***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Dental caries and result ing tooth decay can produce a multifactorial destructive process with a very high incidence . Cariogenic bacteria attack enamel with acids that produce subsurface lesions , thereby weakening the enamel and allowing bacterial progression into the dentin . The formation of dental decay , because of demineralization of the tooth structure , can be prevented or delayed by increasing the rate of the tooth 's remineralization and replacement relative to the tooth 's rate of demineralization . This rebuilding of enamel may be accelerated by the addition of amorphous calcium phosphate ( ACP ) with the aid of casein phosphopeptide ( CPP ) ( Recaldent molecule ) . In this study , the role of CPP in stabilizing and releasing ACP on the tooth surface has been investigated to better underst and its efficacy in the prevention of tooth demineralization in orthodontic patients . Twenty-five patients who wore fixed orthodontic appliances were enrolled in this clinical trial . It was explained to the patients that CPP-ACP would be used for 3 weeks and then suspended for an additional 3 weeks . Salivary pH evaluation , plaque pH evaluation and oral hygiene index ( OHI ) were performed at T0 , T1 and T2 . Results showed an increase in OHI level and an increase of the salivary pH ( 76 % of the patients ) . Instead of plaque pH level that showed trivial results , only 48 % of the patients showed a bacterial plaque pH increase . In conclusion , this study has not provided unequivocal evidence for the protective properties of Recaldent molecule . Long-term studies are necessary to better underst and the role of this molecule PURPOSE To evaluate the efficacy of 10 % casein phosphopeptide amorphous calcium phosphate complex ( CPP-AC P ) used alone or with fluoride as compared to fluoride mouthrinse for the remineralisation of occlusal white spot lesions in an in vivo pilot study . MATERIAL S AND METHODS Forty-five subjects with occlusal white spot lesions ( WSL ) determined by visual examination and confirmed with Diagnodent were r and omly divided into 3 groups : group 1 : 10 % CPP-AC P + 0.2 % NaF ; group 2 : 10 % CPPAC P ; group 3 : 0.5 % NaF mouthrinse for 30 days . The pre-treatment and post-intervention Diagnodent values were tabulated and subjected to statistical analysis . RESULTS Among the groups , the remineralising potential of 10 % CPP-AC P + 0.2 % NaF ( group 1 ) and 10 % CPP-AC P ( group 2 ) were similar , however , both groups were superior to 0.5 % NaF mouthrinse ( group 3 ) . CONCLUSIONS The CCP-AC P technique is highly beneficial for the remineralisation of non-cavitated occlusal white spot lesions when compared to 0.5 % NaF mouthrinse INTRODUCTION Enamel demineralization is a problem in orthodontics . Fluoride is partially effective in addressing this problem , but additional treatment options are needed . The objective of this prospect i ve r and omized controlled trial was to determine the effectiveness of a new product , MI Paste Plus ( GC America , Alsip , Ill ) , in the prevention or reduction of white spot lesions in orthodontic patients . METHODS Sixty patients who were undergoing routine orthodontic treatment were recruited for this prospect i ve r and omized clinical trial . A double-blind method of r and omization was used to determine whether each patient received the MI Paste Plus or a placebo paste ( Tom 's of Maine , Salisbury , United Kingdom ) . Each patient was asked to administer the paste by using a fluoride tray for a minimum of 3 to 5 minutes each day at night after brushing . Photographic records obtained in a light-controlled environment were used to record the presence or absence of white spot lesions in both groups . The enamel decalcification index was used to determine the number of white spot lesions per surface at each time interval . Patients were followed at 4-week intervals for 3 months . A scoring system from 0 to 6 was used to determine the level of caries or cavitations . This system was also used for each tooth at each time interval . RESULTS Fifty patients ( 26 using MI Paste Plus , 24 using the placebo paste ) completed the study . The enamel decalcification index scores for all surfaces were 271 and 135 at the start of treatment and 126 and 258 at the end of treatment for the MI Paste Plus and placebo paste groups , respectively . The enamel decalcification index scores in the MI Paste Plus group reduced by 53.5 % , whereas the placebo group increased by 91.1 % during the study period . A 3-way analysis of variance ( ANOVA ) was done for the average enamel decalcification index scores . The surface type , the product/time interactions , and the product/surface interactions of the mean enamel decalcification index scores were significant ( P < 0.05 ) . CONCLUSIONS MI Paste Plus helped prevent the development of new white spot lesions during orthodontic treatment and decreased the number of white spot lesions already present . The placebo paste had no preventive action on white spot development during orthodontic treatment ; the number of lesions actually increased . MI Paste Plus reduced white spots on the gingival surfaces ; the placebo paste had the opposite effect . The incisal surface effect on the mean enamel decalcification index scores over time and between products was highly significant . The incisal enamel decalcification index scores were consistently higher than those for the other surfaces ( mesial , distal , and gingival ) PURPOSE The purpose of this study was to compare twice daily tooth-brushing using 0.304 percent fluoride toothpaste alone with : ( 1 ) twice daily tooth-brushing plus once daily 10 % casein phosphopeptide-amorphous calcium phosphate ( CPP-ACP ) paste ; and ( 2 ) twice daily tooth-brushing plus once daily 0.12 % chlorhexidine gel ( CHX ) for reducing  early childhood caries ( ECC ) and mutans streptococci ( MS ) colonization . METHODS Subjects ( n=622 ) recruited at birth were r and omized to receive either CPP-ACP or CHX or no product ( study control [ SC ] ) . All children were examined at 6 , 12 , and 18 months old in their homes , and at 24 months old in a community dental clinic . RESULTS At 24 months old , the caries incidence was 1 % ( 2/163 ) in CPP-ACP , 2 % ( 4/180 ) in CHX , and 2 % ( 3/188 ) in SC groups . In children who were previously MS colonized at 12 and 18 months old , 0 % ( 0/11 ) and 5 % ( 3/63 ) , respectively , of the CPP-ACP group remained MS-positive versus 22 % ( 2/9 ) and 72 % ( 18/25 ) in CHX and 16 % ( 4/25 ) and 50 % ( 7/14 ) in SC groups ( P<.001 ) . CONCLUSIONS There is insufficient evidence to justify the daily use of casein phosphopeptide-amorphous calcium phosphate or chlorhexidine gel to control early childhood caries Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Introduction : To promote the remineralization by ionic exchange mechanism instead of invasive techniques many remineralizing agents can be used . Objective : To evaluate the remineralization effects of casein phosphopeptide-amorphous calcium phosphate ( CPP-ACP ) on white spot lesions ( WSLs ) and its inhibitory effect on Streptococcus mutans colonization . Material s and Methods : The study group consisted of 60 subjects exhibiting at least 1-WSL . Subjects were r and omly divided into 2 groups : A test group using CPP-ACP cream ( GC-Tooth Mousse , Leuven , Belgium ) and a control group using only fluoride containing toothpaste for a period of 3-month . Baseline WSLs were scored using DIAGNOdent device ( KaVo Germany ) and the saliva sample s were collected to measure S. mutans counts . After the 3-month period the WSLs were again recorded and the saliva collection was repeated . Result : DIAGNOdent measurements were increased by time ( P = 0.002 ) in the control group and no statistically significant difference ( P = 0.217 ) was found in the test group by the 3-month period . In both groups , the mutans counts were decreased in the 3-month experimental period . Conclusion : These clinical and laboratory results suggested that CPP-ACP containing cream had a slight remineralization effect on the WSL in the 3-month evaluation period however , longer observation is recommended to confirm whether the greater change in WSLs is maintained PURPOSE To evaluate the effect of casein phosphopeptides ( CPP ) and amorphous calcium phosphate ( ACP ) , as an adjunct to average oral hygiene , on the fluorescence of initial carious fissures and pits in vivo . METHODS For this investigator-blind in vivo study 32 volunteers were recruited . Subjects with premolars and molars showing DIAGNOdent-values between 15 and 20 were r and omly assigned to two treatment groups . During a wash-out period of 2 weeks and during the 3-week treatment period all subjects were instructed to use only st and ard fluoride toothpaste ( 1450 ppm F- as NaF ) and to abstain from any oral hygiene products other than dental tape . During the