Anticariogenicity of Casein Phosphopeptide-amorphous Calcium Phosphate: A Review of the Literature

Abstract

This review of the literature examines the role of the natural components of saliva in maintaining tooth mineralization and the role of different casein phosphopeptide amorphous calcium phosphate-based (CPP-ACP) compounds in controlling demineralization/remineralization and their clinical applications. A group of peptides, known as CPP, have been shown to stabilize calcium and phosphate preserving them in an amorphous or soluble form known as amorphous calcium phosphate (ACP). Calcium and phosphate are essential components of enamel and dentine and form highly insoluble complexes, but in the presence of CPP they remain soluble and biologically available. This CPP-ACP complex applied to teeth by means of chewing-gum, toothpaste, lozenges, mouth rinses, or sprays is able to adhere to the dental biofilm and enamel hydroxyapatite providing bioavailable calcium and phosphate ions. Significantly high levels of calcium and phosphate have been found in both biofilm and subsurface incipient caries lesions and in lower level demineralization of enamel or dentine surfaces previously treated with CPP-ACP based compounds. When placed on the surface of a tooth with early carious lesions, pastes with CPP-ACP complexes can prevent tooth demineralization and improve enamel remineralization and enhance fluoride activity. Remineralization of white spot lesions has been achieved clinically by applying pastes based on these compounds, and a similar effect to self-applied fluorides has been observed in reducing the appearance of new caries lesions in patients with xerostomia. Use of CPP-ACP based compounds offers a potential for use in the prevention of dental caries.