Remineralization of enamel subsurface lesions by sugar-free chewing gum containing casein phosphopeptide-amorphous calcium phosphate.

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.     

Acid resistance of enamel subsurface lesions remineralized by a sugar-free chewing gum containing casein phosphopeptide-amorphous calcium phosphate

The aim of this clinical study was to investigate the acid resistance of enamel lesions remineralized in situ by a sugar-free chewing gum containing casein phosphopeptide-amorphous calcium phosphate nanocomplexes (CPP-ACP: Recaldent). The study utilized a double-blind, randomized, crossover design with two treatments: (i) sugar-free gum containing 18.8 mg of CPP-ACP, and (ii) sugar-free gum not containing CPP-ACP as control. Subjects wore removable palatal appliances with insets of human enamel containing demineralized subsurface lesions and chewed the gum for 20 min 4 times per day for 14 days. After each treatment the enamel slabs were removed and half of each lesion challenged with acid in vitro for 8 or 16 h. The level of remineralization was determined using microradiography. The gum containing CPP-ACP produced approximately twice the level of remineralization as the control sugar-free gum. The 8- and 16-hour acid challenge of the lesions remineralized with the control gum resulted in 65.4 and 88.0% reductions, respectively, of deposited mineral, while for the CPP-ACP-remineralized lesions the corresponding reductions were 30.5 and 41.8%. The acid challenge after in situ remineralization for both control and CPP-ACP-treated lesions resulted in demineralization underneath the remineralized zone, indicating that the remineralized mineral was more resistant to subsequent acid challenge. The results show that sugar-free gum containing CPP-ACP is superior to an equivalent gum not containing CPP-ACP in remineralization of enamel subsurface lesions in situ with mineral that is more resistant to subsequent acid challenge.     

Combined effect of Er,Cr:YSGG laser and casein phosphopeptide amorphous calcium phosphate on the prevention of enamel demineralization:: An in-vitro study

ObjectivesTo compare the effect of use of laser, casein phosphopeptide–amorphous calcium phosphate (CPP–ACP), and their combination on prevention of enamel demineralization using polarized light microscopy to assess lesion depth.Materials and MethodsEighty premolars were randomly allocated to four equal groups (n = 20): Group I: Control group, no preventive measures. Group II: CPP–ACP. Group III: Er,Cr:YSGG laser. Group IV: Er,Cr:YSGG laser followed by CPP–ACP. Specimens were subjected to thermocycling and brushing protocols equivalent to 1 year intraorally. Then, all teeth were subjected to acid challenge. Teeth were then sectioned longitudinally and examined under a polarized light microscope and lesion depth was measured.ResultsGroup IV resulted in the least lesion depth with a significant difference between it and all other groups. CPP–ACP alone and laser alone also showed a significant difference in white spot lesion (WSL) depth compared to the control group; however, no significant difference was found between them.ConclusionsThe combined use of laser and CPP–ACP showed the best prevention against WSL development. The use of CPP–ACP or laser alone also resulted in a significant reduction in lesion depth but was significantly less than their combined use, with no significant difference between them.     

Effect of nicotine chewing gum on salivary secretion

The effect of nicotine, placebo for nicotine or menthol-tasting chewing gums on salivation was studied in 25 healthy volunteers. The chewing of a commercial nicotine containing (2 mg) chewing gum (Nicorette) did not give a larger rate of salivation than did the chewing of a placebo chewing gum. For both types of chewing gums the rate of salivation was highest during the initial 5 min and it decreased thereafter. Menthol-tasting chewing gum gave a significantly higher amount of stimulated saliva. It is concluded that the addition of nicotine to a chewing gum does not provide an additional stimulus for salivation.     

Comparison of remineralization by fluoride varnishes with and without casein phosphopeptide amorphous calcium phosphate in primary teeth

Objective: To compare MI (5% NaF with 2% CPP-ACP) and Prevident (5% NaF) varnishes in remineralizing caries-like lesions in primary teeth regarding calcium and phosphate enamel content and lesion depth.

Material and methods: Caries-like lesions were created in 48 primary teeth which were divided into 2 halves; one left untreated (control) and the other half treated with MI or Prevident varnishes. Calcium and phosphate content was assessed using energy dispersive X-ray spectrometer and reduction in lesion depth was assessed using polarized light microscopy. Demineralization and remineralization values in each group were compared using paired t test and percentage change between groups was compared using t test and Mann Whitney U test.

Results: A greater percentage increase of calcium was observed in MI than Prevident specimens (median?=?8.97 and 2.67, p?<?.0001), with greater calcium phosphate ratio percentage increase (median?=?28.96 and 7.40) and phosphate percentage reduction (median?=?15.5 and 4.51). The mean (SD) percentages reduction in lesion depth in the MI varnish was significantly greater than in Prevident varnish (44.41 (7.12) and 22.73 (9.35), p?<?.0001).

