The Anticariogenic Effect of Sugar-Free Gum Containing CPP-ACP Nanocomplexes on Approximal Caries Determined Using Digital Bitewing Radiography

Abstract

This study investigated, using digital bitewing radiography, the progression and regression of approximal caries in adolescent subjects chewing a sugar-free gum containing 54 mg CPP-ACP relative to the identical gum without CPP-ACP. 2,720 subjects from 29 schools were randomly assigned to one of the two gums and were instructed to chew their assigned gum for 3 × 10 min/day, with one session supervised on school days, over the 24-month study period. Standardized digital bitewing radiographs were taken at the baseline and 24-month clinical examinations for each subject. The radiographs, scored by a single examiner, were assessed for approximal surface dental caries at both the enamel and dentine level. Surface level transitions were scored using a transition matrix. Caries progression or regression was analysed using proportional-odds ordered logistic regression modelling of the transition scores at the tooth surface level. There was a statistically significant difference in the frequency distributions of the transition scores between the two gum groups (OR = 0.82, p = 0.03). For subjects chewing the CPP-ACP gum the odds of a surface experiencing caries progression were 18% less than those of a surface experiencing caries progression for subjects chewing the control gum. In conclusion, the 54 mg CPP-ACP sugar-free gum significantly slowed progression and enhanced regression of approximal caries relative to a control sugar-free gum in a 24-month clinical trial.

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

“…Caries progression or regression was analyzed, and for subjects chewing the CPP-ACP gum the odds of a surface experiencing caries progression were 18% less. 47 …”

Impact of Experimental Nano-HAP Pastes on Bovine Enamel and Dentin Submitted to a pH Cycling Model

“…Pastes containing a complex of casein phosphopeptide (CPP) and amorphous calcium phosphate (ACP), with or without fluoride, have shown potential to prevent dental demineralization, increase remineralization in vitro (10)(11)(12)(13)(14) and to repair initial enamel caries lesions in vivo as well (15)(16)(17). It has been suggested that casein phosphopeptides (CPP) have the ability to stabilize calcium phosphate in solution by binding amorphous calcium phosphate (ACP) with their multiple phosphoserine residues, thereby allowing the formation of small CPP-ACP clusters (18).…”

Efficacy of casein derivate CPP-ACP1

“…One of them was the study that was included in the systematic review of Azarpazhooh et al 7 , which was that of Anderson et al, 9 . The other study refers to that of Morgan et al 19 , in which 2,720 children used chewing gum with or without the addition of CPP-ACP. The follow-up period of the study was 24 months, and regression of caries lesions was observed by means of bite-wing radiographs that allowed visualization of the interproximal dental regions.…”

“…As follows below, there is information about these two new in situ studies and the new in vivo study found by Yengopal & Mickenautsch 8 (Table 4). Yengopal & Mickenautsch 8 observed that in spite of the meta-analysis having been conducted only for in situ studies that presented a short period of exposure to this complex, the promising results of the in vivo studies, one of them with a large sample size 19 and both 9,19 with a longer time of exposure to the CPP-ACP complex (12 to 24 months), suggested the remineralizing effect of the CPP-ACP complex, in studies with long follow-up periods. It is suggested that further randomized in vivo studies, with adequate methodology and longer followup periods should be conducted.…”