articles were identified, but the majority were duplicates. Once these were removed 172 articles were inspected and the focus on ‘CPP-ACP formulations of Tooth Mousse® (MI Paste®) and Tooth Mousse Plus® (MI Paste Plus®) resulted in 29 articles being selected, and of these 12 studies met the inclusion criteria and were considered acceptable for the systematic review. Discussion Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) is a compound developed for the prevention of dental caries. This milk-derived agent enables remineralization and prevents demineralization as well as caries by generating a Ca/P reservoir on the teeth [ 22]. Additionally, CPP-ACP adheres to the salivary pellicle and thus may reduce the attachment of S. mutans [ 29, 30]. Based on these findings, these compounds have been incorporated into pastes and varnishes [ 31, 32]. Application of CPP-ACP paste in addition to regular oral hygiene protocol reduced demineralization (white spot lesions) in clinical studies [ 32, 33, 34]. Lemos JA, Palmer SR, Zeng L, Wen ZT, Kajfasz JK, Freires IA, Abranches J, Brady LJ. The biology of Streptococcus mutans. Microbiol Spectr. 2019;7(10):1128.

Using a sensitive toothpaste may not be necessary if you only experience occasional sensitivity, but it is generally safe and effective. The main downside is that they tend to be more expensive than a regular toothpaste.When TMP was first recommended to participants, despite not being pleased with the possibility of keep losing teeth, incorporating an additional step into their oral hygiene routine was not straightforward (Table 7)—as it is expected with any change of habit. However, they knew something had to shift if they sincerely wanted to keep their teeth. Feelings such as anxiety, uncertainty, determination, confidence, and reassurance were part of such process. Participants spoke about three main barriers: (a) being difficult to apply TMP daily, (b) TMP not being available at chemist/pharmacy and (c) TMP being an expensive product. Phillips B, Barton J, Pennay D, Neiger D. The Social Research Centre, Melbourne. Socio-Demographic Characteristics of Telephone Access in Australia: Implications for Survey Research. https://www.srcentre.com.au/our-research/methods-research/Socio-demographic%20Characteristics%20of%20Telephone%20Access%20in%20Australia%20-%20Implications%20for%20Survey%20Research.pdf2019. Accessed 06 Aug 2020. The number of bacteria in the untreated and treated samples was determined by doing repeatedly tenfold serial dilutions in 1 ml BHI and seeding 100 μl of each dilution onto BHI agar plates that were incubated overnight at 37 °C in the presence of 95% air/5% CO 2. After incubation, the number of colonies was counted using the ImageJ software. The following equation was used to calculate the CFU per well in the original sample: Number of colonies x dilution factor x original volume of sample. Biofilm formation by Streptococcus mutans