Conclusions: MI varnish had better remineralization effect in primary teeth than Prevident varnish in terms of higher mineral content and shallower lesion depth.     

Effect of addition of citric acid and casein phosphopeptide-amorphous calcium phosphate to a sugar-free chewing gum on enamel remineralization in situ

Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) has been shown to remineralize enamel subsurface lesions in situ. The aim of this study was to investigate the effects of CPP-ACP in a fruit-flavoured sugar-free chewing gum containing citric acid on enamel remineralization, and acid resistance of the remineralized enamel, using an in situ remineralization model. The study utilized a double-blind, randomized, crossover design with three treatments: (i) sugar-free gum (2 pellets) containing 20 mg citric acid and 18.8 mg CPP-ACP, (ii) sugar-free gum containing 20 mg citric acid alone, (iii) sugar-free gum not containing CPP-ACP or citric acid. Ten subjects were instructed to wear removable palatal appliances, with 4 half-slab insets of human enamel containing demineralized subsurface lesions and to chew gum (2 pellets) for 20 min 4 times per day for 14 days. At the completion of each treatment the enamel half-slabs were removed and half of the remineralized lesion treated with demineralization buffer for 16 h in vitro. The enamel slabs (remineralized, acid-challenged and control) were then embedded, sectioned and subjected to microradiography to determine the level of remineralization. Chewing with gum containing citric acid and CPP-ACP resulted in significantly higher remineralization (13.0 +/- 2.2%) than chewing with either gum containing no CPP-ACP or citric acid (9.4 +/- 1.2%) or gum containing citric acid alone (2.6 +/- 1.3%). The acid challenge of the remineralized lesions showed that the level of mineral after acid challenge was significantly greater for the lesions exposed to the gum containing CPP-ACP.     

咀嚼绿茶多酚胶姆糖对唾液流率及pH值的影响

目的:探讨咀嚼绿茶多酚胶姆糖对唾液分泌及pH值的影响。方法:选取8例受试者,分别检测咀嚼绿茶多酚胶姆糖和对照胶姆糖前后不同时间唾液的流率和pH值。应用单因素方差分析和SNK法进行相关分析。结果:咀嚼2种胶姆糖3min内,唾液流率显著增加,在第1min时达到峰值,实验组和对照组分别为(3.15±1.05)ml和(3.30±0.87)ml。唾液pH值也不断上升,但是与唾液分泌的峰值并非在同一时间,2组之间无显著差异(P>0.05)。结论:咀嚼胶姆糖能促进唾液分泌,提高pH值,有益于口腔健康。     

Effects of casein phosphopeptide amorphous calcium fluoride phosphate paste on white spot lesions and dental plaque after orthodontic treatment: a 3-month follow-up

The effects of casein phosphopeptide amorphous calcium fluoride phosphate (CPP-ACFP) paste vs. control paste on the remineralization of white spot caries lesions and on plaque composition were tested in a double-blind prospective randomized clinical trial. Fifty-four orthodontic patients, with multiple white spot lesions observed upon the removal of fixed appliances, were followed up for 3 months. Subjects were included and randomly assigned to either CPP-ACFP paste or control paste, for use supplementary to their normal oral hygiene. Caries regression was assessed on quantitative light-induced fluorescence (QLF) images captured directly after debonding and 6 and 12 wk thereafter. The total counts and proportions of aciduric bacteria, Streptococcus mutans, and Lactobacillus spp. were measured in plaque samples obtained just before debonding, and 6 and 12 wk afterwards. A significant decrease in fluorescence loss was found with respect to baseline for both groups and no difference was found between groups. The size of the lesion area did not change significantly over time or between the groups. The percentages of aciduric bacteria and of S. mutans decreased from 47.4 to 38.1% and from 9.6 to 6.6%, respectively. No differences were found between groups. We observed no clinical advantage for use of the CPP-ACFP paste supplementary to normal oral hygiene over the time span of 12 wk.     

Effect of xylitol chewing gum on salivary Streptococcus mutans in preschool children

Dental caries remains a significant problem for poor children in the United States. One strategy for treating dental caries is to suppress streptococcus mutans, the chief pathogen responsible for the disease. The purpose of this study was to evaluate the effect of xylitol gum in salivary S. mutans levels in preschool children. Sixty-one children were randomly assigned into the xylitol group and the control group. The xylitol group chewed gum sweetened only with xylitol (XyliFresh100%, Hershey Food Corporation, U.S.A.) three times a day for three weeks. S. mutans counts were tested using the Dentocult-SM Strip Mutans-test (Orion Diagnostica, Finland) at baseline and after three weeks. The shift from higher S. mutans scores to lower was greater in the xylitol group than in the control group (p;lt0.05). This study supports the suggestion that chewing xylitol gum may reduce salivary S. mutans levels. Xylitol chewing gum may provide a feasible caries prevention method for preschool children.     

