Reversal of Root Caries with Casein Phosphopeptide-Amorphous Calcium Phosphate and Fluoride Varnish in Xerostomia

Abstract

Different formulas of topical fluoride have been used to manage root carious lesions. This clinical trial aimed to investigate the efficacy of a dental varnish containing casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and fluoride compared with fluoride alone in reversing/arresting root caries in xerostomic patients over 1 year. A total of 80 patients (age range 45–92 years) with primary root caries (<i>n</i> = 184 root carious lesions) and unstimulated salivary flow rate of <0.2 mL/min were randomly allocated to receive either dental varnish containing CPP-ACP and 5% fluoride (group 1: MI varnish; GC, Japan) (<i>n</i> = 41, 83 lesions), or dental varnish with 5% fluoride alone (group 2: NUPRO White; Dentsply, USA) (<i>n</i> = 39, 101 lesions). Clinical assessments with Severity Index (SI) for root caries, DIAGNOdent measurements, and varnish application were carried out at baseline, 3, 6, and 12 months. Standard oral hygiene instructions with 1,450 ppm fluoride toothpastes were provided for both groups. After 3 months, 63.9% (<i>n</i> = 46) of root caries in group 1 became hard (SI: 0) compared with 39.3% (<i>n</i> = 35) in group 2 (<i>p</i> < 0.01). After 6 and 12 months, the differences in SI were insignificant (group 1, <i>n</i> = 60, 83.3%) (group 2, <i>n</i> = 66, 74.2%) (<i>p</i> = 0.36), and (group 1, <i>n</i> = 60, 89.6%) (group 2, <i>n</i> = 67, 81.7%, <i>n</i> = 1 soft, 1.2%) (<i>p</i> = 0.29), respectively. In both groups, noncavitated leathery lesions were more likely to become hard when compared to the cavitated root caries. A significant decrease in plaque index, surface roughness, lesion dimension, and DIAGNOdent readings with a significant increase in lesion distance from the gingival margin was reported in both groups (<i>p</i> < 0.05). This study has provided evidence that fluoride dental varnish either with or without calcium and phosphate has the potential to arrest/reverse root caries, especially noncavitated lesions for patients with xerostomia.

Immediate and Sustained Root Caries Prevention of Fluoride Varnish Combined with Toothpastes

“…The daily biofilm exposures to fresh sucrose-containing medium as performed in the present model (as well as highly cariogenic conditions encountered clinically) certainly led to marked pH drops that in turn triggered additional and more important fluoride mechanisms of action by also improving remineralization: in the presence of marked acidic pHs, fluoride ions deposited in the dentin after vanish application (calcium fluoride [CaF 2 ]) are gradually released and act by co-precipitating calcium and phosphate and enhancing the precipitation of fluoride apatite. Thus, similarly to enamel surfaces and in agreement to other investigations [Cai et al, 2021;Wierichs et al, 2018; Sleibi et al, 2018a;Sleibi et al, 2018b;Sleibi et al, 2021] where the immediate effect of fluoride varnishes were evaluated, the findings of the present study add to the current evidence showing that fluoride varnish also exhibits sustained anti-cariogenic property against root caries progression.…”

Nonrestorative Caries Treatment: A Systematic Review Update

“…Only 2 articles evaluated these calcium-based remineralising agents by means of visual assessment, recording the results using ICDAS codes. 15 , 16 …”

Prevention of Root Caries Using Oxalic Acid

“…However, several reports stated that even high concentrations of fluoride do not show considerable demineralization-inhibiting effects in weakly acidic artificial saliva [ 7 ]. Moreover, the environmental factors are expected to play a significant role in the demineralization-inhibiting and remineralization effects of dentin [ 12 ].…”

“…Fluoride promotes remineralization; however, its substrates, such as calcium and phosphorus, are supplied naturally by the saliva, which aids in remineralization. Therefore, quantitative and qualitative changes in the saliva exacerbate the risk of dental caries and periodontal disease in the elderly and irradiated patients [ 12 ]. Therefore, the supply of phosphorus, calcium, and fluoride is essential for the prevention of such dental illnesses.…”