Effects of a Topical Crème Containing CPP-ACP with Fluoride (Tooth Mousse Plus™) on Dental Plaque during Orthodontic Treatment

Recent studies have shown prebiotic effects of casein phosphopeptides on dental plaque microflora in orthodontic patients. The aim of this study was to assess dental plaque ecological changes in orthodontic patients that resulted from the application of a topical creme containing casein phosphopeptides and 900 ppm fluoride (GC Tooth Mousse Plus™) (TMP) over a 4-week period. In this study, orthodontic patients being treated with fixed appliances were randomized to 3 groups; 21 received TMP, 22 received a placebo, and 21 were untreated controls. Subjects applied TMP once daily at bedtime. Plaque was stained with GC TriPlaque ID Gel at baseline and after 28 days. Areas of thin (pink), mature (violet) and acid producing (light blue) plaque biofilm in the cervical half of the maxillary anterior teeth were analyzed in a blinded manner, tracking each site over time. The plaque composition at the site with the strongest acid production was assessed using molecular methods (RT-qPCR) for 14 bacterial species. TMP caused a significant reduction in total plaque area, mature plaque area, and acid producing plaque area (all p values < 0.0001). A dose response relationship was noted for these TMP effects, with low users (mean 0.11 g/day) having less changes in plaque acid production than high users (mean 0.30 g/day). On the other hand, more total, mature and acid-producing plaque was seen in the placebo and control groups. With TMP, samples of the most acidogenic plaque had increased levels of the health-related bacterial species Streptococcus salivarius. An opposite trend was seen in both the placebo and control groups. Thus, daily use of TMP exerts beneficial ecological effects on dental plaque composition and metabolism in orthodontic patients.