Enamel subsurface lesion remineralisation with casein phosphopeptide stabilised solutions of calcium, phosphate and fluoride

Casein phosphopeptide stabilised amorphous calcium phosphate (CPP-ACP) and amorphous calcium fluoride phosphate (CPP-ACFP) solutions have been shown to remineralise enamel subsurface lesions. The aim of this study was to determine the effect of ion composition of CPP-ACP and CPP-ACFP solutions on enamel subsurface lesion remineralisation in vitro. CPP-bound and free calcium, phosphate and fluoride ion concentrations in the solutions were determined after ultrafiltration. The ion activities of the free ion species present were calculated using an iterative computational program. The mineral deposited in the subsurface lesions was analysed using transverse microradiography and electron microprobe. CPP was found to stabilise high concentrations of calcium, phosphate and fluoride ions at all pH values (7.0-4.5). Remineralisation of the subsurface lesions was observed at all pH values tested with a maximum at pH 5.5. The CPP-ACFP solutions produced greater remineralisation than the CPP-ACP solutions at pH 5.5 and below. The mineral formed in the subsurface lesions was consistent with hydroxyapatite and fluorapatite for remineralisation with CPP-ACP and CPP-ACFP, respectively. The activity gradient of the neutral ion pair CaHPO(4)(0) into the lesion was significantly correlated with remineralisation and together with HF(0) were identified as important species for diffusion.     

Anticariogenic complexes of amorphous calcium phosphate stabilized by casein phosphopeptides: A review

Using laboratory, animal, and human in situ caries models, investigators have shown that casein phosphopeptide amorphous calcium phosphate complexes (CPP-ACP) exhibit an anticariogenic activity. The casein phosphopeptides (CPP) are produced from a tryptic digest of the milk protein casein by aggregation with calcium phosphate and purification by ultrafiltration. The CPP have a remarkable ability to stabilize calcium phosphate in solution and substantially increase the level of calcium phosphate in dental plaque. Through their multiple phosphoseryl residues, the CPP bind to forming clusters of amorphous calcium phosphate (ACP) in metastable solution, preventing their growth to the critical size required for nucleation and precipitation. The proposed mechanism of anticariogenicity for the CPP-ACP is that they localize ACP in dental plaque, which buffers the free calcium and phosphate ion activities, thereby helping to maintain a state of supersaturation with respect to tooth enamel depressing demineralization and enhancing remineralization. The CPP-ACP, unlike fluoride, can be added to sugar-containing foods and therefore have commercial potential as an additive to foods as well as to toothpastes and mouth-washes for the control of dental caries .     

The efficacy of a fluoride chewing gum on salivary fluoride concentration and plaque pH in children

OBJECTIVES: The purpose of this study was therefore to study the influence of different chewing times on the salivary F concentration and on the recovery of plaque pH directly after a sucrose rinse on both the chewing and the non-chewing side. METHODS: For this purpose, one piece of sugar free chewing gum was chewed to 10 healthy subjects (aged 8-10 years, 5 male and 5 female children). Subjects refrained from toothbrushing for 3 days. On the fourth day, they rinsed for 1 min with 10 microl of a 10% sucrose solutions. After 8 min, chewing gum was given and started to chew for either 5, 10, 20, 30, 45 min or control (sucrose rinse). Thus, altogether six test sessions were repeated at one week intervals. Measurements of F concentration in saliva and pH of approximal plaque were carried out at two contralateral sites for up to 60 min. RESULTS: Higher salivary F concentrations were found on the chewing side than on the non-chewing side (expressed as) (p<0.05). But, the difference between the chewing and the non-chewing side was not obvious for the plaque pH (expressed as AUC) (p>0.05). Therefore, this study showed that: (1) the F concentrations in saliva after chewing a F containing chewing gum had only small numerical differences among the various chewing times, with the exception for 5 min. All chewing time periods showed statistically significant differences between chewing and non-chewing side. (2) The prolonged chewing time increased the plaque pH recovery after a sucrose rinse (p<0.05) but there was no statistically significant difference on both of the chewing and non-chewing side (p>0.05). CONCLUSION: The results of this study indicated that a prolonged chewing time was favorable to the plaque pH recovery after a sucrose rinse and, to a certain extent, to the salivary fluoride concentration. Also it was shown that the F concentration in saliva was strongly dependent on which side the subject chewed on.