3M, GC America and Sultan are driving me crazy! My poor Atlanta Dental Rep is trying his darnedest to help our office figure out which product we want to go with in our office.  Last month we had the GC America MI Paste lady (RDH) at our office for a “lunch-n-learn”, and then the next week we had the 3M guy here for another “lunch-n-learn”.  We love the products from both of these companies, I just need to know which one to give to my patients.  Then out of the blue the representative from Sultan came in on her own showing us their alternative product called Topex Renew.  Geez!

ClinPro 5000:Clinpro5000 tube 3M Clinpro 5000 vs. GC MI Paste vs. Sultan Topex Renew: Who knows which is better? Its a Mystery

The ingredients in 0.3g (pea size) contains approximately 1.5mg of fluoride ion in a neutral pH base, consisting of water, sorbitol, hydrated silica, glycerin, polyethylene-polypropylene glycol, flavor, polyethylene glycol, sodium lauryl sulfate, titanium dioxide, carboxymethyl cellulose, sodium saccharin and tri-calcium phosphate.

When bacterial acids dissolve the calcium phosphates of the outer surfaces of the tooth it can leave behind demineralized white spot lesions that can eventually lead to tooth decay. Clinpro 5000 contains 1.1% sodium fluoride, and tri-calcium phosphate.

During the manufacturing process tri-calcium phosphate is mixed with a foam that gets hard and then is milled into tiny pieces.  This essentially encapsulates the tri-calcium phosphate in a protective barrier so when mixed with fluoride, they do not interact with each other to degrade one another for up to a two year shelf life.

When used as toothpaste the saliva, and brushing breaks down the tri-calcium phosphate’s protective barrier and becomes available for the tooth to absorb.  These products in turn remineralize the tooth as the fluoride strengthens, and protects the tooth from further acid erosion.  This reverses white spot lesions, and strengthens enamel by providing maximum fluoride benefits while gently cleaning, and whitening the teeth.

The above is paraphrased right from their website, and clinical literature provided by their representative.

MI Paste:

MI Paste ingredients are pure water, glycerol, CPP-ACP, D-sorbitol, CMC-Na, propylene glycol, silicon dioxide, titanium dioxide, xylitol, phosphoric acid, (sodium fluoride in the MI Paste Plus only, 0.5mL (pea size) of MI Paste Plus will contribute 0.45mg of fluoride ion), flavoring, zinc oxide, sodium saccharin, ethyl p-hydroxybenzoate, magnesium oxide, guar gum, propyl p-hydroxybenzoate, butyl p-hydroxybenzoate. (Available in mint, vanilla, strawberry, melon, tutti-frutti).

RECALDENT™ (CPP-ACP) is the active ingredient and it is derived from cows milk. Casein phosphopeptides (CPP) and amorphous calcium phosphate (ACP) are highly insoluble.  Peptides maintain the calcium and phosphate in an ionic state, preventing insoluble calcium phosphate from forming.  This enables calcium and phosphate ions to enter the tooth structure and remineralize hypomineralized enamel rods.  It further binds to plaque reservoirs in the mouth that provide calcium and phosphate to the tooth surface for a longer period of time.

They claim that when remineralizing the white spot lesions of a tooth that too much fluoride can actually get in the way.  While a small amount of fluoride can actually help catalyze the process of remineralization, too much can precipitate out the calcium and phosphate into a insoluble salt preventing the absorption of either calcium or phosphate into the white spot lesion.

The other products are actually toothpastes, but MI Paste is not.  Because of the sticky milk proteins used, it is smeared onto the teeth with your finger.  If you used a toothbrush to place it onto the teeth then most of it would stick to the brush and not the teeth.  This can and does cause some confusion with dental patients, and dental professionals alike.  I have noticed that this point is exploited by their competitors.  Maybe is should not have been called a paste in the first place since it has been engrained into the populations psyche over the years that paste goes on a toothbrush.  Go figure.

Screen shot 2011 02 14 at 6.25.22 PM 3M Clinpro 5000 vs. GC MI Paste vs. Sultan Topex Renew: Who knows which is better? Its a Mystery

Screen shot 2011 02 14 at 6.25.56 PM 3M Clinpro 5000 vs. GC MI Paste vs. Sultan Topex Renew: Who knows which is better? Its a Mystery

Screen shot 2011 02 14 at 6.26.13 PM 3M Clinpro 5000 vs. GC MI Paste vs. Sultan Topex Renew: Who knows which is better? Its a Mystery

Screen shot 2011 02 14 at 7.12.16 PM 3M Clinpro 5000 vs. GC MI Paste vs. Sultan Topex Renew: Who knows which is better? Its a Mystery

Topex Renew:sultan topex renew ad30222 3M Clinpro 5000 vs. GC MI Paste vs. Sultan Topex Renew: Who knows which is better? Its a Mystery

Active ingredient is 1.1% sodium fluoride, with inactive glycerine, polyethylene glycol, calcium sodiumphosphosilicate (NovaMin), silica, sodium lauryl sulfate.

