I have concerns about an article in the November 2011 issue of the AJO-DO examining the use of MI Paste Plus to prevent demineralization. It is an extremely important topic; we’ve been discussing this issue in the orthodontic literature since, well, apparently Angle’s day, since his 1907 text was included as a reference in the article. And we seem to be getting nowhere, as evidenced by the fact that there is no less, and probably more, demineralization in our patients than in the past.

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

Strangely though, the authors completely neglected to discuss another very active and well-studied ingredient in MI Paste Plus—fluoride. The paste contains 900 ppm of fluoride. Could this be causing the effect? So, we look at the placebo paste. “Tom’s of Maine” is stated as the placebo paste. Tom’s of Maine is a company, not a particular product. Tom’s of Maine produces 14 different dentifrices, of which 6 are fluoride-free. Which one was used in this study? Who knows, since the product name was left out of the article.

Then we look at the data actually collected and shown in the article. Many of the “white spots” are not demineralization at all. For example, in Figures 5, 6, and 8, none of that is demineralization. Maybe the MI Paste Plus reduced the appearance of the incisal white spots (that predate the orthodontic treatment). Well, that is interesting, but that is not what the article is about and should not have been included. We are then left with Figures 4 and 7 to show the differences between the 2 interventions. I am aware of how difficult it is to get a good photograph of demineralization. However, I would assume that these 2 series of photographs were the best available of the 60 patients in the study. I can’t tell any difference in either series from T1 to T4.

I have nothing against MI Paste Plus, and perhaps it really works as advertised. This article does very little to answer the question.