Lecture: CPP/ACP

Topics:
o The role of Saliva
o What is CPP-ACP?
o Tooth Mousse and Tooth Mousse Plus
o Indications for Use
o Evidence
o Other Calcium & Phosphate Technologies
Some Basic Principles of Saliva
o Demineralization and Remineralisation
are pH Driven
o Increase alkalinity= higher number. &
vice versa.

o Statherin is the main salivary protein that

fulfills this role
o Without Statherin, saliva cannot protect
teeth.

Casein Phosphopeptides (CPP) COWW

o Milk Protein
o Developed by Prof Eric Reynolds at
Univesrity of Melbourne.
o C
P
P

is an excellent delivery vehicle to colocalise Calcium and Phosphate at the

tooth surface in a slow release
amorphous
form;
CPP-ACP.
o Watch a
video on Tooth
Mousse !
F
o Teeth do not decay, they dissolve!
o Teeth CAN remineralise.
o Saliva contains: calcium and phosphate
SO it CAN build hydroxyapatite and keep
our teeth healthy!
Protein:
o Special proteins in saliva package up the
calcium and phosphate so that it doesnt
start crystallizing.

Total Levels of Calcium and Phosphate:

Effect of Tooth
mousse Plus and
Cervitec Gel on S.
mutans
o Aim: Test
the efficacy
of Tooth
Mousse Plus

against S. mutans and to

compare it with that of Cervitec
Gel
o Method: Daily application of
either TMP+ or Cervitec gel with
plaque analysis prior to starting
and following 15 day treatment.
o Results: Reduction in the count
of s. mutans following
application was found to be significant
those at risk of developing caries could
benefit from regular and prolonged
application of TMP+
o Subramaniam P1, Naidu P1: effect of
tooth mousse plus and cervitec gel on S.
mutans. Oxford Dental College, Hospital
and research centre, Bangalore, India.
CPP-ACP Treatment of Dentine

o
C

o
l
r

ea

White Mint
o Wisteria Grape
Whats the difference b/w Tooth Mousse and
Tooth Mousse Plus?
o Tooth Mousse contains: 10% CPP-ACPCasein phosphopeptide- amorphous
calcium phosphate
o Tooth Mousse Plus: contains all the
benefits of TM PLUS fluoride
Tooth Mousse Plus:
o PLUS CONTAINS:
o 10% CPP-ACP & 0.2% NaF (900 ppmF)
o Combined together they form CPP-ACPF
(Casein phosphopeptide- amorphous
calcium phosphate fluoride)

CPP-ACP (Recaldent)TM
o Helps to maintain a state of
SUPERsaturation of Calcium and
Phosphate ions on the tooth surface.
o Depressing enamel demineralisation
o ENHANCING remineralisatin
o Buffers plaque pH
o Safe (unless you have a Milk Protein
allergy or Benzoate allergy)
o Tastes good
Recaldent Chewing gum range:

In Preventive Dentistry: TM+

o To counteract any lifestyle issues

o Beer/wine,
sport
drink/coke,
smoking,
coffee

In Paediatric
Dentistry: TM
o

During
o
o
o
o

Pregnancy: TM
Hormonal changes
Impacts on saliva
Reflux
Morning sickness

In Periodontics: TM+
o TO protect exposed root surfaces

During Orthodontic Treatment TM &

TM+
o Cleaning difficult
o High plaque retention
o Increase levels of Strep Mutans
o Increased risk factors
o Decalcification

In Prosthodontics : TM+
o Maintenance to prevent caries recurrence
o Restorations per se will NOT prevent or
eliminate disease. Until the micro flora is
controlled, all restorations are at risk of
FURTHER demineralisation.
After Orthodontic Treatment: TM & TM+
o Before: loss of minerals white spots
o After: a 5 minute application 2x daily
produced these results ~1 month later

A Randomized Clinical Trail of MI Paste Plus

Usage in Orthodontics:
o In addition to normal hygiene practice 60
orthodontic patients undertook a 20 min
tray application of MI paste Plus or
Placebo for 3 months
o Results:
50 Patients (26 MI Paste Plus and
24 Placebo Paste) completed the
study. The EDI (Enamel
Decalcification Index) scores in
the :
MI Paste Plus group reduced
by 53.5% whilst the
Placebo group increased by
91.1% during the study
period.
o Conclusions:
MI Paste Plus appears to have a
preventive action of white spot
development during orthodontic
treatment.
MI Paste Plus appears to decrease
the number of white spot lesions
during the orthodontic treatment.

For Medically Compromised or Special

Needs Patients: TM & TM+
o Patients suffering from medical
conditions that impact oral health
o Diabetics, Asthma sufferers, HIV, etc

Effect of CPP-ACPF Paste on Oral

Complications Induced by Chemotherapy
o Objective: the aim of this study which is
considered as a pilot study in this area,
was to evaluate the effect of CPP-ACPF
paste on oral and salivary status of
patients undergoing chemotherapy.
o Result: Application of CPP-ACPF paste
twice daily didnt cause any significant
difference in oral complications of
participants but significantly increased
the resting and stimulated saliva rate and
saliva buffering capacity in day 21 and
42.
o Conclusion: Results of this study showed
that application of CPP-ACPF paste could
be considered as a useful method to
improve the salivary status of patients
undergoing chemotherapy.
For Geriatric Patients: TM+
o More gingival recession
o More salivary dysfunction
o Impact of medical
conditions
For Tooth Whitening TM+
o Sensitivity
o Replaces lost mineral

o Improving your bleaching results. One

week after in office bleach and home
bleach kit use.
o 3 months use of GC tooth mousse
o Improving translucency and brightness
o Ie 2 weeks home bleach 2x/daily GC TM
for 2x months was compliant.

For Reversing White Spot Lesions TM+

Active Lesions:
o In surgery application of TM
o Morning and night use of TM
o Daily use CPP ACP sugar free gum (after
meals and snacks)
Inactive or Arrested Lesions: TM+
o In surgery bleaching, acid etch and/or
microabrasion
o In surgery application of TM
o Morning and night use of TM
o Daily use of CPP-ACP sugar free gum
(after meals and snacks)
For treatment of Fluorosis TM+

In Surgery Topical Fluoride

Application TM+
o More effective uptake of
fluoride using TM+ than
using a higher dose
fluoride alone

How Does the Patient Apply it at Home?

o For routine application the best time to
apply tooth mousse plus is just PRIOR TO
RETIRING TO BED.
o 1. Smear TM across CLEAN tooth surfaces
with a FINGER or COTTON tipped
applicator
o 2. Hold in the mouth for 3 minutes (saliva
will be stimulated) then expectorate the
excess
o 3. DO NOT RINSE
o 4. Residual material is bound to tooth and
soft tissue and left to slowly dissipate
overnight.

Intra Oral Appliance

Below: see pictures of
demin/remin/fluoride in notes, not that
important.

Recaldent CPP-ACP tech is based on 25+ years

of research. TM can be used on patients of all
ages. TM+ is the ideal fluoride delivery system.
ITEM NUMBERS FOR USE:*******