Remineralization of Enamel Subsurface Lesions by Sugar-free Chewing Gum Containing Casein Phosphopeptide-Amorphous Calcium Phosphate

Abstract

Casein phosphopeptide-amorphous calcium phosphate nanocomplexes (CPP-ACP) exhibit anticariogenic potential in laboratory, animal, and human in situ experiments. The aim of this study was to determine the ability of CPP-ACP in sugar-free chewing gum to remineralize enamel subsurface lesions in a human in situ model. Thirty subjects in randomized, cross-over, double-blind studies wore removable palatal appliances with six human-enamel half-slabs inset containing sub-surface demineralized lesions. The appliances were inserted immediately before gum-chewing for 20 min and then retained for another 20 min. This was performed four times per day for 14 days. At the completion of each treatment, the enamel half-slabs were paired with their respective demineralized control half-slabs, embedded, sectioned, and subjected to microradiography and densitometric image analysis, for measurement of the level of remineralization. The addition of CPP-ACP to either sorbitol- or xylitol-based gum resulted in a dose-related increase in enamel remineralization, with 0.19, 10.0, 18.8, and 56.4 mg of CPP-ACP producing an increase in enamel remineralization of 9, 63, 102, and 152%, respectively, relative to the control gum, independent of gum weight or type.

White Spot Lesions: Prevention and Management During the Orthodontic Treatment

“…Reynolds reported that CPP-ACP, which is derived from milk casein, was capable of being absorbed through the enamel surface and could affect the demineralization-remineralization processes [35]. Recently, research has shown that this activity is due to a part of the casein protein called CPP, which carries calcium and phosphate ions 'stuck' to it, in the form of APP [36]. This complex of CPP-ACP is an ideal delivery system for bio-available calcium and phosphate ions.…”

White-spot lesions during multibracket appliance treatment: A challenge for clinical excellence

“…Using milk casein products (casein phosphopeptide amorphous calcium phosphate) suggested to potentially enhancing remineralization by allowing freely available calcium and phosphate ions to attach to enamel (Reynolds, 1987;Reynolds, 1997;Reynolds et al, 2003). It was also reported, that chewing gum promotes remineralization of enamel by increasing the salivary secretion (Leach et al, 1989;Lijima et al, 2004;Shen et al 2001). Microabrasion techniques using 18% hydrochloric acid and pumice have also been described to treat WSL after MB treatment (Welbury et al, 1993;Croll et al, 1994) resulting in a mean WSL reduction of 83% (Murphy et al, 2007).…”

The cariogenic dental biofilm: good, bad or just something to control?

“…This product, in a series of in situ studies, has demonstrated the ability to remineralize enamel that was previously demineralized. 45 The effectiveness of the CPP-ACP product in reducing dentin hypersensitivity was demonstrated utilizing a toothpaste delivery system. 46 A recent double-blind clinical study investigated, using digital bitewing radiography, the progression and regression of approximal caries in 2,720 adolescent subjects chewing a sugar-free gum containing CPP-ACP over a 24-month study period.…”