What are the benefits of using MI Paste Plus (RECALDENT (CPP-ACP) and Fluoride) in patients at high risk of tooth decay?

Benefits of MI Paste Plus for High-Risk Dental Caries Patients

MI Paste Plus provides dual-mechanism caries prevention through combined calcium-phosphate remineralization and fluoride protection, making it particularly valuable for high-risk patients who require additional fluoride measures beyond standard toothpaste, as recommended by CDC guidelines for targeted intensive prevention. 1

Primary Benefits

Remineralization of Existing White Spot Lesions

• MI Paste Plus reduced existing white spot lesions by 53.5% over 12 weeks in orthodontic patients, while placebo paste resulted in a 91.1% increase in lesions 2
• The product demonstrated a 44.8% reduction in ICDAS scores (comprehensive caries assessment) compared to a 43% increase with placebo 2, 3
• Gingival surfaces showed the most dramatic improvement, where white spot lesions are typically most problematic during orthodontic treatment 2

Prevention of New Demineralization

• MI Paste Plus prevented development of new white spot lesions during active orthodontic treatment, a period of particularly high caries risk 2
• The combination of CPP-ACP and 900ppm fluoride provides protection against enamel demineralization during erosive-abrasive challenges 4

Mechanism of Action

Dual Protection Strategy

• The CPP-ACP component delivers bioavailable calcium and phosphate ions directly to tooth surfaces, promoting remineralization of subsurface lesions 2, 5
• The 900ppm fluoride provides the frequent low-dose fluoride exposure that CDC guidelines identify as optimal for caries prevention 1
• This combination addresses the CDC recommendation that "frequent exposure to small amounts of fluoride each day will best reduce the risk for dental caries in all age groups" 1

Immediate Protection Without Waiting

• Both fluoridated and CPP-ACP toothpastes are equally effective in protecting enamel hardness, and delaying toothbrushing after erosive exposure offers no protective benefits 4
• The product can be applied immediately after acid exposure without concern for timing 4

Target Patient Populations

High-Risk Patients Requiring Additional Fluoride Measures

• CDC guidelines specifically state that "for persons at high risk for dental caries, additional fluoride measures might be needed" beyond standard fluoride toothpaste 1
• High-risk patients include those with low socioeconomic status, limited dental care access, history of high caries, reduced salivary flow, or poor oral hygiene 6
• Patients with low salivary buffering capacity require enhanced fluoride exposure and strict dietary acid limitation 7

Orthodontic Patients

• Orthodontic patients face elevated demineralization risk due to plaque accumulation around brackets and bands 2
• MI Paste Plus demonstrated significant efficacy specifically in this population during the 12-week active treatment period 2, 3

Patients with Active White Spot Lesions

• The product is particularly beneficial for patients with existing early carious lesions requiring reversal 2
• Exposed root surfaces represent another high-risk scenario where additional fluoride measures are warranted 6

Application Protocol

Recommended Usage

• Apply using a fluoride tray for 3-5 minutes daily at night after brushing with regular fluoride toothpaste 2, 3
• This timing maximizes overnight contact time when salivary flow is reduced 2
• The tray delivery method ensures adequate coverage and contact time with tooth surfaces 2

Integration with Standard Care

• MI Paste Plus should be used in addition to, not as a replacement for, twice-daily brushing with fluoride toothpaste (1,000-1,100 ppm fluoride) 6
• Patients should know their community water fluoride concentration, as this influences total fluoride exposure 1, 6

Important Caveats and Limitations

Evidence Quality Considerations

• A 2015 systematic review found limited evidence to support widespread use of MI Paste products for general caries prevention, noting that most studies showed no significant benefits over fluoride toothpaste alone 5
• A 12-month follow-up study found no significant difference between MI Paste Plus and placebo for long-term remineralization after orthodontic treatment, though both groups showed improvement 8
• The strongest positive evidence comes from a single 12-week trial in orthodontic patients, which had relatively small sample size (50 completers) 2, 3

Clinical Context

• The product appears most effective during active high-risk periods (such as during orthodontic treatment) rather than for long-term maintenance 2, 8
• Non-compliance significantly impacts effectiveness, as demonstrated by dropout rates in clinical trials 8

Safety Considerations for Young Children

• For children aged <6 years, carefully weigh fluoride exposure from all sources to minimize enamel fluorosis risk 1
• The CDC recommends that dentists consider community water fluoride levels and other fluoride sources before recommending additional fluoride products for young children 1
• Children with casein allergy (IgE-mediated) should not use this product 3

Fluoride Toxicity Awareness

• The "probably toxic dose" of fluoride is 5.0 mg/kg body weight for a 70 kg adult 6
• Normal safe intake levels are up to 4 mg/day for men and 3 mg/day for women 6
• When using multiple fluoride sources, monitor total daily fluoride intake 6

Role in Comprehensive Caries Management

Positioning in Treatment Algorithm

• MI Paste Plus functions as an adjunctive high-concentration fluoride product for targeted use in high-risk patients, consistent with CDC recommendations to "apply high-concentration fluoride products to persons at high risk for dental caries" 1
• It should not replace professionally applied fluoride gel, foam, or varnish for patients requiring maximum protection 1
• The product is most appropriate when standard preventive measures (fluoridated water, twice-daily fluoride toothpaste) prove insufficient 1

Cost-Effectiveness Considerations

• While fluoride toothpaste is identified as "a cost-effective way to reduce the prevalence of dental caries," additional products like MI Paste Plus represent increased cost 1
• Reserve use for genuinely high-risk patients where the additional benefit justifies the expense 1