Consumption of milk with added casein phosphopeptide-amorphous calcium phosphate remineralizes enamel subsurface lesionsin situ

Material of choice for non-invasive treatment of dentin caries: An in vitro study using natural carious lesions

INTRODUCTION

In community settings with limited dental personnel and equipment, and in an era when the aerosol transmission of infectious agents is on the rise, a non-invasive approach to caries management is critical. To provide information on non-invasive material selection, the aim of this study was to compare the remineralization effect of commonly used fluoride-containing materials, adjunctive to the everyday use of fluoride toothpaste (F-toothpaste), on primary tooth natural dentin caries.

METHODS

Fifty-five specimens were randomly divided into five groups: 38% silver diamine fluoride (SDF), 5% fluoride varnish (F-varnish), glass-ionomer cement (GIC), deionized water (DW) with F-toothpaste slurry, and DW as a control group (n = 11). The lesion depth and mineral density were measured before and after bacterial pH-cycling using micro-computed tomography. The percentage of mineral density change (%MDchange) was quantified. The dependent t-test, Wilcoxon-Signed-Rank Test, and one way ANOVA with Bonferroni correction were used to analyse the data.

RESULTS

SDF application reduced lesion depth from 844.6 to 759.1 μm (p < 0.045) while increasing mineral density from 551.4 to 763.0 mgHA/cm3 (p < 0.003). Only mineral density rose from 600.2 to 678.4 mgHA/cm3 (p < 0.013) when GIC was used. The other groups showed no difference. The highest %MDchange was also found after SDF treatment (49.7%, p < 0.05), whereas GIC (17.2%, p < 0.05) presented a higher percentage than the F-varnish (2.0%), F-toothpaste (-1.1%) and no-treatment groups (-1.4%).

CONCLUSION

In this in vitro study, where the pH of cycling was almost neutral, using SDF as an adjunct to F-toothpaste resulted in the highest remineralization compared with other remineralizing materials.

Comparison of therapies of white spot lesions: a systematic review and network meta-analysis

OBJECTIVE

White spot lesions (WSLs), the earliest evidence of enamel demineralization, are considered amenable to intervention to achieve a remineralized or arrested state of caries. The management of WSLs is quite challenging, and there is no definitive cure as yet. We performed a network meta-analysis to assess the efficacy of seven therapies for WSLs and gave a hierarchy of them.

MATERIALS AND METHODS

We systematically searched the PubMed, EMBASE, Cochrane, and Web of Science databases (last search: July 2022) to identify all relevant studies. We limited our search to studies published in English. Randomized controlled designed in vitro/clinical trials related to the efficacy of the seven therapies for WSLs were included. Data extraction was performed independently by two reviewers. The risk of bias (ROB) 2.0 tool from Cochrane and a previous in vitro methodological tool will be used for the quality assessment. Variations in quantitative light-induced fluorescence (QLF), laser fluorescence (LF), and lesions area were the primary outcome measures. Standard mean difference (SMD) was used as the effect size for the Network meta-analysis (NMA). Consistency and inconsistency tests were conducted. The hierarchy of 7 treatment effects was evaluated using surface probabilities under cumulative ranking (SUCRA). Publication bias was evaluated using a bias plot.

RESULTS

Forty-two articles were included in the systematic review. Thirty-one of them, with a total of 1906 participants, were included in the network meta-analysis. The studies owned a low and moderate risk of bias. This analysis does not suffer from significant inconsistency. The difference between 4 groups 'self-assembled peptide (SAP) P11-4', 'P11-4 + Fluoride Varnish (FV)', 'Resin Infiltration (RI)', 'casein phosphor peptides-amorphous calcium fluoride phosphate (CPP-ACFP)' and the 'Control' group was found to be statistically significant. Compared to the 'FV' and 'casein phosphor peptides-amorphous calcium phosphate (CPP-ACP)' groups, the 'P11-4 + FV" group and 'RI" group made a significant difference. The hierarchy was evident in the SUCRA values of 7 therapies. P11-4 + FV and RI were considered effective therapies compared to the control group or the FV group (gold standard group).

