Louis Malcmacher, DDS, MAGD
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Let me introduce you to the wonderful world of remineralization. Let's start with this common scenario that occurs with so many of our patients - you or your hygienist are doing a clinical exam and the patient has some decalcified white spots on a number of teeth.
These may be due to wearing orthodontic appliances, the patient's having a high sugar diet, heavy plaque buildup, or for some reason not readily apparent. In addition to these white spots, or possibly not related at all, your patient has a problem with dental hypersensitivity. We all face this clinical question every day that we practice.
If you perform an invasive procedure into these white spot lesions and the tooth is a virgin tooth, you will have to restore it, and the future of this tooth includes repeating this restoration a number of times over the patient's lifetime. The restoration will get bigger, and possibly someday involve the pulp.
As we often say, every restoration grows up to be a crown. If you do nothing, chances are that lesions will cavitate anyway, but you may not feel right about cutting into this tooth at this time. This is where the wonderful world of remineralization comes into play for your patients.
These white spots really are the precursors to dental caries. The spots are produced by acids released by the bacteria that attack the enamel, leech out apatite-forming calcium and phosphate ions from the tooth, and cause demineralization. Over time, this leads to the destruction of the enamel subsurface that is seen clinically as white spots.
There is a mineral imbalance going on here and if left alone, only bad things will happen. The natural balance has shifted, with the demineralization reaction occurring over remineralization.
The wonders of ACP
Amorphous calcium phosphate, ACP, has been known for years to be able to restore this mineral imbalance by providing the necessary calcium and phosphate ions to rebuild the tooth surface. The trick here is to get the calcium and phosphate ions directly delivered to where they are needed most, which is on the enamel surface.
There needs to be a molecular delivery system to get this ACP to the tooth surface. Thankfully for our patients, this technology exists today. Recaldent™ is derived from the milk protein casein.
For many years it has been known that milk has a tooth protective effect. Research from the University of Melbourne in Australia, Dr. E. C. Reynold's group, has shown that casein phosphopeptide (CPP) can carry the amorphous calcium phosphate and bind it to enamel, dental plaque, and soft tissue, which will deliver these calcium phosphate ions exactly when and where it is needed, right up against the tooth structure.
Numerous studies have proven the effectiveness of Recaldent™ (CPP-ACP) in preventing and reversing early carious lesions seen as white spot lesions.
MI Paste Plus™ by GC America was the first product for professional use to include the amazing technology of Recaldent™. It is a water-based, sugar-free cream that is applied topically to the tooth surface.
This is a major advancement in the minimally invasive treatment of these precarious lesions. We now have a huge paradigm shift in the way that we should be thinking about treating patients with these white spot lesions.
MI Paste Plus™ has become an integral part of my daily treatment for patients. It allows me to treat these precarious lesions medically instead of surgically. We all know that both tray and in-office whitening causes significant sensitivity to patients, even with the best desensitizing formulas of whitening gels. MI Paste Plus™ is now included with every whitening treatment that I provide to eliminate the sensitivity and remineralize the enamel.
As you can see, from both a clinical and practice management perspective, using this new minimally invasive paradigm can be a terrific addition to current techniques. The success of your clinical cases is not just measured on the day you seat the case, but also on what the smile looks like five to 10 years later.
Remineralizing white spots, eliminating dentin hypersensitivity, and ensuring long-term wellness are within the realm of today's dental practice. It is truly an exciting time to be practicing dentistry.
Dr. Louis Malcmacher is a practicing general dentist and internationally known lecturer, author, and dental consultant known for his comprehensive and entertaining style. An evaluator for CLINICIANS REPORT, Dr. Malcmacher is the president of the American Academy of Facial Esthetics at facialesthetics.org. Contact him at (440) 892-1810 or e-mail [email protected]. His Web site is www.commonsensedentistry.com, where you can sign up for a free monthly e-newsletter.
