Effects of three commercial toothpastes incorporating “chitosan, casein phosphopeptide-amorphous calcium phosphate, sodium monofluorophosphate, and sodium fluoride” on remineralization of incipient enamel caries in the primary dentition: A preliminary in vitro study

Abstract

Given the importance of primary dental caries, assessment of new preventive/therapeutic materials is necessary. In light of the scarcity of such studies on the role of new agents in primary dentition, this study assessed the efficacy of three commercial toothpastes with different ingredients on remineralization of early caries in the primary dentition. Thirty-nine intact primary canines were used in this in vitro experimental study. The baseline microhardness of enamel was measured. Particular demineralizer was used for 96 h and then secondary microhardness was measured. Then, samples were divided into three groups treated by toothpastes with sodium fluoride, chitosan, and casein phosphopeptide-amorphous calcium phosphate and sodium monofluorophosphate (CPP-ACP+SMFP). Each group was incubated and pH-cycled. Subsequently, they were demineralized and remineralized using toothpastes. Eventually, tertiary microhardness was measured. Percent of enamel microhardness recovery (EMHR%) and efficacy of toothpastes in remineralization were established. Data were analyzed using paired t-test, repeated-measures test, Kruskal-Wallis, and Mann-Whitney U-test (α = 0.05, 0.017). Demineralization significantly reduced microhardness from 316.2 to 248.5 Vickers hardness number (VHN) (P = 0.000). All toothpastes succeeded to remineralize the enamel significantly (P = 0.000). The efficacies of toothpastes differed significantly (P < 0.05). Mean EMHR percentages of toothpastes incorporating NaF, chitosan, and CPP-ACP+SMFP were 75.1%, 52.5%, and 55.8%, respectively. The highest increases in enamel microhardness were observed after using NaF-containing toothpaste (~53 VHN) which was significantly superior to other toothpastes (P ≤ 0.001). However, there was no statistically significant difference between EMHR percentages of toothpastes including chitosan and CPP-ACP+SMFP (P = 0.739). Although all three toothpastes could increase the microhardness of primary enamel, NaF toothpaste was superior to others. Toothpastes having chitosan and CPP-ACP+SMFP acted rather similarly.