CONCLUSIONS

The available evidence suggests that resin infiltration and P11-4 in combination with fluoride varnish had advantages over gold standard (FV). The effect of tricalcium phosphate-based drugs and fluoride is not very noticeable. Overall, drugs based on P11-4 and resin infiltration will be better therapies. Using more than two drugs in combination also would increase efficacy.

Fluoridated milk enhances the mineral density of artificial proximal carious lesions in situ

OBJECTIVE

To compare the mineral density (MD) of non-fluoridated-milk (non-F-milk), fluoridated-milk (F-milk), adjunctive to 1000-ppm-fluoride dentifrice (FD), and 1000-ppm-FD alone of proximal artificial enamel carious lesions (AECL) in high caries-risk patients.

MATERIALS AND METHODS

This double-blind, cross-over in situ study comprised seven high caries-risk volunteers. Orthodontic brackets with one slab of AECL were fixed randomly to each volunteer per phase. The study comprised three experimental periods with a 7-d wash-out period using FD between sessions; (1) A four-week tooth brushing with FD 2×/day by all subjects as a control. The participants were then randomly allocated to (2) drinking 2.5-ppm-F-milk 1×/day or (3) non-F-milk 1×/day, adjunctive to tooth-brushing with FD for 4-weeks. The subjects crossed over from each type of milk and continued the same protocol for another four weeks. After each phase, the MD of each specimen was analyzed using micro-computed tomography (Micro-CT).

RESULTS

The baseline MD was not significantly differences (p = .653). When brushing with FD and drinking F-milk, the MD gain was significantly higher (11.68 ± 2.89%) compared with brushing with FD and drinking non-F-milk (4.59 ± 1.78%) (p = .003) or brushing with FD alone (5.30 ± 2.10%) (p = .003).

CONCLUSIONS

F-milk adjunctive to FD significantly increased MD gain compared with non-F-milk + FD or FD alone.

Remineralization of early enamel lesions with a novel prepared tricalcium silicate paste

To evaluate the remineralization potential of prepared tricalcium silicate (TCS) paste compared to silver diamine fluoride-potassium iodide (SDF-KI) and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) on artificial enamel lesions. Thirty permanent sound molars were collected for the study. After cleaning, root cutting, and applying acid-resistant nail varnish, leaving a 4 × 4 mm buccal window, the teeth were subjected to demineralization process. The teeth were divided into three treatment groups (n = 10). In each group, the teeth were sectioned buccolingually to obtain two halves (30 self-control and 30 experimental halves). The self-control halves were subjected to cross-sectional microhardness (CSMH), energy-dispersive X-ray spectroscopy at 50, 100, and 150 µm from the external enamel surface, and micromorphological analysis at the superficial enamel surface. The experimental halves were subjected to the same tests after 30 days of remineralization. Three-way analysis of variance (ANOVA) outcomes showed no significant difference in CSMH after treatment among the three different groups at the different levels (p > 0.05). Meanwhile, three-way ANOVA outcomes showed a significant difference in calcium/ phosphate ratio after treatment among the three different groups at the different levels. (p < 0.05). The tricalcium silicate paste used in this study showed potential remineralization in subsurface enamel lesions.

Synthetic amorphous calcium phosphates (ACPs): preparation, structure, properties, and biomedical applications

Amorphous calcium phosphates (ACPs) represent a metastable amorphous state of other calcium orthophosphates (abbreviated as CaPO₄) possessing variable compositional but rather identical glass-like physical properties, in which there are neither translational nor orientational long-range orders of the atomic positions. In nature, ACPs of a biological origin are found in the calcified tissues of mammals, some parts of primitive organisms, as well as in the mammalian milk. Manmade ACPs can be synthesized in a laboratory by various methods including wet-chemical precipitation, in which they are the first solid phases, precipitated after a rapid mixing of aqueous solutions containing dissolved ions of Ca²⁺ and PO₄^3- in sufficient amounts. Due to the amorphous nature, all types of synthetic ACPs appear to be thermodynamically unstable and, unless stored in dry conditions or doped by stabilizers, they tend to transform spontaneously to crystalline CaPO₄, mainly to ones with an apatitic structure. This intrinsic metastability of the ACPs is of a great biological relevance. In particular, the initiating role that metastable ACPs play in matrix vesicle biomineralization raises their importance from a mere laboratory curiosity to that of a reasonable key intermediate in skeletal calcifications. In addition, synthetic ACPs appear to be very promising biomaterials both for manufacturing artificial bone grafts and for dental applications. In this review, the current knowledge on the occurrence, structural design, chemical composition, preparation, properties, and biomedical applications of the synthetic ACPs have been summarized.

