Effect of CPP-ACP paste on tooth mineralization: an FE-SEM study

Milk and milk products, such as cheese, have been shown to exhibit anticariogenic properties in human and animal models. CPP-ACP shows an anti-caries effect by suppressing demineralization, enhancing remineralization, or possibly a combination of both. The purpose of this study was to evaluate the effect of CPP-ACP paste on demineralization by observing the treated tooth surface using an FE-SEM. The specimens were prepared by cutting enamel and dentin of bovine teeth into blocks. A few specimens were stored in 0.1 M lactic acid buffer solution for 10 min and then in artificial saliva (negative control). The remaining specimens were stored in a 10 times-diluted solution of CPP-ACP paste or a placebo paste containing no CPP-ACP for 10 min, followed by 10 min immersion in a demineralizing solution (pH = 4.75, Ca) twice a day before storage in artificial saliva. After treatment of the specimens for 3, 7, 21 and 28 days, they were fixed in 2.5% glutaraldehyde in cacodylate buffer solution, dehydrated in ascending grades of tert-butyl alcohol, and then transferred to a critical-point dryer. The surfaces were coated with a thin film of Au in a vacuum evaporator, and were observed under field emission-scanning electron microscopy (FE-SEM). The SEM observations revealed different morphological features brought about by the various storage conditions. Demineralization of the enamel and dentin surfaces was more pronounced with the longer test period in the control and negative control specimens. On the other hand, enamel and dentin specimens treated with CPP-ACP paste revealed slight changes in their morphological features. From the morphological observations of the enamel and dentin surfaces, it could be considered that the CPP-ACP paste might prevent demineralization of the tooth structure.     

Ultrasonic determination of the effect of casein phosphopeptide-amorphous calcium phosphate paste on the demineralization of bovine dentin

The purpose of this study was to investigate the demineralization of dentin by measuring changes in the velocity of the sonic longitudinal waves transmitted through this substrate. One group of samples was immersed in demineralization solution for 10 min twice a day and then stored in artificial saliva. Two additional groups of samples were treated with a solution of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) paste or a placebo paste without CPP-ACP before demineralization and a control group was stored in artificial saliva. The sonic velocity of the demineralized specimens was found to decrease significantly over time. No significant increase in sonic velocity was observed in specimens treated with CPP-ACP, suggesting that CPP-ACP acted to prevent demineralization.     

Ultrasonic assessment of the effects of self-assembling peptide scaffolds on preventing enamel demineralization

Objectives. This study evaluates the effect of self-assembling peptide P₁₁-4 (Curodont Repair, CDR) on bovine enamel remineralization by measuring changes in ultrasonic propagation velocity. Methods. Six specimens per group were prepared by sectioning bovine teeth into enamel blocks. These blocks were then immersed in lactic acid buffer solution (pH = 4.75) for 10 min twice a day and stored in artificial saliva. Other specimens were first treated with CDR, followed by a 10-min immersion in the lactic acid buffer solution twice a day, before storage in artificial saliva. The propagation time of longitudinal ultrasonic waves was measured using a pulser/receiver. Six specimens were used for each treatment protocol. The obtained data were statistically analyzed using ANOVA followed by Tukey’s honestly significant difference tests (α = 0.05). Specimens were observed using laser scanning microscopy and scanning electron microscopy. Results. Sonic velocity was found to decrease with time for specimens stored in the demineralizing solution. On the other hand, increases in sonic velocity were found for specimens treated with CDR. These specimens also exhibited signs of mineral deposition. Conclusions. By measuring the ultrasonic propagation velocity, it can be concluded that CDR application has an ability to promote bovine enamel remineralization.     

酪蛋白磷酸多肽牙膏抑制牙釉质脱矿和促进牙釉质再矿化的实验研究

目的　评价含酪蛋白磷酸多肽 (CPP)的牙膏抑制牙釉质脱矿和促进再矿化的作用。方法　牙釉质片分为实验组 (A组 :含 0 1%CPP、B组 :含 0 5 %CPP)和对照组 (C组 :不含CPP)。①抑制脱矿实验 :釉质片每天用脱矿液处理 2次 ,再分别用 3种牙膏处理 15min ,于实验第 1、3、5、10、15天取每组 3例送检表面钙、磷含量。②再矿化实验 :脱矿的釉质片置于再矿化液 ,每天分别用 3种牙膏处理 2次 ,于实验第 5、10、15天取每组 3例送检。结果　①抑制脱矿实验 :实验组与对照组钙、磷含量差异无显著性。②再矿化实验 :10d时两实验组钙含量高于对照组 ;15d时仅B组钙高于对照组。结论　未能证明实验牙膏有抑制釉质脱矿的作用 ,但提示有促进再矿化的功能 ,B牙膏的作用较A牙膏稳定和持久。     

Comparison of the remineralization potential of CPP-ACP and CPP-ACP with 900 ppm fluoride on eroded human enamel: An in situ study

Objective

The aim of this in situ study was to compare the remineralization potential of pastes containing CPP-ACP and CPP-ACP with 900 ppm fluoride on human enamel softened by a cola drink.