They take the marketing point to call themselves the “All-in-One” product which centers itself between all the other competing brands.

NovaMin is made up of calcium, sodium, phosphorus, and silica to make a chemical compound named calcium sodiumphosphosilicate.  When in contact with the water in saliva NovaMin forms a crystalline hydroxyl-carbonate apatite product that is identical to that of the tooth. NovaMin also has desensitizing and anti-microbial characteristics.

NovaMin is not proprietary to just Sultan.  It is going to be a compound that is placed in many dental products from dental floss, chewing gum, resorbable breath strips, including product manufactured by 3m/Omni, Sultan Healthcare, and Dentsply.  As early as 2008, Dentsply placed NovaMin in their top prophy paste product, Nupro.

NovaMin1 732x1024 3M Clinpro 5000 vs. GC MI Paste vs. Sultan Topex Renew: Who knows which is better? Its a MysteryNovaMin 3M Clinpro 5000 vs. GC MI Paste vs. Sultan Topex Renew: Who knows which is better? Its a Mystery

Colgate Prevident 5000 Booster:COL00751 3M Clinpro 5000 vs. GC MI Paste vs. Sultan Topex Renew: Who knows which is better? Its a Mystery

Active Ingredient: Sodium fluoride (NaF) 1.1% (w/w)

Inactive Ingredients: Spearmint flavor: purified water, sorbitol, hydrated silica, PEG-12, sodium lauryl sulfate, sodium phosphate monobasic, flavor, xanthan gum, tetrapotassium pyrophosphate, sodium benzoate, sodium saccharin, mica, FD&C Blue #1. Fruitastic* flavor: sorbitol, purified water, hydrated silica, PEG-12, sodium lauryl sulfate, sodium phosphate monobasic, xanthan gum, tetrapotassium pyrophosphate, sodium benzoate, flavor, sodium saccharin, mica, D&C Red #33

This product has no special claims other than significant remineralization of root caries in as little as three months (38%) and six months (57%).  They do have a product that contains 5% potassium nitrate for tooth sensitivity like Senodyne, and another that is SLS-free formula (sodium lauryl sulfate) for those with dry mouths and who are prone to have aphthous ulcers, but no claims of special weapons for white spot lesions, just the same amount of fluoride as Clinpro 5000.

I’ll tell you I like them all!  Sodium lauryl sulfate is a problem for some of my patients; the MI Paste needs some explaining and re-education; I don’t like it when a dental product doesn’t have xylitol in it, I really like all the benefits of NovaMin, and the 1.1% fluorides are pretty strong.  I’ll think it all over, and get back to you later…  Now I’m going to hammer out prices with them!

References:

1. IN VITRO EVALUATION OF CASEIN PASTE CYTOTOXICITY – MI PASTE. SK. Bussadori, FERNANDES KPS, GUEDES CC, MARTINS MD, SANTOS EM

2. Casein Phosphopeptide-Amorphous Calcium Phosphate Paste: Root Surface Caries Formation. J. HICKS, Baylor College of Medicine, Houston, TX, USA, and C. FLAITZ, University of Texas – Houston / Health Science Ctr, USA

3. The Effects of Casein-Phosphopeptide-Amorphous-Calcium-Phosphate Paste on Plaque Calcium and Phosphate. C. AMORNPIPITHKUL, S. SANGUANSIN, and P. LEELATAWEEWUD, Mahidol University, Bangkok, Thailand

4. Dentine Bonding Following Casein Phosphopeptide Amorphous Calcium Phosphate Paste ApplicationO. ADEBAYO, M. BURROW, and M. TYAS, University of Melbourne, Melbourne VIC, Australia

5. Amorphous Calcium Phosphate-Casein Phosphopeptide Paste: Effect on Enamel Caries FormationJ. HICKS, Baylor College of Medicine, Houston, TX, USA, and C. FLAITZ, University of Texas Dental Branch – Houston, USA

6.  CPP-ACP Paste and ACP-Fluoride Varnish: In Vitro Root Caries. F. GARCIA-GODOY, C.E. GARCIA-GODOY, C.M. FLAITZ, and J. HICKS, Nova Southeastern University, Fort Lauderdale, FL, University of Texas – Houston/Health Science Center, Houston, TX, Baylor College of Medicine, Houston, TX

7. Effect of Argon Laser and Remineralizing Paste on Root Caries. G. WESTERMAN, Creighton University Medical Center School of Dentistry, Omaha, NE, C. FLAITZ, University of Texas Houston/Health Science Center, Houston, TX, G. POWELL, University of Utah, Salt Lake City, UT, and J. HICKS, Baylor College of Medicine, Houston, TX