Anti-demineralization characteristics of surface pre-reacted glass-ionomer (S-PRG) filler-containing varnishes

This study investigated the anti-demineralization effects of surface pre-reacted glass-ionomer (S-PRG) filler-containing varnishes. Thirty-five bovine root specimens were divided into five treatment groups, with seven specimens each coated with 1) MI varnish (MIV), 2) F varnish (FV), 3) PRG varnish I (PV), 4) PRG varnish II (with sodium fluoride added, PVF), and 5) acid-resistant nail varnish (Control). A 3×1 mm area of the dentin surface adjacent to each varnish was demineralized for one week at 37°C. Integrated mineral loss (IML) of these lesions was determined by transverse microradiography, as was the amount of fluoride released by each material. IML was significantly lower in the PV and PVF groups than in the Control group, and was significantly lower in the PVF than in the MIV and FV groups. These findings indicated that S-PRG filler-containing varnishes, especially varnish containing sodium fluoride, had superior anti-demineralization effects on root dentin.

Remineralization of enamel subsurface lesions using toothpaste containing tricalcium phosphate and fluoride: an in vitro µCT analysis

Background

This study aimed to compare the efficacies of experimental toothpastes containing functionalized tricalcium phosphate (fTCP) with and without fluoride for in vitro enamel remineralization under pH-cycling conditions.

Methods

To create artificial white spot lesions, 36 bovine enamel specimens were immersed in a demineralization solution for 10 days. During pH-cycling for 12 days, the specimens were divided into four groups based on the experimental toothpaste type used: (a) fTCP-free, fluoride-free (fTCP − F −); (b) fTCP-containing, fluoride-free (fTCP + F −); (c) fTCP-free, fluoride-containing (fTCP − F +); and (d) fTCP-containing, fluoride-containing (fTCP + F +). Micro-focus X-ray computed tomography (μCT) scans of all specimens were obtained before demineralization, after demineralization, and after pH-cycling. The mineral density and mineral loss (ΔZ) in the enamel subsurface lesions were measured and the percentage of remineralization (%R) was calculated from ΔZ after demineralization and pH-cycling. One-way ANOVA with Tukey’s test was used for statistical analysis of the %R values. The treated enamel surface was investigated via scanning electron microscopy (SEM).

Results

The fTCP − F − group presented with the lowest amount of mineral gain after pH-cycling. In contrast, the fTCP + F + group showed the highest degree of remineralization within all lesion parts. The %R was highest in the fTCP + F + group (38.2 ± 7.8, all P < 0.01). SEM revealed the presence of small crystals on the enamel rods in the fTCP + F − and fTCP + F + groups.

Conclusions

The experimental toothpaste containing fTCP and fluoride increased remineralization of the artificial enamel subsurface lesions during pH-cycling. Furthermore, fTCP and fluoride appear to act independently on the remineralization of enamel subsurface lesions, although they coexisted in one toothpaste type.

Trial registration: This is not a human subject research.

Adjunctive use of fluoride rinsing and brush-on gel increased incipient caries-like lesion remineralization compared with fluoride toothpaste alone in situ

