Tooth Mousse® for caries prevention – little evidence available

shutterstock_34500700 - caries sign

Despite declines in caries prevalence in industrialised countries, caries remains a public health problem. Fissure sealants, topical fluoride and diet modification are key pillar in preventive approaches to caries reduction but other agents have been investigated.

Tooth Mousse® whose active ingredient is casein phosphopeptide-amorphous calcium phosphate is thought to act by providing bioavailable calcium and phosphate into saliva and plaque fluid enabling it to drive remineralisation of the tooth. The aim of this review is to assess the evidence for the use of Tooth Mousse® (MI Paste®) and Tooth Mousse Plus® (MI Paste Plus®) over a routine oral care regimen for the prevention and treatment of early dental caries


Searches were conducted in the Cochrane Central register of controlled trials, the Cochrane database of systematic reviews, Medline, Premedline and Embase databases. Clinical trials comparing Tooth Mousse® (MI Paste®) or Tooth Mousse Plus® (MI Paste Plus®) against routine oral care regimen for the prevention of dental caries with or without comparisons to additional preventive products were considered. Study quality was assessed independently by two reviewers using the Cochrane risk of bias tool. A narrative summary of the findings was presented.


  • 12 studies involving a total of 1481 patients were included.
  • 8 of the 12 studies were randomised. Only 2 of the studies were considered to be at low risk of bias.
  • 3 studies reported on prevention 9 on treatment or regression of caries.
  • 5 of the studies had a duration less than 3 months.
  • A wide range of outcome measures were used and a narrative summary was presented.


The authors concluded:

The findings of this systematic review suggest there is a lack of evidence to support the use of Tooth Mousse® (MI Paste®) over a routine preventive fluoride regimen for the prevention of early dental caries. With regard to the use of Tooth Mousse® (MI Paste®) and Tooth Mousse Plus® (MI Paste Plus®) for the regression of white spot lesions associated with orthodontic treatment there is a tendency towards a benefit for their use but the quality of evidence is limited.


The authors have searched wide range of databases so it is unlikely that they have missed any relevant studies. However, the question is narrowly focused resulting is a small number of small trials with many being of a short duration for caries studies. The outcome measures of the included studies were highly variable, including enamel microhardness, laser and light-induced fluorescence and visual scoring of photographs in addition to traditional clinical indices. This heterogeneity of outcomes, study designs and variation in study duration meant that meta-analysis was not possible. The available evidence does not suggest a significant benefit for Tooth Mousse® over traditional fluoride regimens for caries prevention but the quality of the available evidence is very low. Previous reviews (see Dental Elf -17th Jan 2014) have had similar findings and a protocol for a broader Cochrane review of non-fluoride topical remineralising agents is available on the Cochrane library (Parnell et al).


Raphael S, Blinkhorn A. Is there a place for Tooth Mousse® in the prevention and treatment of early dental caries? A systematic review. BMC Oral Health. 2015 Sep 25;15(1):113. doi: 10.1186/s12903-015-0095-6. PubMed PMID: 26408042; PubMed Central PMCID: PMC4583988.

Dental Elf – 17th Jan 2014 – Review finds limited evidence for effectiveness of Casein phosphopeptide-amorphous calcium phosphate in caries prevention

 Parnell C, Gugnani N, Sherriff A, James P, Beirne PV. Non-fluoride topical remineralising agents containing calcium and/or phosphate for controlling dental caries (Protocol). Cochrane Database of Systematic Reviews 2012, Issue 3. Art. No.: CD009732. DOI: 10.1002/14651858.CD009732.

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