treatment period , one group additionally applied a CPP-ACP containing cream on the respective fissures for 3 minutes , once per day . At Days 1 , 8 , 15 , and 22 , DIAGNOdent measurements and a visual assessment of the fissures were performed by two calibrated independent examiners . RESULTS No significant changes of DIAGNOdent values were found in the control group during the study period . Fissures additionally treated with the CPP-ACP containing cream showed significantly lower laser fluorescence values after Day 15 ( P = 0.001 ) and Day 22 ( P < 0.001 ) compared to the control group . No significant difference in the visual classification between the two groups could be found PURPOSE To investigate and compare the effects of a dental cream containing complexes of casein phosphoprotein-amorphous calcium phosphate ( CPP-ACP ) and fluoride mouthwashes on the regression of white spot lesions ( WSL ) . MATERIAL S AND METHODS The study group consisted of 26 healthy adolescents ( mean age 14.6 years ) exhibiting 60 teeth with 152 visible WSL sites on incisors and canines immediately after debonding of fixed orthodontic appliances . After bracket removal , professional tooth cleaning and drying , a visual scoring ( 0 - 4 ) and laser fluorescence ( LF ) readings were carried out . The patients were r and omly assigned to two different treatment protocol s with the aim of remineralising the lesions : A ) daily topical applications of a dental cream containing CPP-ACP ( Topacal ) for 3 months followed by a 3-month period of daily toothbrushing with fluori date d dentifrice , or B ) daily 0.05 % sodium fluoride mouthwash combined with fluori date d dentifrice for 6 months . The registration s were repeated after 1 , 3 , 6 and 12 months and follow-up data were compared with baseline with aid of chi-square and paired t-tests . RESULTS A significant improvement of the clinical WSL-scores was found over time in both groups , but there was a statistically significant difference ( p < 0.01 ) concerning the number of sites that totally disappeared after 12 months in favour of the CPP-ACP regime , 63 % compared with 25 % respectively . The clinical registration s were mirrored by a statistically significant decrease ( p < 0.05 ) in the LF readings at the 6- and 12-month follow-ups compared with baseline . No significant differences were displayed between the groups . CONCLUSIONS Clinical scoring and LF assessment suggested that both regimens could promote regression of WSL after debonding of fixed orthodontic appliances . The visual evaluation suggested an aesthetically more favourable outcome of the amorphous calcium phosphate treatments Casein phosphopeptide-amorphous calcium phosphate ( CPP-ACP ) slows the progression of caries and remineralizes enamel subsurface lesions . The aim of this study was to determine the ability of CPP-ACP to increase the incorporation of fluoride into plaque and to promote enamel remineralization in situ . R and omized , double-blind , cross-over studies involved mouthrinses and dentifrices containing CPP-ACP and fluoride .  The mouthrinses were used for 60 sec , three times/day for 5 days , and supragingival plaque was collected and analyzed for F. The dentifrices were rinsed as a water slurry for 60 sec four times/day for 14 days in an in situ model . The addition of 2 % CPP-ACP to the 450-ppm-F mouthrinse significantly increased the incorporation of fluoride into plaque . The dentifrice containing 2 % CPP-ACP produced a level of remineralization similar to that achieved with a dentifrice containing 2800 ppm F. The dentifrice containing 2 % CPP-ACP plus 1100 ppm F was superior to all other form 
    Output:
    
Discussion The overall findings of this review did not show any significant benefits of using Tooth Mousse ® ( MI Paste ® ) products over brushing with a fluoride toothpaste for the prevention of early dental caries .
With regard to the regression of white spot lesions in orthodontic patients there is a tendency towards a benefit for the use of Tooth Mousse ® ( MI Paste ® ) but the quality of evidence is limited .
There is a lack of evidence to support the use of Tooth Mousse Plus ® ( MI Paste Plus ® ) over Tooth Mousse ® ( MI Paste ® ) at this time .
Conclusion This review suggests that further well- design ed r and omized controlled trials are required prior to the widespread recommendation of Tooth Mousse ® products for the prevention and treatment of early dental caries in the general population