Design

Forty-five enamel specimens obtained from human third molar teeth were eroded in a cola drink for 8 min and then attached to intra-oral devices worn by five volunteers. The specimens were subjected to three different in situ remineralization protocols using: (1) CPP-ACP (Group I), (2) CPP-ACP with 900 ppm fluoride (Group II), and (3) saliva (Group III, control). Vickers microhardness measurements were obtained at baseline followed by demineralization and remineralization stages.

Results

The CPP-ACP, CPP-ACP with 900 ppm fluoride and saliva controls resulted in 46.24%, 64.25% and 2.98% increase in post-erosion microhardness values, respectively. One-way ANOVA revealed statistically significant differences in the mean microhardness values between pastes containing CPP-ACP and CPP-ACP with 900 ppm fluoride.

Conclusions

Both CPP-ACP and CPP-ACP with 900 ppm fluoride substantially remineralized the softened enamel, with the CPP-ACP and fluoride combination showing higher remineralization potential than CPP-ACP. This study confirmed the synergistic effect of fluoride with CPP-ACP on remineralization of eroded enamel.     

Effect of a CPP-ACP agent on the demineralization and remineralization of dentine in vitro

OBJECTIVES: The aim of this study was to determine in vitro the effect of a commercial paste based on CPP-ACP complex on the demineralization of sound human dentine and on remineralization potential of artificial caries-like lesions formed on dentine surfaces. METHODS: Forty dentine specimens were prepared with hard tissue microtome. The specimens were divided in four groups the A, B, C and D (n=10). The specimen surfaces were subjected to surface analysis by Fourier transformance micro multiple internal reflectance infrared spectroscopy (micro MIR-FTIR). Tooth mousse was applied on surface specimens of A group, while no agent were applied on the specimens of B group. Afterwards, groups A, B, C and D were immersed in demineralization solution for 7 days. Afterwards, the surfaces were subjected to micro MIR-FTIR analysis and the mineral to matrix ratio was used to assess the extent of dentin demineralization (DM). Tooth mousse was applied on specimens of group C, while no agent was applied on specimens of group D. The groups C and D immersed in artificial saliva for 7 days and were subjected to analysis by micro MIR-FTIR and the mineral to matrix ratio was used to assess the extent of dentin remineralization (RM). RESULTS: Group A showed significant lower %DM in comparison to group B. Group C resulted in a significant higher %RM compared to group D. CONCLUSIONS: The presence of agent CPP-ACP on dentine surfaces provoked lower demineralization and higher remineralization in comparison with the dentine surfaces without agent.     

CPP-ACP与不同浓度氟促进釉质再矿化的研究

目的：探讨酪蛋白磷酸多肽-无定形磷酸钙(casein phosphopeptide-amorphous calcium phosphate,CPP-ACP) 与不同浓度氟离子联合应用对脱矿釉质再矿化的作用。方法：取正畸拔除的健康前磨牙30颗,乳酸凝胶法制备人工早期釉质脱矿后, 随机分为对照组(5% CPP-ACP组)、实验组1(5% CPP-ACP+500 mg/L F-组)和实验组2(5% CPP-ACP+900 mg/L F-组),采用MH-5型显微硬度仪测量处理前、后釉质标本的显微硬度,采用SPSS 18.0软件包对数据进行统计学分析。结果：显微硬度测量显示,实验组2牙釉质的表面显微硬度变化显著高于实验组1(P<0.05)及对照组(P<0.01)。结论：CPP-ACP能够促进脱矿釉质再矿化,氟对其有加强协同作用。在一定范围内,氟浓度越高,协同作用越好。     

The potential of deciduous and permanent bovine enamel as substitute for deciduous and permanent human enamel: Erosion-abrasion experiments