Objective: The objective of this study was to compare the remineralizing effect of sodium fluoride (NaF) mouth rinse or NaF gel as an adjunct to NaF dentifrice on incipient caries-like lesions in an in situ cross-over design study, with three sessions of 30 days each. Materials and methods: Orthodontic brackets with artificial demineralized enamel slabs were attached to the upper first molars of 12 participants. A set of 3 test specimens from the same tooth was randomly assigned to each participant and allocated into three 30-day sessions: 1) brushing with 0.22% NaF dentifrice 2 times/day (F dentifrice), 2) brushing with 0.22% NaF dentifrice 2 times/day+ rinsing with 0.05% NaF before bedtime (F mouth rinse), 3) brushing with 0.22% NaF dentifrice 2 times/day + brushing with 1.1% NaF gel before bedtime (F brush-on gel). The mineral gain and lesion depth of the specimens were evaluated by micro-computed tomography. Results: The mean mineral gain from the NaF mouth rinse and the NaF brush-on gel was similar, but greater than that from the NaF dentifrice (p < .05). The NaF brush-on gel yielded the greatest mean depth of remineralization (168 µm), followed by the NaF mouth rinse (144 µm). Both depths were significantly greater than that of the NaF dentifrice (84 µm) (p < .05). Conclusions: Both 0.05% NaF mouth rinse and 1.1% NaF brush-on gel, used at bedtime, increased incipient caries-like lesion remineralization in situ in combination with brushing with NaF dentifrice twice a day.

Effects of soy and bovine milk beverages on enamel mineral content in a randomized, double-blind in situ clinical study

Soy beverages are promoted as healthy alternatives to bovine milk even though they can contain added sugar.

OBJECTIVES

To compare enamel mineral content after consumption of bovine milk or a soy beverage in a double-blind, randomized, cross-over in situ clinical study.

MATERIALS AND METHODS

Human enamel slabs with subsurface lesions were prepared and inserted into intra-oral appliances worn by volunteers who consumed 200 ml of either bovine milk or a soy beverage over a 60 s period once a day for 15 days. Enamel lesion depth and mineral content were measured using transverse microradiography. Saliva samples were collected immediately after consuming the beverages and calcium, inorganic phosphate and fluoride levels analysed. Data were statistically analysed using a linear mixed model.

RESULTS

Depth of the enamel subsurface lesions increased by 7.1 ± 2.0 μm and mineral content decreased by 47 ± 22 vol% min.μm after consumption of the soy beverage indicating demineralization. However, after consumption of bovine milk the depth of the lesions decreased by 7.6 ± 3.5 μm and mineral content increased by 202 ± 43 vol% min.μm indicating remineralization. The changes were significantly different (p < 0.001) between the two beverages. Fluoride levels were similar in the saliva samples for both beverages, however the calcium and inorganic phosphate levels for the bovine milk group were significantly higher (p < 0.02) than those for the soy beverage group.

CONCLUSIONS

In this randomized, double-blind in situ clinical trial consumption of a soy beverage demineralized enamel whereas bovine milk produced remineralization.

CLINICAL SIGNIFICANCE

Although soy beverages are promoted as healthy alternatives to bovine milk the added sugar and low calcium bioavailability of the soy drink makes frequent consumption a caries risk. (Trial registration no. ISRCTN19137849).

Preparation, properties, and uses of enzymatic milk protein hydrolysates

Enzymatic hydrolysis of milk proteins has been a subject of numerous research studies and patents. The driving force for these studies has been the increased utilization of milk proteins. The industrial uses of milk proteins are based on their unique composition, functionality, and nutritive values. The diversity of milk protein fraction, the large number of proteinases, and controlled hydrolysis conditions used resulted in the preparation of hydrolysates suitable for several purposes. Enzymatic hydrolysis of milk proteins modifies the techno-functional and biofunctional properties of hydrolysates depending on the enzyme(s) and hydrolysis conditions used. Milk protein hydrolysates (MPH) are used commonly in normal and clinical nutrition and as a functional food ingredient. In the present review, emphasis has been made to highlight methods applied for the preparation of MPH, and the functional properties and utilization of the obtained hydrolysates.

The innovative applications of therapeutic nanostructures in dentistry

Nanotechnology has paved multiple ways in preventing, reversing or restoring dental caries which is one of the major health care problems. Nanotechnology aided in processing variety of nanomaterials with innovative dental applications. Some showed antimicrobial effect helping in the preventive stage. Others have remineralizing potential intercepting early lesion progression as nanosized calcium phosphate, carbonate hydroxyapatite nanocrystals, nanoamorphous calcium phosphate and nanoparticulate bioactive glass particularly with provision of self-assembles protein that furnish essential role in biomimetic repair. The unique size of nanomaterials makes them fascinating carriers for dental products. Thus, it is recentlyclaimedthat fortifying the adhesives with nanomaterials that possess biological meritsdoes not only enhance the mechanical and physical properties of the adhesives, but also help to attain and maintain a durable adhesive joint and enhanced longevity. Accordingly, this review will focus on the current status and the future implications of nanotechnology in preventive and adhesive dentistry.

