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MI Paste has a shelf life of 2 years from date of manufacture. Each tube is marked with an expiration date.
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The active ingredient in MI Paste, RECALDENT™ (CPP-ACP) is milk derived. RECALDENT™ (CPP-ACP) is a complex of casein phosphopeptides (CPP) and amorphous calcium phosphate (ACP). Calcium phosphate is highly insoluble, however the peptides are able to maintain the calcium and phosphate in an ionic form, preventing the formation of insoluble calcium phosphate and therefore enabling calcium and phosphate ions to enter the tooth matrix and strengthen areas of hypomineralized enamel. Furthermore, the peptides bind to the surface of the tooth, and to the bacteria surrounding the tooth, presenting a reservoir of ionic calcium and phosphate at the tooth surface.
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Based on the known average Ca and PO4 concentrations in saliva and plaque fluid, the critical pH for tooth enamel is reported to be between 5.2 and 5.5.
The purpose of the phosphoric acid is to buffer the CPP-ACP. MI Paste is an exceptionally good buffer of acid yet we still need the formulation to be relatively neutral to be able to get the most effective levels of remineralization to strengthen the teeth. The final pH of MI Paste is around 7.8 (slightly alkaline), without the phosphoric acid it would be higher (more alkaline) which is helpful for buffering an acidic mouth but not as effective for the remineralization strengthening process.
Phosphoric acid is used to adjust the pH of MI Paste to get it close to neutral instead of alkaline (basic).
The percentage composition of phosphoric acid is < 00.3% (ie less than .3 of one percent) so it is very small. You can imagine it is more added as a formulation "tweak" to ensure the optimum performance (phosphoric acid is a recognized food additive and antioxidant) balancing between buffering and remineralization strengthening benefits. There is absolutely zero chance/potential for demineralization.
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For some white spot lesions it may be necessary to first pre-treat the lesion before application of MI Paste. 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 MI Paste application.
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All the ingredients in MI Paste and MI Paste Plus are listed on the product's box and tube.
MI Paste: pure water, glycerol, CPP-ACP, D-sorbitol, CMC-Na, propylene glycol, silicon dioxide, titanium dioxide, xylitol, phosphoric acid, flavoring, zinc oxide, sodium saccharin, ethyl p-hydroxybenzoate, magnesium oxide, guar gum, propyl p-hydroxybenzoate, butyl p-hydroxybenzoate (available in 5 flavours: mint, vanilla, strawberry, melon and tutti-frutti).
MI Paste Plus: pure water, glycerol, CPP-ACP, d-sorbitol, CMC-Na, propylene glycol, silicon dioxide, titanium dioxide, xylitol, phosphoric acid, sodium fluoride, flavoring, sodium saccharin, ethyl p-hydroxybenzoate, propyl p-hydroxybenzoate, butyl p-hydroxybenzoate (available in 5 flavours: mint, vanilla, strawberry, melon and tutti-frutti).
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Para-hydroxybenzoate is often called as Paraben and is widely used as preservatives in the cosmetic and pharmaceutical industries, such as shampoos, lotions, toothpaste etc. They are also used as food additives. Parabens are considered to be safe, but can cause skin irritation or dermatitis on some individuals with paraben allergies.
Hydroxybenzoate: an antioxidant used in food preservation; the butylated product is the standard form of usage. Also used as a preservative in pharmaceutical preparations. Called also parabens. Saunders Comprehensive Veterinary Dictionary, 3 Ed. © 2007 Elsevier, Inc. All rights reserved.
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The reason why you wouldn't want to use it as a dentifrice is because it is "sticky" which gives it the substantivity. Having the milk protein in it, with most toothbrushes, more of it will stick to the bristles of the brush than when you use the tray or finger technique.
The patient would be wasting too much product in the bristles of the toothbrush and not on the tooth surfaces. We want the patient to get the most use out of her tube of MI Paste. Also, most people rinse after brushing and again this would defeat the benefit of MI Paste.
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Yes, you now can purchase MI Paste through your local pharmacy as long as you have a prescription from you dentist and the prescription sheet from GC America.
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Because MI Paste Plus contains a level of fluoride similar to that of adult strength toothpastes, there are issues when the material is ingested either accidentally or deliberately in children because of their low birth weight. Ingestion of a pea-size amount (0.5mL) of MI Paste Plus will contribute 0.45mg of fluoride ion to the daily fluoride intake.
In young children (up to six years of age), use of MI Paste Plus is contra indicated because it may increase the risk of dental fluorosis. Children aged six years and above can use both standard (adult strength) toothpaste (1000ppm) and MI Paste Plus without an increased risk of dental fluorosis.
CAUTION
- MI Paste Plus contains 0.2% (900ppm) fluoride; it is not recommended for children under the age of 6
- It is not recommended for overnight application in children under the age of 12
- Do not use on patients with a milk protein allergy (caesin IgE) and/or sensitivity to benzoate preservatives
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If a patient is trying to strengthen a lesion in an aesthetic area, MI Paste Plus is recommended. Adding too much fluoride to the process doesn't result in faster teeth strengthening. When it comes to enamel strengthening, less fluoride is better. A little fluoride acts as a sort of catalyst for strengthening, but too much causes the calcium and phosphate ions to precipitate prematurely.
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It is suggested to wait 2-3 hours after rinsing with antimicrobial rinses, such as Chlorhexidine Gluconate (CHX) or Cetylpyridinium Chloride (CPC) before applying MI Paste. Chlorhexidine Gluconate adheres to the tooth surface just as MI Paste. |
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Both Chlorhexidine Gluconate (CHX) and MI Paste adhere to the tooth surfaces. It has not been determined if they affect each other. It is best to wait 2-3 hours after rinsing and applying MI Paste.
As to which goes first the order is not the important factor, as long as there is sufficient amount of time between applications.
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