ACP Empowers Improved Perio Treatment By Cutting Sensitivity
Treating periodontal disease has been the cornerstone of dental hygiene for over two decades. Some things have changed in the way we pursue periodontal health; but one thing that hasn’t changed much is the way patients perceive the pain and sensitivity caused by periodontal therapy. Luckily, the way we treat that sensitivity has changed significantly.
Peeling patients from the ceiling is not part of any procedure manual, so manufacturers and researchers have continued to seek effective methods to treat and prevent dentin sensitivity. The science of ACP technology is a relatively new technology developed to address hypersensitivity conditions, both clinically and in daily home care practices.
ACP is short for Amorphous Calcium and Phosphate, which is a bioavailable form of these two minerals. Without the amorphous configuration, calcium and phosphorus are highly attracted to each other and bond before either has a chance to provide therapeutic benefits. Together in this amorphous form they have proved useful in blocking newly opened dentinal tubules.
Sensitivity: A Closer Look
Sensitivity following vigorous instrumentation – or even the normal amount of instrumentation needed to remove calcareous deposits from the root surface -- causes a great deal of anxiety for patients and practitioners. Applying sensitivity control therapies at the optimum moment is a simple way to improve patient compliance and create better working conditions for you.
There are two ways teeth become sensitive during periodontal therapy: instrumentation and tissue healing. Removing deposits from the root surface exposes the nerve endings to new stimuli. And newly exposed root surfaces created by tissue healing expose the nerves to temperature changes they never had to deal with before. Each tubule has a nerve ending associated with it.
Treatment Opportunities
Until recently, potassium nitrate, a chemical means to control sensitivity, and fluoride, a mechanical means to block tubule openings, were the most commonly utilized methods and options. In products containing ACP, the calcium and phosphate react together to plug the tubules and block the nerve endings from direct contact of temperature changes, touch and acids. ACP works so well at decreasing dental sensitivity that many hygienists use ACP-containing prophy paste prior to instrumentation to increase comfort with ultrasonic scaling, a staple in periodontal therapy.
Another effective use of ACP technology is to use it in toothpaste a few days before treatment to increase comfort. Power scaling, regardless of the unit or operator, can be hard to take for some clients. Using advanced products can virtually eliminate all sensitivity issues when used properly.
Calcium Phosphate Systems Overview
- Casein Phosphopeptide Amorphous Calcium Phosphate (CPP-ACP): Recaldent™ - casein (milk protein) enclosed system that binds to oral tissues, plaque, etc. and then releases ACP at an acidic pH.
- Calcium Sodium Phosphosilicate (CSP): NovaMin® - bioactive glass assists in sustained release of calcium & phosphate while neutralizing the pH.
- Amorphous Calcium Phosphate (ACP): ADA Foundation Technology – immediate release formulation found in numerous clinical and daily care products.
- Other:
- Arginine Bicarbonate & Calcium Carbonate (Sensistat products)
- Sodium Phosphate, Disodium Phosphate & Calcium Disodium (ACT Restoring MR)
Casein Phosphopeptide Amorphous Calcium Phosphate (CPP – ACP: Recaldent)
- From milk protein casein
- Can be added to foods and dental products
- Releases calcium & phosphate at a pH of 5.5 or below – ‘sticky’ substance lends to retention & release kinetics
- Contraindicated for those with true milk protein allergy – OK for lactose intolerant
- Products: Trident Chewing Gum & MI Paste & MI Paste Plus(contains sodium fluoride.) General Use Recommendations
- Delivered via prophy cup or tray
- 3 - 5 minute contact time recommended for professional and consumer daily application 2 times a day
- Application with finger or toothbrush
- Pre & post whitening use indicated to relieve sensitivity
- Chewing gum: 2 – 4 times a day
Calcium Sodium Phosphosilicate (CSP - Novamin)
- Solid bioactive glass that releases calcium, phosphate and silicate
- 15-year history as a bone regenerations system
- Found in various dental products
- May have anti-microbial properties, mechanism of action not understood
- Clinical Products
- NuCare Prophy Paste by Sunstar
- Daily Care Products
- Pre & post whitening use indicated to relieve sensitivity
- General Use Recommendations ~ see individual product lines, varies
- Contact time 2 - 3 minutes, no rinsing for 30 minutes
- No specific recommendations for use with fluoride products
Other CP Systems
- Sensistat products: Arginine Bicarbonate & Calcium Carbonate Proclude & Denclude. Recommended for use in whitening desensitization treatment and prevention
- Reach ACT Restoring Mouthrinse by Johnson & Johnson: Sodium Phosphate, Disodium Phosphate & Calcium Disodium
Amorphous Calcium Phosphate (ACP)
- American Dental Association Foundation system/technology
- Immediate release (under 1 minute) to generate bio-available calcium and phosphate in the oral cavity
- Very high solubility in saliva
- Rapidly transforms into stable apatite
- Can be delivered in many different forms and methods with or without fluoride
- Clinical Use Products
- Premier Enamel Pro Prophy Paste or Sunstar NuCare Prophy Paste and check out the latest in prophy technologies for optimal infection control and ergonomics: esa Disposable Prophy Angles
- Premier Enamel Pro Varnish: 5% Sodium fluoride varnish with ACP
- Quell Desensitizer
- Relief ACP Oral Care Gel: Placed in tray - dual barrel syringe delivery with fluoride, KNO3 and ACP
- Daily Care Products
- Relief ACP Oral Care Gel: Placed in tray or brushed on for home use - dual barrel syringe delivery with fluoride, KNO3 and ACP
- General Use Recommendations ~ see individual product lines, varies
- Contact time 2 - 3 minutes, no rinsing for 30 minutes (when using toothpaste, mouthrinse, gel in tray, etc. type formulations)
- Use prior to fluoride application in office or daily
Maximizing Success:
Combating sensitivity in periodontal cases is an important part of optimal therapy and patient comfort. Calcium phosphate containing products are not only effective in the prevention and treatment of dentin hypersensitivity but they also play a significant role in remineralization. This is an important consideration since those going through periodontal therapy may be vulnerable to root caries. Combining these products with fluoride and other agents will also enhance clinical results, in fact some products combine fluoride and CPP - ACP and others even contain fluoride, potassium nitrate and ACP to that end.
Do yourself and your clients a favor. Not everyone wants to have local anesthetic for periodontal treatment, and it can be avoided in many cases with proper treatment planning. Using ACP products, you’ll be a hero to patients, and the whole team while having the advantage of being able to practice comfortably.