Remineralizing potential of CPP-ACP applied for 1 min in vitro

AIM

To evaluate (1) the remineralizing potential of Tooth Mousse(®) (TM) on artificial carious lesions, when applied for 1 min, and (2) the benefit of a fluoridated dentifrice prior to TM application.

METHODS

Demineralisation caries-like lesions 120-200 μm deep were produced by placing molars in demineralizing solution for 96 h, sections 100-150 μm thick were then randomly assigned to four groups. Specimens were treated thrice daily with a non-fluoridated (Group A), or fluoridated dentifrice (1000 ppm) (Group B), or TM (Group C), or a fluoridated dentifrice followed by TM (Group D) then subjected to a 10-day pH cycling model. Lesion evaluation involved polarizing light microscopy and microradiography.

RESULTS

Application of TM in isolation (Group C) for 1 min resulted in significant increase in lesion depth (LD), however, an increase in mineral content deposition (V max) was not significant. Post treatment LD increases were greatest in Group A, then Group C and Group B respectively. A decrease in LD (by 19.9 %) was noted only after fluoridated dentifrice and TM (Group D) were applied consecutively for 1 min each (p < 0.05). Mineral content deposition was also greatest in this group (Group D) and both V max and LD changes were statistically significant when compared to other groups.

CONCLUSIONS

TM alone failed to remineralize carious lesions when applied for 1 min. However, remineralization occurred after a prior application of a fluoridated dentifrice.

Silver diamine fluoride and glass ionomer differentially remineralize early caries lesions, in situ

OBJECTIVES

The aim of the present study was to evaluate the percent mean mineral density (MD) change of early caries lesions after the application of silver diamine fluoride (SDF) or glass ionomer cement (GIC).

MATERIALS AND METHODS

This double-blind, crossover study involved two experimental phases of 28 days each. Thirty-two pairs of enamel slabs were created from the proximal surfaces of 16 premolars. Each pair of artificial carious slabs was randomly divided into the control or test group (38 % SDF or GIC). The slabs were attached to orthodontic brackets and bonded to the maxillary first permanent molars of 16 subjects for 28 days. After a 7-day washout period between phases, the subjects received the other material for the second phase. The mean MD of the lesions was measured by microcomputed tomography.

RESULTS

SDF yielded a percent mean MD increase at a depth of 0-84 μm, although increase in the GIC group was observed at a depth of 24-108 μm. The percent mean MD changes of the SDF and GIC groups were similar (p = 0.100) and significantly higher than in control (p < 0.001, p = 0.003, respectively).

CONCLUSIONS

The two materials increased the percent mean MD change of early proximal caries lesions to a similar extent, but with different spatial patterns.

CLINICAL RELEVANCE

Due to deeper level of GIC remineralization, the refractive index of the GIC applied enamel might be closer to sound enamel. Hence, GIC is recommended for remineralization of anterior teeth. SDF staining makes it unsuitable for use in anterior teeth; thus, it is reserved for use in posterior teeth.

Effect of Nano-Tricalcium Phosphate and Nanohydroxyapatite on the Staining Susceptibility of Bleached Enamel

Objective. This study was designed to evaluate the effect of nano-tricalcium phosphate (n-TCP) and nanohydroxyapatite (n-HAP) on prevention of restaining of enamel after dental bleaching. Methods. Forty bovine incisors were bleached with 20% carbamide peroxide for two weeks. Afterward, they were divided into five groups based on remineralization solution: no treatment (control), 10% n-TCP, 5% n-TCP, 10% n-HAP, and 5% n-HAP. Each group was daily immersed for 10 minutes in the restaining solution (tea) and for 3 minutes in the remineralization agent, respectively. This protocol was repeated for five days. Subsequently, three digital photographs (baseline, after bleaching, and after restaining) were analyzed by Adobe Photoshop software. The obtained L^∗, a^∗, b^∗, and ΔE parameters were compared using ANOVA and Wilcoxon and Bonferroni tests. Results. After bleaching, there were significant changes in tooth colors (P < 0.001) while, after restaining and immersion in remineralization solutions, there were no significant differences in L^∗, a^∗, and b^∗ values of different groups (P > 0.05). However, ΔE of 10% TCP was significantly lower than the control (P = 0.02) while there were no significant differences between the other groups (P > 0.05). Conclusion. 10% n-TCP could significantly maintain the resultant color and reconstruct the enamel structure after bleaching.