8. Effect of CPP-ACP Paste and Fluoride Gel on Eroded Enamel. U. KALLAYATHI, M. PANICH, and S. POOLTHONG, Chulalongkorn University, Bangkok, Thailand

9. SEM evaluation of casein phosphopeptide-amorphous calcium phosphate-treated and conditioned enamel. O. ADEBAYO, M. BURROW, and M. TYAS, University of Melbourne, Melbourne VIC, Australia

10. Resin Bonding to Dentine After Casein Phosphopeptide-Amorphous Calcium Phosphate TreatmentsV. SATTABANASUK, M. BURROW, Y. SHIMADA, and J. TAGAMI, Srinakarinwirot University, Bangkok, Thailand, University of Melbourne, Melbourne VIC, Australia, Tokyo Medical & Dental University, Tokyo, Japan

11. Argon Laser and Remineralizing Paste Effect on Root Surface Caries. G. WESTERMAN, Creighton University Medical Center School of Dentistry, Omaha, NE, USA, J. HICKS, Baylor College of Medicine, Houston, TX, USA, C. FLAITZ, University of Texas Houston / Health Science Ctr, USA, and G. POWELL, University of Utah, Salt Lake City, USA

12. Remineralization Potential of Casein Phosphopeptide-Amorphous Calcium Phosphate—- Confocal Microscopy Study
E.C. KAO1, S. HODNETT2, P. NGAN1, C. MARTIN1, and E. GUNEL3, 1West Virginia University School of Dentistry, Morgantown, WV, 2private practice, Morgantown, WV, 3West Virginia University, Morgantown, WV

13. CPP-ACP Paste with Fluoride: In Vitro Root Surface Caries Formation
C.P. TRAJTENBERG, University of Texas – Houston/Health Science Center, USA, C. FLAITZ, University of Texas Houston / Health Science Ctr, USA, and J. HICKS, Baylor College of Medicine, Houston, TX, USA

14. Remineralization of Eroded Teeth Using CPP-ACP Paste
A. HUANG, and D. TANTBIROJN, University of Minnesota, Minneapolis, USA

15. Artificial Caries Inhibited with MI Paste and Two Restorative Materials
S. WRIGHT, J.O. BURGESS, L.C. RAMP, and P. BECK, UAB School of Dentistry, Birmingham, AL, USA

16. Effect of CPP-ACP Paste on Demineralization of Bovine Tooth
T. TAKAMIZAWA1, K. YAMAGUCHI1, M. MIYAZAKI1, K. HINOURA2, and B.K. MOORE3, 1Nihon University, Tokyo, Japan, 2Hinoura Dental Clinic, Tokyo, Japan, 3University of Indiana – Indianapolis, USA

17. COMPARISON OF TOOTH MOUSSE (MI PASTE) WITH CLINPRO IN SITU
E. REYNOLDS, F. CAI, P. SHEN, G. WALKER, Y. YUAN, N. COCHRANE, D. MANTON, and C. REYNOLDS, Oral Health CRC, Melbourne Dental School, University of Melbourne, Melbourne, Australia

18. Remineralization of Artificial Caries by CPP-ACP Paste
U. THEERAPIBOON, R. PUANAIYAKA, and C. MANEENUT, Chulalongkorn University, Bangkok, Thailand

19. Incorporation of Casein Phosphopeptide-Amorphous Calcium Phosphate into a Temporary Cement
R. WONG1, J. PALAMARA2, and P.R. WILSON2, 1Cooperative Research Centre for Oral Health, University of Melbourne, Melbourne, Australia, 2University of Melbourne, Australia

20. CALCIUM-CONTAINING REMINERALIZING GEL AND PASTE EFFECTS ON ROOT CARIES
J. HICKS, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, and C. FLAITZ, Department of Diagnostic Sciences, University of Texas at Houston, Houston, TX

21. Preventing Acid Induced Enamel Demineralization Using CPP-ACP Containing Paste
Y. SAKAGUCHI, S. KATO, T. SATO, S. KARIYA, and L. CHEN, GC corpolation, Tokyo, Japan

22. Enamel Hardening Properties of Two Dental Pastes
V.J. SETIEN, M. KOIKE, P. RAGHUNATH, and K. AJLOUNI, Baylor College of Dentistry, Dallas, TX

23. In-vitro Remineralization Effect of Calcium-Containing Pastes in Enamel Lesions
T. SMITH, M. FONTANA, and C. GONZALEZ-CABEZAS, Indiana University School of Dentistry, Indianapolis, IN

