ones risk for developing caries. Finally, we have to encourage mineral exchange between the saliva and the teeth. If there’s not an adequate amount of saliva or the properties within saliva is not adequate either, then we don’t have a great reservoir of calcium, phosphate, fluoride, buffering agents, enzymes, proteins, you name it. If the beneficial minerals are not present in the saliva, we need to flood that saliva chemotherapeutically with calcium, phosphate, protein, and fluoride. Why a milk-based protein you might ask? Because a milk-based protein is structurally similar to the proteins that exist in nature.
So there you have it. MI Paste products are extremely beneficial for my high-risk patients, and I really think that MI Paste One is worth checking out. My patients love it, and it removes the extra step, and it’s extraordinarily beneficial to reduce caries risk.
Thank you very much, and hopefully I’ll see you soon.
Michelle Strange: We hope you enjoyed this week’s TIPisode. Be sure to reach out to our guest experts and let them know how helpful their tips were. Follow A Tale of Two Hygienists on Facebook, Instagram, and head over to ataleoftwohygienists.com and subscribe to our newsletter. You can also email us at [email protected], and keep listening for more awesome content from your unofficial dental hygiene podcast.