Casein phosphopeptide-amorphous calcium phosphate and glass ionomer show distinct effects in the remineralization of proximal artificial caries lesion in situ

This study aimed to compare the ability of casein-phosphopeptide amorphous-calcium-phosphate (CPP-ACP) and glass-ionomer (GI) in remineralizing proximal artificial caries lesions (ACLs). Molar enamel-slabs were divided into: original-lesion control, intra-oral controls, and experimental (CPP-ACP or GI) groups. Specimens received ACLs and were bonded on subject maxillary first molars. After 4-weeks, mineral density (MD) was analyzed by μCT. Compared to control, CPP-ACP increased MD at 0-38/68-84 microns and the GI group had an increase at 0-68 microns, with a greater increase in MD compared to the CPP-ACP group from 0-53 microns. The mean percent remineralization (%R) showed differences between the GI, CPP-ACP groups and their paired controls. GI tended to increase remineralization more than CPP-ACP. In conclusion, CPP-ACP and GI demonstrated distinct remineralizing ability. GI induced greater remineralization in the superficial lesion, while CPP-ACP remineralized the lesion body. Their effects on percent remineralization and reducing lesion depth of proximal ACLs were similar.

Sodium fluoride mouthrinse used twice daily increased incipient caries lesion remineralization in an in situ model

OBJECTIVES

To investigate the remineralizing effects of fluoride mouthrinses used at different times and frequency in addition to fluoride toothpaste.

METHODS

A randomized crossover single blinded study comprised 4 experimental phases of 21 days each. Twelve orthodontic volunteers were fixed with an orthodontic bracket containing an artificial carious enamel slab, which was from the same tooth in all 4 phases, and were randomly assigned to the following groups: (1) brushing with F toothpaste 2× per day (F- brush), (2) F- brush+rinsing with 0.05% NaF (F- rinse) after lunch, (3) F- brush+F-rinse before bedtime, and (4) F- brush+F- rinse 2× per day. Mean mineral gain after each phase was determined from mineral density profiles obtained using Micro-CT.

RESULTS

The mean mineral gain in all treatments with F- brush and F-rinse were significantly greater than those in F- brush (p<0.05). Moreover F- rinse 2× per day increased lesion remineralization more than F- rinse once a day.

CONCLUSIONS

The twice-daily use of 0.05% NaF mouthrinse combined with twice-daily regular use of fluoride toothpaste resulted in the greatest remineralization of incipient caries. These data indicate that rinsing frequency is a factor affecting the effectiveness of fluoride mouthrinse.

CLINICAL SIGNIFICANCE

The rinsing frequency of NaF mouthrinse, when used with fluoride toothpaste, also affects the remineralization. This finding, if confirmed by a clinical study, would lead to a new recommendation for fluoride mouthrinse used in high caries risk patients who could benefit from using it twice a day.

The effects of beverages on plaque acidogenicity after a sugary challenge

BACKGROUND

Caries prevention traditionally has emphasized the restriction of cariogenic foods and beverages, but it has placed less emphasis on how the choice, combination and sequence of consumed foods and beverages may help reduce plaque acidogenicity. The authors conducted a study to examine whether whole milk, 100 percent apple juice or tap water affect dental plaque acidity in people after a sugary challenge.

METHODS

Twenty adults participated in a randomized controlled crossover study. Participants consumed four combinations of foods: 20 grams of dry sugary Froot Loops (FL) (Kellogg's, Battle Creek, Mich.) cereal, 20 g of FL followed by 50 milliliters of milk (FL/milk), 20 g of FL followed by 50 mL of juice (FL/juice) and 20 g of FL followed by 50 mL of water (FL/water). The authors used a touch microelectrode to take plaque pH readings at the interproximal space just below the contact area between the maxillary premolars on both left and right sides at two and five minutes after FL consumption and at two to 30 minutes after milk, juice or water consumption.