Wilson TG Jr. Compliance and its role in periodontal therapy. Periodontology. 2000a;1996(12):16–23. There is a wide variation in the study designs, blinding, protocols and outcome measures in this group of studies making meta-analysis impossible. Clearly, more randomised longer-term trials are required utilizing Tooth Mousse® (MI Paste®) and Tooth Mousse Plus® (MI Paste Plus®) in accordance with the manufacturer’s instructions to clarify the benefits of use in orthodontic patients. In the general population, those individuals at high risk of developing dental caries are commonly of low socio-economic status and have less disposable income for oral care products. Whilst Tooth Mousse® (MI Paste®) has the advantage of being fluoride-free, making it suitable for use in very young children, the risk of development of fluorosis of the permanent teeth from the excessive ingestion of fluoride toothpaste is not a concern for children 6 years of age and older. The two papers [ 31, 32] in this review that studied the efficacy of Tooth Mousse® (MI Paste®) in children under 6 years of age do not support its use over the twice-daily use of either 1000 ppm [ 31] or 400 ppm [ 32] fluoride toothpaste. As it is also much more expensive than fluoride toothpaste the recommendation of this product in very young children cannot be supported. Sweet L. Telephone interviewing: is it compatible with interpretive phenomenological research? Contemp Nurse. 2002;12(1):58–63. Ren Y, Jongsma MA, Mei L, van der Mei HC, Busscher HJ. OUltimately, tooth sensitivity is caused by exposed dentin tubules (the nerves that sense pain lie within these parts of the tooth). A change in hot/cold/pH etc causes movement of the nerve within the tubule, which causes a pain signal to be sent to your brain. Untreated and treated biofilms were fixed in 2% glutaraldehyde in DDW for 20 min, washed in DDW, air-dried, gold-coated and visualized using an analytical Quanta 200 Environmental High-Resolution Scanning Electron Microscope (EHRSEM) (FEI, Eindhoven, The Netherlands). The biofilm structure was observed in different regions, each with increasing magnifications. Statistical analysis Bowen WH, Burne RA, Wu H, Koo H. Oral biofilms: pathogens, matrix, and polymicrobial interactions in microenvironments. Trends Microbiol. 2018;26:229–42. The flavour helps stimulate saliva flow, which rinses bacteria and food residues from the teeth and enhances the effectiveness of CPP-ACP. The longer CPP-ACP is in the mouth, the more effective the result. Pithon MM, Baiao FS, Sant’Anna LID, Tanaka OM, Cople-Maia L. Effectiveness of casein phosphopeptide-amorphous calcium phosphate-containing products in the prevention and treatment of white spot lesions in orthodontic patients: a systematic review. J Investig Clin Dent. 2019;10(2):e12391.

Forty years ago dental caries was a major health problem for most children and adults living in developed countries and the dental profession was unable to cope with the demand for clinical care [ 1]. Since then the prevalence and severity of dental caries has declined. For example the mean DMFT for 12 year olds in Australia dropped from 4.8 in 1977 to 1.1 in 1993 [ 2] and in the United Kingdom from 3.1 in 1973 to 0.8 in 2003 [ 3]. The change in caries prevalence has been accompanied by an alteration in the distribution of lesions, with pit and fissure caries levels increasing [ 4]. Despite the general improvements in oral health, caries continues to be a challenge for the dental team, particularly for those clinicians working in low income and socially disadvantaged areas where the prevalence of caries is still a public health issue. Another change that has had an impact on clinical practice is the increased prevalence of new carious lesions in adults, reaching a level as high as that seen in children [ 5]. Therefore, the profession has to plan treatment and preventive care pathways based on the understanding that dental caries is no longer a rapidly developing problem in childhood, but a slowly progressing disease of adulthood. Nine studies [ 33– 41] reported on the treatment or regression of dental caries (Table 4). In the majority of studies fluoride toothpaste was used by participants in all the study groups. However, one study [ 39] did not specify whether fluoride toothpaste was used, a second study did not fully specify the use of fluoride toothpaste in all groups [ 38] and in another [ 37] a non-fluoride toothpaste was used in the test group but fluoride toothpaste was used in the control group. Parnell C, Gugnani N, Sherriff A, James P, Beirne P. Non-fluoride topical remineralising agents containing calcium and/or phosphate for controlling dental caries (Protocol). Cochrane Database Syst Rev. 2012(3).

Cross KJ, Huq NL, Stanton DP, Sum M, Reynolds EC. NMR studies of a novel calcium, phosphate and fluoride delivery vehicle-alpha(S1)-casein(59-79) by stabilized amorphous calcium fluoride phosphate nanocomplexes. Biomaterials. 2004;25(20):5061–9. Charmaz's iteration of the constant comparative method was used during data analysis [ 27]. This involved coding of interview transcripts, detailed memo writing and drawing diagrams. The transcripts were analysed as soon as possible after each interview. Coding and interpretation of data was conducted by AS, a trained researcher with PhD and experience of qualitative research and grounded theory methodology [ 28]. Team meetings were held where AS, GGA and ECR discussed data analysis findings and compared their interpretations.