Aim of the present study was to compare toothbrushing abrasion of eroded human and bovine enamel utilizing a toothpaste slurry. The surfaces of each 36 teeth from cattle and calves and from each 36 human wisdom teeth and deciduous teeth were polished. Each 12 specimens from the respective tooth type were used for assessing toothbrushing abrasion only (A), erosion only (E) and the combination of erosion and toothbrushing abrasion (EA). The EA samples were subjected to 20 cycles comprising a demineralization/remineralization procedure directly followed by toothbrushing abrasion (100 strokes, 300 g load, toothpaste slurry: 3 ml artificial saliva mixed with 1g dentifrice). Demineralization in form of erosion was performed with 1% citric acid (1 min), remineralization with artificial saliva (15 min). Between the cycles, the samples were stored in artificial saliva. Wear of the treated surfaces with reference to untreated areas was determined profilometrically. The samples subjected to abrasion only (A) did not show a significantly different wear between the different kinds of teeth. The comparisons of substance loss between teeth of different species revealed that hard tissue loss of the human deciduous teeth was significantly lower as compared to calves' teeth after both erosion and erosion-abrasion. Also, both erosion only and erosion-abrasion caused higher enamel loss in cattle's teeth than in human wisdom teeth. It is concluded that human eroded enamel offers better resistance against brushing than bovine enamel.     

Change in surface hardness of enamel by a cola drink and a CPP-ACP paste

OBJECTIVES: This in vitro study used surface microhardness to evaluate whether a paste containing casein phosphopeptide amorphous calcium phosphate (CPP-ACP) can reharden tooth enamel softened by a cola drink, and how different saliva-substitute solutions affect the enamel hardness. METHODS: Twenty-four bovine incisors, each tooth consisting of treatment and control halves, were immersed in a cola drink (Coke) for 8 min, then placed under a 0.4 mL/min drip with various saliva-substitute solutions. The saliva-substitute solutions were: saliva-like solution (SLS) with 1 ppm fluoride, SLS without fluoride, and Biotene mouthwash. CPP-ACP paste was applied to the treatment halves for 3 min at 0, 8, 24, and 36 h. Knoop microhardness measurements were performed at baseline, after the cola drink immersion, and after 24 and 48 h contact with saliva-substitute solution. RESULTS: Enamel hardness significantly decreased after immersion in cola drink (ANOVA, p<0.05). After contact with saliva-like solutions for 48 h, those treated with CPP-ACP paste were significantly harder than those untreated regardless of the presence of 1 ppm fluoride in the saliva-like solution (ANOVA, p<0.05). Biotene mouthwash significantly softened the enamel surface (ANOVA, p<0.05). Two-way ANOVA showed significant effects of the CPP-ACP paste application and types of saliva-substitute solutions on the changes in surface hardness of the softened enamel at a significance level of 0.05. CONCLUSION: The application of CPP-ACP paste with continuous replenishment of saliva-like solution for 48 h significantly hardened enamel softened by a cola drink. Biotene mouthwash softened enamel surface after 48 h contact.     

Effects of aluminum (III) and fluoride on the demineralization of bovine enamel: a longitudinal microradiographic study

Longitudinal microradiography has been used to determine inhibiting effects of aluminum (III), Al, and fluoride on mineral loss from slices of bovine enamel exposed to a demineralizing solution 4 h daily for 35 days. Inhibitor treatment was 5 min four times daily. For the remaining time, the samples were immersed in a neutral calcium phosphate solution which allowed neither remineralization nor demineralization. This study indicates that a 1-mM (27 ppm) solution of Al in a 0.1-M lactate solution, pH 5, has an inhibitory effect on the in vitro demineralization of bovine enamel. Application of this solution alternating with 20 mM (380 ppm) fluoride gave the same total inhibition as treatment with 20 mM fluoride alone.     

Binding characteristics of Streptococcus mutans for calcium and casein phosphopeptide

Casein phosphopeptides (CPP) stabilize amorphous calcium phosphate (ACP) and may be used to localize ACP in dental plaque, maintaining a state of supersaturation with respect to tooth enamel, reducing demineralization and enhancing remineralization [Reynolds, J Dent Res 1997;76:1587-1595]. The aim of this paper is to investigate these effects by measuring the affinity and capacity of Streptococcus mutans for CPP-ACP. Using the equilibrium dialysis system described by Rose and Hogg [Biochim Biophys Acta 1995;1245:94-98], assessment of calcium binding by a plaque streptococcus at a fixed CPP-ACP concentration gives a series of CPP-ACP-influenced dissociation constants for calcium. These data can then be used to derive a true dissociation constant for CPP-ACP itself. The results demonstrate that CPP-ACP binds with about twice the affinity of the bacterial cells for calcium up to a value of 0. 16 g/g wet weight cells. Application of CPP-ACP to plaque may cause a transient rise in plaque fluid free calcium which may assist remineralization. Subsequently, CPP-ACP will form a source of readily available calcium to inhibit demineralization. Hence, CPP-ACP binds well to plaque, providing a large calcium reservoir, which is likely to restrict mineral loss during a cariogenic episode and provide a potential source of calcium for subsequent remineralization. Overall, once in place, CPP-ACP will restrict the caries process.     