24. INSTANT/LASTING DENTIN HYPERSENSITIVITY REDUCTION EFFICACY OF TWO PROFESSIONALLY-APPLIED DESENSITIZING PASTES
Y. LI1, S. LEE1, E. DELGADO2, Y.P. ZHANG2, W. DE VIZIO2, and L.R. MATEO3, 1Loma Linda University School of Dentistry, CA, USA, Loma Linda, CA, 2Colgate Palmolive Technology Center, Piscataway, NJ, 3LRM Statistical Consulting, Hoboken, NJ

25. Calcium-Containing Remineralizing Gel and Paste Effects on Root Caries
J. HICKS, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, and C. FLAITZ, Department of Diagnostic Sciences, University of Texas at Houston, Houston, TX

26. Effect of CPP-ACP and adhesive procedures on µTBS of sealant
F.H.B. AGUIAR1, B.C.D. BORGES2, A. CATELAN3, R. SASAKI2, G.M.B. AMBROSANO4, J.R. LOVADINO2, and A.F. REIS5, 1Restorative Dentistry, Piracicaba Dental School / State University of Campinas, Piracicaba / SP, Brazil, 2Restorative Dentistry, Piracicaba Dental School, State University of Campinas, Piracicaba, Brazil, 3Piracicaba Dental School, State University of Campinas, Piracicaba, Brazil, 4Piracicaba Dental School -University of Campinas – UNICAMP, Piracicaba, SP, Brazil, 5Department of Operative Dentistry, Guarulhos University, Guarulhos, SP, Brazil

27. Comparison of Tooth Mousse (MI Paste) with Clinpro in situ
E. REYNOLDS, F. CAI, P. SHEN, G. WALKER, Y. YUAN, N. COCHRANE, D. MANTON, and C. REYNOLDS, Oral Health CRC, Melbourne Dental School, University of Melbourne, Melbourne, Australia

28. Fluoride Varnish and CPP-ACPF: Effect on Enamel Resistance to Demineralization
S. BANAVA1, S. TOGHYANI1, B.T. AMAECHI2, and M. SAFAIE YAZDI1, 1Islamic Azad University, Dental branch, Department of Restorative Dentistry, Tehran, Iran, 2Department of Comprehensive Dentistry, University of Texas – San Antonio / Health Science Ctr, San Antonio, TX

29. Calcium-Containing Remineralizing Gel and Paste Effects on Root Caries
J. HICKS, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, and C. FLAITZ, Department of Diagnostic Sciences, University of Texas at Houston, Houston, TX

30. Instant/Lasting Dentin Hypersensitivity Reduction Efficacy of Two Professionally-Applied Desensitizing Pastes
Y. LI1, S. LEE1, E. DELGADO2, Y.P. ZHANG2, W. DE VIZIO2, and L.R. MATEO3, 1Loma Linda University School of Dentistry, CA, USA, Loma Linda, CA, 2Colgate Palmolive

31. Can Fluoridated Toothpaste and CPP-ACP Reduce Enamel Softening from pH-cycling?
D. TANTBIROJN, D.G. AUGUSTSON, and A. VERSLUIS, University of Minnesota, Minneapolis, USA

32. Progression of erosion following use of calcium and phosphorus compounds
C.P. TURSSI, F.A. MAEDA, D.C.F. MESSIAS, F.C. REHDER NETO, D. GALAFASSI, and M.C. SERRA, Universidade de São Paulo – School of Dentistry of Ribeirão Preto, Brazil

33. Remineralization Effects of Grape Seed Extract on Artificial Root Caries
Q. XIE, A.K. BEDRAN-RUSSO, and C.D. WU, University of Illinois at Chicago, USA

34. Remineralization Effects of CPP-ACP and Proanthocyanidin on Artificial Root Caries
Q. XIE, C.D. WU, and A.K.B. BEDRAN-RUSSO, University of Illinois at Chicago, USA

35. After Bleach Treatments for Reducing Roughness by SPM
T. TOKO1, K. TAMAOKA1, A. IMAIZUMI1, H. HISAMITSU1, M. NISHIO2, and T. ARAKAWA2, 1Showa University, Tokyo, Japan, 2SANGI Co., Ltd, Tokyo, Japan

36. Efficacy of Hypersensitivity Agents on Demineralization under Provisional Crowns
L. FREML, C. STANFORD, J.D. HARLESS, M. HOGAN, F. QIAN, and J.S. WEFEL, University of Iowa, Iowa City, USA

37. Remineralization Potential of CPP-ACP and Its Synergy with Fluoride
Y. SAKAGUCHI, S. KATO, T. SATO, S. KARIYA, S. NAGAO, and L. CHEN, GC Corporation, Tokyo, Japan

38. Effect of CPP-ACP on bacterially induced demineralization
T. SATO, E. YASUDA, S. KATO, E. YOSHII, and T. SAKUMA, GC Corporation, Tokyo, Japan