Effect of Addition of Citric Acid and Casein Phosphopeptide-Amorphous Calcium Phosphate to a Sugar-Free Chewing Gum on Enamel Remineralization in situ

• Published in: Caries research Vol. 41; no. 5; pp. 377 - 383
• Main Authors: Cai, F., Manton, D.J., Shen, P., Walker, G.D., Cross, K.J., Yuan, Y., Reynolds, C., Reynolds, E.C.
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland S. Karger AG 01.01.2007
• Subjects: Adult; Cariostatic Agents - pharmacology; Caseins - pharmacology; Chewing Gum; Citric Acid - pharmacology; Dental Enamel - drug effects; Epidemiologic Methods; Female; Humans; Hydrogen-Ion Concentration - drug effects; Male; Middle Aged; Original Paper; Tooth Remineralization - methods; Chewing gum; CPP-ACP; Enamel; pH; Calcium chelation; Citric acid; Remineralization
• ISSN: 0008-6568; 1421-976X; 1421-976X
• DOI: 10.1159/000104796

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.