Annals and Essences of Dentistry
Open Access
ISSN: 0975-8798, 0976-156X
ISSN: 0975-8798, 0976-156X
Betul Kargul
Aim: Casein phosphopeptides (CPP) stabilize calcium phosphate through the formation of casein phosphopeptide amorphous calcium-phosphate complexes (CPP-CP). Contemporary caries prevention protocols recommend not only effective remineralizing of CPP-ACP but also to reverse the dental plaque dysbiosis responsible for caries. This brief overview aims to propose the mechanisms and the evidence for CPP-ACP effects on the ecology of oral microbiome
Background: Ideally, casein phosphopeptide amorphous calcium phosphate (CPP-ACP) should be able to influence the cariogenic bacteria responsible for the microbial dental plaque dysbiosis. Some studies showed that fluoride ions can inhibit the acidogenicity, aciduricity and glucan synthesis of cariogenic bacteria. However, it is still unclear the antimicrobial effect of fluoride for caries prevention. There are alternatives that have been extensively researched, such as casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) which provides essential ions, like phosphate and calcium, acting as an adjuvant in the remineralization process. Manufacturers of CPP-ACP-based products also suggest that it can produce desensitizing effects. This nanocomplex has been used experimentally with some dental cements and adhesive systems, but it is important to clarify the effects of this procedure, and the remineralizing/desensitizing advantages it offers. The objective of this topic review was to present the state of the art on CPP-ACP nanocomplex. In terms of dental caries prevention, this remineralizing option is not better than NaF. CPP-ACP provides a dental desensitizing action, but it is temporary, similar or less effective than other alternatives such as potassium nitrate or NaF. The experimental incorporation of CPP-ACP into dental cements should be controlled for not to compromise the physico-chemical properties of the material. The study demonstrated that fluoride containing toothpastes could not sustain anti-acid activity over time. In this regard, vidence is now emerging that CPP-ACP may also have a beneficial influence on the dental plaque microbial ecology and homeostasis. The ecological cariostatic effects of CPP-ACP are believed to be mediated predominantly through its anti-adhesion, buffering and biofilm disrupting actions new remineralizing technologies promise a beneficial shift in the dental plaque microbiology.
Methods: Saliva-derived polymicrobial biofilms were grown for 96 h in a cariogenic environment and treated every 12 h with 2% CPP-ACP or vehicle control. Colony forming units (CFUs) and acidogenicity were estimated from the treated biofilms. Microbial ecological effects of CPP-ACP were assessed based on the relative abundance of 14 specific caries- and health-associated bacterial species using a real-time quantitative PCR assay
Results: CPP-ACP is probably the most studied non-fluoride remineralizing technology. CPP-ACP and higher bacterial loads of commensal Streptococcus sanguinis(fold change 30.22, p < 0.001), S.mitis/oralis (fold change 9.66, p = 0.012), and S. salivarius/thermophilus (fold change 89.35, p < 0.001) than the control-treated biofilms. maintenance the high calcium concentrations in dental plaque may have antibacterial effect. Calcium induces streptococcal membrane permeability and partial lysis. CPP-ACP may possibly ecological measures to reverse the dental plaque dysbiosis reductions in microbial CFUs (21% reduction, p = 0.008) and acidogenicity (33% reduction, p < 0.001), compared to the control-treated biofilms. The CPP-ACP treated biofilms also exhibited significantly lower bacterial loads of cariogenic Scardovia wiggsiae (fold change 0.017, p < 0.001) and Prevotella denticola(fold change 0.005, p < 0.001) responsible for the disease pathogenesis. There is a high-level of evidence supporting the remineralizing efficacy of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) from studies around the world have cariostatic action as inhibition of There is a high
Published Date: 2020-10-20;