A growing focus on prevention

Prevention is better than cure is an idiom we are all familiar with and dentistry, more than any other arm of the healthcare community, has well and truly entrenched this notion into the psyche of pretty much every man, woman and child on earth. Everyone knows they should brush their teeth much more than they are aware of other activities that can benefit their health, and compliance is also extremely high.

Conversely, mainstream dentistry, with due deference to dental hygienists of course, has been heavily focused on a restorative approach to the treatment of dental disease.

Through the efforts of many from within the profession however, the minimally invasive movement has started to gain some ground which, as the name suggests, looks at ways to treat that include a chemotherapeutic approach to heal and remineralise tooth structure without the need to employ the traditional armamentarium of restorative tools.

Prevention and restoration have and always will be a part of dental practise though clinicians need to constantly rebalance the two and be aware of the many new developments occurring in the spectrum of the former that can negate or delay the need for the latter.

In April 2006, 3M ESPE, a company long associated with products to support the restorative aspects of dentistry, acquired OMNII Oral Pharmaceuticals, a provider of differentiated preventive dental products, solutions and support for dental professionals.

Stemming from this, the company has developed a range of products to target specific areas of need in dentistry with new science for better prevention and care. The first product to be launched onto the Australian market in 3M ESPE's preventive range is new Clinpro Tooth Créme, a 950ppm fluoride toothpaste that includes an innovative Tri-Calcium Phosphate ingredient.

We caught up with 3M ESPE Preventive Care Business Unit Manager Aaron Pfarrer during his recent visit to Australia to talk about the company's move into this new realm. Mr Pfarrer was formerly the Scientific Affairs and Professional Relations manager at OMNII and before that, held research positions at Procter & Gamble.

Q: Restorative dentistry is the principal focus of most dentists in the world today. Is there a paradigm shift evident in the US or elsewhere that preventive dentistry will take a stronger role in the future?

A: Yes, there is a paradigm shift. For example, a few years ago, educators at our West Coast dental schools formed the "CaMBRA coalition". CAMBRA is an acronym for Caries Management by Risk Assessment. This group has done a remarkable job understanding and teaching the idea that moderate-to-high-risk patients can have a lower caries incidence simply by altering the balance between caries pathological factors and caries protective factors. This program has now expanded to the Central Region and East Coast dental schools.

Also, there is increasing recognition of the link between oral health and whole-body health. This is resulting in more focus on the need for preventive oral health care. Not only are we thinking about the prevention of tooth decay and periodontal disease, we are thinking about how these diseases might have a longer-term effect on other diseases or conditions. Earlier and better control of our oral health is a logical first step in the prevention of these diseases.

Q: 3M ESPE's business has also largely focused on restorative dentistry to date. What was the catalyst for acquiring a preventive arm?

A: We have a very nice offering in restorative, but it's certainly not limited to that. While we had a small offering in prevention such as Clinpro Sealant for a while, we felt we had R&D expertise that could help move preventive dentistry ahead. Acquiring OMNII Oral Pharmaceuticals helped provide the critical mass and the focus required to start making a difference in prevention much like we have done in other areas of dentistry. 3M ESPE has always been committed to strengthening and expanding its position in the dental industry and prevention is an exciting and growing segment.

Q: What can 3M ESPE's preventive products offer clinicians that they cannot already find elsewhere?

A: 3M ESPE has a complete line of preventive products, many of which are industry firsts. In addition to the innovative products themselves, we offer support in the form of field sales, tele-sales, tech support and confidence that our attention to detail and high standards provides products that work as expected not only the first time you try them, they work the same time every time.

Q: What is TCP, what benefits does it offer and who developed it?

A: TCP is a name we've given to the innovative calcium-based additive we use in our preventive products. One of the major components of the additive is tri-calcium phosphate. What makes it so innovative is the way tri-calcium phosphate is prepared so that it can coexist with fluoride in aqueous environments. In very simple terms, tri-calcium phosphate is milled with a simple organic ingredient found in nearly all toothpaste formulations. During the milling process, an organic-calcium phosphate hybrid is formed. Calcium oxides are then protected from undesirable interactions with fluoride, which could render both calcium and fluoride inactive. Additionally, the organic component is 'sticky' and responds to the tooth surface. This ensures the calcium is carried to the tooth surface and not just expectorated with the bolus of toothpaste. Instead, the calcium is effectively made available at the tooth surface. TCP offers us the ability to add a calcium-based additive to preventive products and ensure that the fluoride remains bioavailable.

When we set-out to develop a truly innovative product, we consulted first with Dr George Stookey, one of the most experienced and respected cariologists the world has to offer. He introduced us to Dr Robert Karlinsey, a brilliant chemist who was doing some fascinating work with novel calcium-based compounds for the orthopedic and dental fields. Dr Karlinsey has also developed innovative ingredients that have applicability in other preventive products. With the right combination of experience, fresh, novel ideas and the R&D powerhouse of 3M, we were able to develop the new to the world, truly innovative product, Clinpro Tooth Crème.

Q: What are the clinical protocols for Clinpro Tooth Créme?

A: Clinpro Tooth Crème is indicated for use as part of a professional program for the prevention and control of tooth decay. We've designed this product to gently clean extrinsic stains without unnecessary abrasion, a must for patients with delicate, exposed root surfaces. Most importantly, we designed the product to be used in place of conventional toothpaste. Our experience tells us that patients are often reluctant to add steps to their daily oral hygiene routine. This product easily fits into every patient's daily routine.

Q: What other preventive products are on the horizon?

A: Later this year we'll be introducing Clinpro XT Varnish, a durable fluoride-releasing coating. This is a resin-modified glass ionomer that forms a layer of protection to provide immediate relief of dentinal hypersensitivity; and it remains on the tooth for six months or longer. It releases fluoride, calcium and phosphate and can also be used as a site specific protective coating for newly erupted teeth and other at-risk tooth surfaces such as non-cavitated lesions and around orthodontic brackets.

Looking forward, we will continue working with customers to help solve their problems, focusing our efforts on inventing products that make dentistry easier, faster and better for the professional and patient.