READERS' FORUM

Letters to the editor*

MI Paste Plus research

Ihave concerns about an article in the November 2011issue of the AJO-DO examining the use of MI Paste

Plus to prevent demineralization.1 It is an extremelyimportant topic; we’ve been discussing this issue inthe orthodontic literature since, well, apparently An-gle’s day, since his 1907 text was included as a refer-ence in the article. And we seem to be gettingnowhere, as evidenced by the fact that there is noless, and probably more, demineralization in ourpatients than in the past.

The article purports to show that MI Paste Plus is thelatest magic bullet to reduce demineralization, and thatthe casein phosphopeptide-amorphous calcium phos-phate ingredient causes the effect.

Strangely though, the authors completely neglectedto discuss another very active and well-studied ingredi-ent in MI Paste Plus—fluoride. The paste contains 900ppm of fluoride.2 Could this be causing the effect? So,we look at the placebo paste. “Tom’s of Maine” is statedas the placebo paste. Tom’s of Maine is a company, nota particular product. Tom’s of Maine produces 14 differ-ent dentifrices, of which 6 are fluoride-free.3 Which onewas used in this study? Who knows, since the productname was left out of the article.

Then we look at the data actually collected andshown in the article. Many of the “white spots” arenot demineralization at all. For example, in Figures 5,6, and 8, none of that is demineralization. Maybe theMI Paste Plus reduced the appearance of the incisalwhite spots (that predate the orthodontic treatment).Well, that is interesting, but that is not what the articleis about and should not have been included. We arethen left with Figures 4 and 7 to show the differencesbetween the 2 interventions. I am aware of how diffi-cult it is to get a good photograph of demineralization.However, I would assume that these 2 series of photo-graphs were the best available of the 60 patients in thestudy. I can’t tell any difference in either series fromT1 to T4.

I have nothing against MI Paste Plus, and perhaps itreally works as advertised. This article does very little toanswer the question.

Diane JohnsonMooresville, Ind

*The viewpoints expressed are solely those of the author(s) and do not reflectthose of the editor(s), publisher(s), or Association.

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Am J Orthod Dentofacial Orthop 2012;141:5260889-5406/$36.00Copyright � 2012 by the American Association of Orthodontists.doi:10.1016/j.ajodo.2012.03.001

REFERENCES

1. RobertsonMA, Kau CH, English JD, Lee RP, Powers J, Nguyen JT. MIPaste Plus to prevent demineralization in orthodontic patients:a prospective randomized control trial. Am J Orthod Dentofacial Or-thop 2011;140:660-8.

2. GC America, Inc., 2012. Available at: http://www.gcamerica.com/products/preventive/MI_Paste/FAQ.php. Accessed on January 10,2012.

3. Tom's of Maine, 2012. Available at: http://www.tomsofmaine.com/products. Accessed on January 10, 2012.

Author’s response

Thank you very much for your letter. The placebopaste used in this trial did not contain fluoride. How-

ever, it would be difficult to extrapolate from the data thatthe positive results seen in the MI Paste Plus group werea direct result from either the casein phosphopeptide-amorphous calcium phosphate, the fluoride content inthe paste, or both.

The pictures you mentioned are from a series that wecollect on every patient. The reproduction of these clin-ical pictures in print and the actual images that we ob-served on the monitor screen are very different and donot do justice to the trial. We also acknowledge that clin-ical judgment in the evaluation of the data can be sub-jective. However, we made every effort to calibrate theinvestigators and to control the lighting environment.We would also be happy to send you further data setsif you wish.

Finally, as with all procedures carried out in ortho-dontics, patient compliance is always an issue. Underthese trial conditions, the results seem to indicatethe benefits of the use of MI Paste Plus containingboth casein phosphopeptide-amorphous calcium phos-phate and fluoride. However, the real “antidote to thepoison” is the effective use of the product by thepatient.

Chung How KauBirmingham, Ala

Am J Orthod Dentofacial Orthop 2012;141:5260889-5406/$36.00Copyright � 2012 by the American Association of Orthodontists.doi:10.1016/j.ajodo.2012.03.002