RESULTS

Consumption of FL plaque pH (standard deviation [SD]) was 5.83 (0.68) at 30 minutes, whereas plaque pH (SD) in the FL/milk group was 6.48 (0.30), which was significantly higher than that for FL/juice (5.83 [0.49]) or FL/water (6.02 [0.41]) (P < .005) at 35 minutes.

CONCLUSION

Drinking milk after a sugary cereal challenge significantly reduced plaque pH drop due to the sugary challenge.

PRACTICAL IMPLICATIONS

When discussing the cariogenicity of foods and beverages with patients, dentists and other health care professionals should emphasize that the order of ingesting sugary and nonsugary foods is important and may affect their oral health.

Calcium orthophosphates in dentistry

Dental caries, also known as tooth decay or a cavity, remains a major public health problem in the most communities even though the prevalence of disease has decreased since the introduction of fluorides for dental care. Therefore, biomaterials to fill dental defects appear to be necessary to fulfill customers' needs regarding the properties and the processing of the products. Bioceramics and glass-ceramics are widely used for these purposes, as dental inlays, onlays, veneers, crowns or bridges. Calcium orthophosphates belong to bioceramics but they have some specific advantages over other types of bioceramics due to a chemical similarity to the inorganic part of both human and mammalian bones and teeth. Therefore, calcium orthophosphates (both alone and as components of various formulations) are used in dentistry as both dental fillers and implantable scaffolds. This review provides brief information on calcium orthophosphates and describes in details current state-of-the-art on their applications in dentistry and dentistry-related fields. Among the recognized dental specialties, calcium orthophosphates are most frequently used in periodontics; however, the majority of the publications on calcium orthophosphates in dentistry are devoted to unspecified "dental" fields.

A simple competitive enzyme-linked immunosorbent assay for the specific detection of the multiphosphorylated 1–25 β-casein fragment

A specific and simple competitive enzyme-linked immunosorbent assay (ELISA) was developed to determine bovine β-casein phosphopeptides (β-CPP) in casein phosphopeptides (CPP) or CPP complexes such as casein phosphopeptide amorphous calcium phosphate complexes added into dairy products. The method combines sample pretreatment designed for CPP enrichment and anti-β-CPP(f(1–25)) monoclonal antibody 1A5 (mAb 1A5). The mAb 1A5 bound specifically to the tryptic phosphopeptides from β-casein but not from αs1- or αs2-casein. Reactivity was also influenced by the extent of the phosphorylated form of serine residues. Based on the sequence-specific recognition and contribution of phosphorylated serine residues, the epitope of mAb 1A5 was found to reside within the cluster motif Ser(P)-Ser(P)-Ser(P)-Glu-Glu and the surrounding residues in β-CPP. The competitive ELISA developed here can be used as an alternative to specialised and expensive techniques such as mass spectrometry. In particular, it is suitable for the measurement of CPP or CPP complexes in dairy products, which contain closely related endogenous molecular species.

Calcium phosphopeptides -- mechanisms of action and evidence for clinical efficacy

Phosphoproteins/phosphopeptides with clusters of acidic residues are found throughout nature, where they aid in the prevention of unwanted precipitation of solid calcium phosphates. The acidic residues, particularly phosphoserine, interact with calcium and stabilize clusters of calcium and phosphate. Saliva and milk are two examples of biological fluids that contain such phosphoprotein/phosphopeptide-stabilized calcium phosphates, and both share a similar evolutionary pathway. Saliva has been shown to have remineralization potential and is of critical importance in maintaining the mineral content of teeth in the oral environment. Milk can be enzymatically modified to release casein phosphopeptides that contain the clusters of residues that allow milk to stabilize high concentrations of calcium and phosphate. These casein phosphopeptide-stabilized amorphous calcium phosphate nanocomplexes (CPP-ACP) can stabilize even higher concentrations of calcium and phosphate than milk and can be considered a salivary biomimetic, since they share many similarities to statherin. The mechanisms of action and the growing body of scientific evidence that supports the use of CPP-ACP to augment fluoride in inhibiting demineralization and enhancing the remineralization of white-spot lesions are reviewed.