Enamel Demineralization Prevention during Fixed Orthodontic Treatment and Remineralization Strategies

Preventing enamel demineralization and remineralization of orthodontic patients is important and it di-ffers from other dental patients. Oral hygiene education and oral examination is essential to prevent enamel demi-neralization, and dietary education or control of sugar intake should not be ignored during fixed orthodontic treat-ment. Laser irradiation is a noteworthy method to prevent enamel mineralization. Products containing fluoride andfluoride released not only can be used to prevent demineralization but also have the ability of remineralization during orthodontic treatment. Oral hygiene products containing casein-phosphopeptide amorphous calcium phosphate(CPP-ACP) have been demonstrated to have the ability of remineralization such as sugar-free chewing gum added CPP-ACP, lozenges containing CPP-ACP and milk protein casein stabilized by phosphopeptides.     

Effect of mucin alone and in combination with various dentifrices on in vitro Remineralization

The aim of this in vitro study was to evaluate the effect of combining various fluoridated dentifrices with mucin on remineralization of bovine enamel. Enamel specimens were embedded in epoxy resin, partly covered with nail varnish, and demineralized in a lactic acid solution (pH 5.0, 14 days). Parts of the demineralized areas of the specimens were then covered with nail varnish. Half of the samples were exposed to a mucin-containing (2.7 g/l) remineralizing solution, the other half to a mucin-free remineralizing solution for 30 days. In each group, the specimens were divided into four subgroups, which were brushed twice a day with a toothpaste containing sodium, stannous/amine, or amine fluoride. The specimens of the fourth subgroup were not brushed, but stored in one of the two solutions. Mineral loss and lesion depth were evaluated from microradiographs. After the remineralization period, specimens that were brushed with one of the dentifrices and stored in the mucin-containing remineralizing solution reacquired more mineral than those brushed and stored in the mucin-free solution (p < 0.05; Bonferroni post hoc test). The results indicate that mucin in combination with various fluorides seems to affect enamel remineralization significantly. Thus, mucin could be considered as an additive to saliva substitutes or mouthwashes in patients with hyposalivation.     

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.     

奥乐V护牙剂对早期釉质龋再矿化作用的研究

目的 观察奥乐V护牙剂对早期釉质龋的再矿化作用。方法 将50个牛牙釉质块建立人工龋模型后随机分为5组：奥乐V护牙剂组、GC护牙素组、氟化钠（NaF）组、奥乐V护牙剂+NaF组、去离子水（DDW）组,分别进入 pH循环模型。采用显微硬度计测定各组标本脱矿前和pH循环后的釉质表面硬度值,扫描电镜观察各组再矿化后釉 质表面形态结构的改变。结果 各实验组经再矿化处理后其表面显微硬度均明显提高（P<0.001）,奥乐V护牙剂组再矿化后其表面显微硬度低于NaF组（P<0.001）,但与GC护牙素组间差异无统计学意义（P>0.05）;再矿化后奥乐V护牙剂组釉质表面有较大颗粒沉积。结论 奥乐V护牙剂具有促早期人工釉质龋再矿化的作用。     

Effects of CPP-ACP with sodium fluoride on inhibition of bovine enamel demineralization: a quantitative assessment using micro-computed tomography

Objectives

The present study evaluated the effects of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and CPP-ACP with 900 ppm fluoride (CPP-ACPF) pastes on inhibition of enamel demineralization over time, using polychromatic micro-computed tomography (micro-CT).

Methods

Enamel blocks were prepared from bovine teeth. The specimens were each treated by one of the following agents, 30 min daily for 7 days: deionized water (negative control); CPP-ACP paste; CPP-ACPF paste; and NaF solutions (positive controls) (90, 900, and 9000 ppm F). After treatment, the specimens were immersed in a demineralizing solution (pH 4.5) for 24, 72, and 120 h. Mean mineral loss (ML) and lesion depth (LD) after each period were determined from mineral density profiles obtained using micro-CT.

