Can Tooth Mousse reverse white spot lesions?
Tooth Mousse can rebuild subsurface areas of defects in enamel, including white spot lesions from dental caries, white spot lesions associated with orthodontic treatment and fluorosis. In these defects, there are subsurface voids which can be very effectively remineralised by application with Tooth Mousse, and this has been shown using optical and also radiographic tests at the University of Melbourne. For some white spot lesions it may be necessary to first pre-treat the lesion before application of Tooth Mousse. This pre-treatment may involve bleaching, acid etching or microabrasion. Recent research at the Dental School at the University of Melbourne has demonstrated that pre-bleaching is an effective pre-treatment for Tooth Mousse application.
Can Tooth Mousse be used in patients with dental erosion?
Tooth Mousse is extremely effective at remineralising erosion areas, and can be used in patients who have gastro esophageal reflux disease, or eating disorders such as bulimia in order to protect these areas from dental erosion. If the saliva in the mouth is of good quality, as shown by saliva profiling, then fluoride is able to promote limited remineralisation because calcium and phosphate is present. However, fluoride will ineffectively remineralise teeth if the salivary flow is inadequate, because of the low levels of calcium and phosphate. Tooth Mousse provides bioavailable calcium and phosphate ions at the tooth surface at much higher levels than can be maintained by normal salivary flow. Therefore Tooth Mousse is recommended even for patients with normal salivary flow.
What about caries in children?
In terms of the question of caries prevention in children, APF is not recommended for use by children under 7 years of age, since this may cause nausea and has a poor toxicology profile. It may be ingested in amounts that can cause gastric upset through the creation of hydrofluoric acid. If there are white spot lesions in children, professional neutral fluoride application and/or weekly 0.2% chlorhexidine gel can be used to reduce the levels of mutans streptococci, in combination with Tooth Mousse. Because of toxicology considerations, the extensive use of fluoride by young children, is contraindicated, e.g. products such as Neutrofluor 5000 Plus have labeling that explicitly states that they are not to be used by children. Thus, for the high-caries risk child, Chlorhexidine gel used in the morning and Tooth Mousse at night after flossing and brushing with a 500 ppm fluoride toothpaste is an excellent protocol.
Is a one-off application of Tooth Mousse beneficial?
Yes, particularly after and/or with a professional fluoride application because Recaldent® CPP-ACP (Tooth Mousse) promotes the uptake of fluoride ion by tooth enamel. Tooth Mousse may also be used for a patient who has a sensitivity problem. Tooth Mousse could be used as a single application for a patient who had cervical dentinal hypersensitivity where most of the issues of lifestyle were comfortably addressed at that same visit. If one had concerns about compliance, then the patient could be given Tooth Mousse to take home with them.
What time of day is best to use with Tooth Mousse?
In terms of the binding properties of Tooth Mousse, CPP-ACP binds to oral soft tissues, to dental pellicle and also to plaque. This binding elevates the salivary levels of calcium and phosphate for extended periods. For this reason, Tooth Mousse works best in patients when it is applied at night before bed, since the salivary clearance rate is low during sleep. In patients who need intensive treatment, then a twice daily application is sufficient in most individuals. It is recommended that Tooth Mousse be applied immediately after flossing and brushing with a 1000 ppm fluoride toothpaste, particularly at night before bed.
Recaldent® CPP-ACP, the active ingredient of Tooth Mousse, is extremely effective for desensitizing, and this is due to the combination of surface effects and its ability to remineralise hard tissues.
Some patients who have generalized cervical dentinal hypersensitivity, may also have dental erosion, and thus one needs to look carefully at their lifestyle (using particularly the resting salivary parameters) to gain insight into whether they have sub-clinical dehydration.
Should Tooth Mousse be used after every fluoride treatment in the surgery?
Yes, studies at the University of Melbourne have demonstrated that Recaldent® CPP-ACP significantly increases the uptake of fluoride into the tooth enamel creating fluorapatite that is more resistant to acid challenge. Thus Tooth Mousse is recommended for treatment of patients of both high and low caries risk.In terms of a patient who has a low caries risk, a six monthly application of neutral sodium fluoride gel followed by Tooth Mousse is recommended.
In patients who use no fluoride products, Recaldent® CPP-ACP will still be effective, since in all patients there are halo effects of fluoride in the diet, for example, from tea and from many of the processed foods that are made in Sydney and Melbourne where there is a small fluoride component to the foods. CPP-ACP is able to remineralise tooth structure in the complete absence of fluoride, and this is through the formation of hydroxyapatite.
Is Tooth Mousse alone an alternative to fluoride for anti-fluoride patients?
Yes. The fact that Tooth Mousse is derived from the milk protein, casein, it is completely natural and safe and therefore is often an effective work-around for patients who are anti-fluoride.
Is Tooth Mousse the same as Topacal C-5?
Tooth Mousse is not the same as Topacal C-5. The research which has been done on CPP-ACP in Australia, which has been published in numerous dental journals around the world, is the same CPP-ACP formula in Tooth Mousse. The material which is now marketed as Topacal C-5 is chemically different from CPP-ACP.
Clinical Applications for Tooth Mousse
•White spot prevention /removal (during/after orthodontic bracket treatment).
•Post bleaching.
•Post scaling and root planing.
•Dentinal hypersensitivity.
•Treatment of erosion and incipient carious lesions.
•Caries prevention.
•Promote fluoride uptake.
Recaldent® is used under licence and permission of the owner. Recaldent® CPP-ACP is derived from milk casein and is lactose free. It should not be used on patients with milk protein allergies.