- ACP – CPP
- Benefits of Recaldent
- Recaldent and Fluoride
- Recaldent Prebiotic Properties
- Who Is Recaldent For?
- Patient Application
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, this week brought to you by GC America.
Dr. Pam Maragliano-Muniz: Hi, everyone. I’m so happy to be with you today. I’m Dr. Pam Maragliano-Muniz. I’m very happy to talk with you about Recaldent. It’s one of my favorite materials out there.
So, for those of you that don’t know, it’s the trade name for ACP-CPP, or amorphous calcium phosphate-casein phosphopeptide. Or, in other words, it’s a formulation of calcium and phosphate bound by a milk-based, or casein, protein. Why is this important? Because saliva is everything to maintain oral homeostasis.
Properly functioning saliva contains minerals including fluoride, calcium and phosphate, proteins, enzymes, and immunoglobulins. Immunoglobulins help to promote a healthy immune system. Enzymes aid in digestion and have antimicrobial properties. Fluoride is important for remineralization and enamel repair. Calcium and phosphate help to neutralize oral pH and aid in remineralization. Salivary proteins help to maintain ideal concentrations of calcium and phosphate. Proteins, mainly histidine and statherin, bind to calcium and phosphate to keep the ions available to aid in enamel stability and repair. Proteins also prevent a rapid drop in oral pH and aid in buffering oral pH and have a bacteriostatic property.
How does Recaldent fit in to all this? Recaldent replenishes the saliva with calcium and phosphate that are readily available to repair tooth structure and obstruct dentinal tubules. Calcium and phosphate are considered bioavailable because they exist in their neutral state because they are bound to a protein.
Casein, a milk-based protein, is structurally similar to the salivary proteins that facilitate mineral exchange when patients have an ideal salivary quality and quantity. Benefits of Recaldent include neutralization of oral pH. When using Recaldent alone, oral pH is elevated for up to 48 hours. When Recaldent is used in conjunction with fluoride, oral pH can be buffered up to 96 hours. Recaldent also inhibits demineralization and promotes remineralization and enamel repair.
Recaldent, additionally, has a synergistic relationship with fluoride. Fluoride is incorporated into plaque and sub-surface enamel. The plaque and pellicle that sit on the tooth can actually provide functional and protective benefits, and there is greater fluoride uptake into the tooth in the presence of Recaldent than when fluoride products are used alone. Recaldent also has prebiotic properties. It suppresses the growth of strep mutans and promotes the growth of beneficial bacteria.
Now, you might ask yourself who may benefit from Recaldent? Well, in my practice, pretty much everybody will benefit. Any patient that is at a high risk for caries or suffer from dentinal hypersensitivity can benefit from Recaldent. I would also suggest Recaldent for anyone who presents with poor oral hygiene, xerostomia, a high caries risk or incidence, patients with white spots or watch areas, patients with radiographic or clinical demineralizations, orthodontic patients, heavily restored patients, patients with partial dentures or big bridges, oral environments that are acidic, patients undergoing or planning chemotherapy or radiation therapy, patients with GI issues, newly erupted teeth, and a diet that contributes to caries. Recaldent is safe for children, pregnant patients, adults, and older adults.
Those who cannot have Recaldent really are only those that have an allergy. Recaldent is safe for those with lactose intolerance, but it is contraindicated for those with an allergy to a milk-based protein. So check your medical histories. Medical histories will help you identify those that will greatly benefit from recaldent and identify those that simply can’t have it.
How do we get Recaldent to our patients? Well, there’s a few products out there that contain Recaldent. Simple oral hygiene products that can be used topically are MI Paste. MI Paste is basically Recaldent in a tube. It has calcium, phosphate, and milk-based protein. There’s also a formulation called MI Paste Plus that is Recaldent plus fluoride, so that contains Recaldent and 900 parts per million fluoride.
Both of those products are simple and easy to use. You just place a little pea-sized amount or so on your fingertip and apply it to the tooth surfaces with a clean finger after brushing and flossing. I’ll have my patients kind of rub their tongue over their teeth, and voila, Recaldent is on their teeth.
I actually am undergoing clear aligner therapy right now, so I always place my MI Paste onto my teeth and pop my aligners in before bed. I know I’m raising my oral pH and hopefully protecting my teeth from any demineralization associated with what I’m doing.
Another way to apply Recaldent to our patient’s teeth is to use MI Paste ONE. That is a toothpaste, so that would replace the patient’s toothpaste. That product is — it contains Recaldent, fluoride, also some potassium nitrate to help with greater antihypersensitivity benefits, and it has a mild abrasive. If it’s a toothpaste, all toothpastes contain an abrasive. But MI Paste ONE, I believe the RDA is about 64, so basically, it’s a non-abrasive toothpaste that will deliver Recaldent to your patient’s teeth if they prefer to brush it on. It’s just basically a different delivery system than MI Paste or MI Paste ONE [sic].
Another great way to apply Recaldent to your patient’s teeth is via fluoride varnish. MI Varnish contains Recaldent and a high concentration of fluoride just like any other fluoride varnish out there. So a few patients that fall into the categories that I previously mentioned, after your dental hygiene visit, what a great way to replenish their saliva by using something like MI Varnish.
MI Varnish is nice because it comes in two flavors, mint and strawberry. It’s applied very quickly, easily. It’s got a very low film thickness. Patients, they may feel it on their teeth, but most of the time, they don’t see it. So it’s very, very acceptable by many patients.
Now, you might think, “Wow. These all sound great. But wouldn’t it be nice to have a material where Recaldent can just sit on the tooth?” Well, look no further. One of my favorite sealants out there are sealants that are glass-ionomer-based sealants. Glass-ionomer-based sealants are awesome because, number one, they’re hydrophilic, easy to place on everybody, especially newly erupted teeth, kids that saliva’s hard to control, or basically anybody.
Well, Fuji TRIAGE was my go-to sealant, but now there’s Fuji TRIAGE EP for extra protection, and that sealant contains Recaldent. And glass-ionomer-based sealants are amazing for many reasons, one of which that they can be recharged with fluoride varnish treatments and can be now recharged with Recaldent-based treatments. So this sealant will not only protect the tooth, but it will also provide functional benefits to the tooth structure underneath and adjacent to that sealant.
There are other products probably coming out that contain Recaldent. I won’t give too much away, but I will tell you to keep your eyes and ears open because I think there’s a few other things coming out as well.
MI Paste, MI Paste ONE, MI Paste Plus, MI Varnish, and Fuji TRIAGE EP are all products of GC America. So, next time you’re at work and you’re conducting your exam and your risk assessments, ask yourself “would this patient benefit from Recaldent technology?” If your practice is like mine, the answer most of the time is yes.
So I find these products to be very well accepted by my patients. They taste good, they’re easy to use, and they’re a win-win for pretty much every patient population. So give it a thought and check it out, and I hope that you got something out of this.
Until next time, have a great day.
Michelle Strange: Thanks for listening to another TIPisode, and thank you to GC America for sponsoring this week’s episode. You can find out more about their great products at gcamerica.com. And don’t forget to hit the “subscribe” button in your podcast app, follow us on Facebook or Instagram, and head over to our website, ataleoftwohygienists.com, to sign up for our newsletter. We always appreciate ratings and reviews. Thanks again for listening to your unofficial dental hygiene podcast.