Results

ML values in all the treatment groups were significantly smaller than those in the control group after 72 and 120 h of demineralization (p < 0.05, two-way ANOVA and t-test with Bonferroni correction). ML values in CPP-ACPF and NaF solution groups were significantly smaller compared to CPP-ACP group after 72 h (p < 0.05). LD values in the CPP-ACPF and all the NaF solutions groups were significantly smaller compared to the control group after 120 h (p < 0.05). The 9000 ppm F group showed the lowest nominal ML and LD values.

Conclusions

The application of CPP-ACP or CPP-ACPF pastes to sound enamel surfaces resulted in inhibition of enamel demineralization, and a better effect was noted for the latter paste. Quantitative assessment using polychromatic micro-CT demonstrated to be useful for detecting mineral density changes.     

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.     

酪蛋白磷酸肽-无定型磷酸钙凝胶治疗釉质脱矿效果的系统评价

目的 对有关酪蛋白磷酸肽（CPP）-无定形磷酸钙（ACP）凝胶对于釉质脱矿治疗的随机对照试验（RCT）进行系统评价,评价其治疗的效果。方法 依照Cochrane系统评价员手册（5.1.0版本）指导进行分析,包含检索策略、纳入排除标准、数据提取及质量评价。通过计算机检索PubMed、Embase、Cochrane Library、中国知网（CNKI）、万方、维普（VIP）数据库,查找有关CPP-ACP的RCT,检索时间截至2016年9月。由2位研究者独立根据纳入与排除标准进行文献筛选、资料提取和质量评价后,对纳入研究进行系统评价。结果 共纳入12个RCT,各文献中的实验设计、评价标准差异较大无法进行定量分析。结论 尚无有力证据表明,CPP-ACP比常规含氟制剂存在优越性;但纳入研究数量、随访时间、设计存在局限性,且样本量较小,仍需更多高质量、长时间随访、大样本的RCT以进一步验证。     

Effect of casein phosphopeptide - amorphous calcium phosphate containing chewing gum on salivary concentration of calcium and phosphorus: An in-vivo study

Aim: Caries clinical trials of sugar-free chewing gum have shown that the gum is noncariogenic and in fact has anticariogenic effect through the stimulation of saliva. Sugar-free gums, therefore, may be an excellent delivery vehicle for safe and effective additive, capable of promoting enamel remineralization. Casein phosphopeptide - amorphous calcium phosphate (CPP-ACP) nanocomplexes incorporated into sugar-free chewing gum have shown to remineralize enamel subsurface lesions in situ. So this study was conducted to evaluate the effect of CPP-ACP containing sugar-free chewing gum on salivary concentration of calcium and phosphorous. Materials and Methods : Unstimulated saliva from each 24 selected subjects was collected. Then each subject was given two pellets of chewing gum containing CPP-ACP and asked to chew for a period of 20 min, after which saliva samples were collected from each individual. Once all the samples were collected they were assessed for calcium and phosphorous concentration using affiliated reagent kits and photometer. Statistical Analysis Used: Data obtained were analyzed using student's paired t test. Results: Significant difference was found in the calcium and phosphorus concentration of saliva before and after chewing CPP-ACP containing chewing gum. Conclusions: Chewing of CPP-ACP containing chewing gum showed a significant increase in the salivary concentration of calcium for a prolonged period of time hence it may help in the remineralization of tooth surfaces.     

Effects of experimental xylitol varnishes and solutions on bovine enamel erosion in vitro

This in vitro study aimed to analyze the effects of application of xylitol varnishes and solutions to protect against enamel erosion. Twelve bovine enamel specimens were pre-treated with 5% NaF-Duraphat varnish, 10% xylitol varnish, 20% xylitol varnish, placebo varnish, 5% NaF solution, 10% xylitol solution or 20% xylitol solution. The varnishes and solutions were applied for 6 h and 1 min, respectively. Controls remained untreated (n = 12). Specimens were then subjected to erosive demineralization (Coca-Cola, 4 × 90 s/d) and remineralization (artificial saliva, 2 h) cycling for 10 days. After 5 days, the varnishes and solutions were reapplied. After reapplication, two specimens per group were analyzed by SEM. Enamel loss was measured profilometrically after the 5th and 10th days. Data were then analyzed statistically by ANOVA and Tukey's post-hoc test (n = 10, P < 0.05). After the 5th day, all varnishes and 20% xylitol solution significantly reduced the enamel loss when compared to the placebo varnish/control. After 10 days of erosive pH cycling, both xylitol varnishes and solutions significantly reduced the enamel erosion when compared with the control. However, 10% xylitol solution produced a smooth layer on eroded enamel and significantly reduced the enamel erosion when compared to the placebo varnish/control. Xylitol thus appears to be a good option to partially reduce enamel erosion.