Biofunctional properties of caseinophosphopeptides in the oral cavity

Caseinophosphopeptides (CPPs), bioactive peptides released from caseins, have the ability to enhance bivalent mineral solubility. This is relevant to numerous biological functions in the oral cavity (promotion of tooth enamel remineralisation, prevention of demineralisation and buffering of plaque pH). Therefore, CPPs may play a positive role as prophylactic agents for caries, enamel erosion and regression of white spot lesions. Most in vitro and in situ studies demonstrate strong evidence for the bioactivity of CPPs in the oral cavity. Nevertheless, relatively little is known concerning their use as adjuvants for oral health and more particularly regarding their long-term effects on oral health.

Influence of extra- and intra-oral application of CPP-ACP and fluoride on re-hardening of eroded enamel

OBJECTIVES

This in-situ study aimed to investigate the potential of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) crème and fluoride mouth rinse to re-harden erosively softened enamel and to evaluate the influence of an intra-oral or extra-oral application.

METHODS

Ten volunteers performed five experimental series. Per series, four bovine enamel samples were extra-orally softened by immersion in Sprite light(®) (2 min) and subsequently worn intra-orally for 5 min in intra-oral appliances. Thereafter, samples were treated (3 min) with either 250 ppm AmF/SnF(2) solution (Meridol) (series 1 and 3) or CPP-ACP crème (Tooth Mousse) (series 2 and 4). Application of the substances was performed extra-orally (series 1 and 2) or intra-orally (series 3 and 4). Untreated specimens served as control (series 5). The appliances were worn for 4 h afterwards. Knoop microhardness (KHN) measurement was performed at baseline, after softening and after completing of the respective run. Data were statistically analyzed by ANOVA and Bonferroni/Dunn post-hoc test.

RESULTS

No significant difference in baseline microhardness was observed, while immersion in Sprite light reduced the microhardness significantly. Significant re-hardening after intra-oral exposure occurred in all series, but baseline microhardness was not achieved. Microhardness in series 2 was significantly higher than that in series 1 and 5. No significant differences in KHN were detected between series 3, 4 and 5. The re-hardening ΔKHN (final microhardness - microhardness after erosion) was not significant different in all five series.

CONCLUSION

Intra-oral application of CPP-ACP crème or fluoride solution provides no benefit regarding re-hardening of erosively softened enamel.

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.

Analysis of the effect of CPP-ACP tooth mousse on enamel remineralization by circularly polarized images

OBJECTIVE

To evaluate the effect of casein phosphopeptide-amorphous calcium phosphate tooth mousse on the remineralization of bovine incisor by circularly polarized images.

METHODS

Eighty bovine incisors, each with a 4 x 4 mm artificially demineralized area, were used. The samples were divided into four groups: Group A, casein phosphopeptide-amorphous calcium phosphate tooth mousse; Group B, fluoride toothpaste; Group C, casein phosphopeptide-amorphous calcium phosphate tooth mousse and fluoride toothpaste; and Group D, no treatment. Circularly polarized images were taken after the specimens were treated for 3, 6, 9, or 12 weeks, and the size of the demineralized area and the mean grey level were measured. Data analysis was done using repeated measures variance analysis. Pearson correlation coefficients were computed to evaluate the correlation between the size of the demineralized area and the mean grey level.

RESULTS

In all four groups, the size of the demineralized area and the mean grey level declined with time. The size of the demineralized area of Group C was significantly smaller than that of Group A at the end of the third and sixth weeks (P = .039, P = .000, respectively), and the mean grey level of Group C was lower than that of Group A at the end of the 6th and 12th weeks (P = .037, P = .004, respectively). At the end of the 6th, 9th, and 12th weeks, the size of the demineralized area of Group C was smaller (P = .000, P = .005, P = .005, respectively) and the mean grey level was lower (P = .000) than those of Group B. No statistically significant correlations were detected between the size of the demineralized area and the mean grey level.

CONCLUSION

Casein phosphopeptide-amorphous calcium phosphate tooth mousse can reduce the size and mean grey level of demineralized areas and promote the remineralization of bovine enamel. Combined application with fluoride toothpaste strengthens the effect.