Abstract
Remineralisation has been shown to be an effective mechanism of preventing the progression of enamel caries. The aim of this double-blind, randomised, cross-over in situ study was to compare enamel remineralisation by chewing sugar-free gum with or without casein phosphopeptide amorphous calcium phosphate (CPP-ACP) where the enamel lesions were exposed to dietary intake and some were covered with gauze to promote plaque formation. Participants wore removable palatal appliances containing 3 recessed enamel half-slabs with subsurface lesions covered with gauze and 3 without gauze. Mineral content was measured by transverse microradiography, and plaque composition was analysed by real-time polymerase chain reaction. For both the gauze-free and gauze-covered lesions, the greatest amount of remineralisation was produced by the CPP-ACP sugar-free gum, followed by the gum without CPP-ACP and then the no-gum control. Recessing the enamel in the appliance allowed plaque accumulation without the need for gauze. There was a trend of less remineralisation and greater variation in mineral content for the gauze-covered lesions. The cell numbers of total bacteria and streptococci were slightly higher in the plaque from the gauze-covered enamel for 2 of the 3 treatment legs; however, there was no significant difference in Streptococcus mutans cell numbers. In conclusion, chewing sugar-free gum containing CPP-ACP promoted greater levels of remineralisation than a sugar-free gum without CPP-ACP or a no-gum control using an in situ remineralisation model including dietary intake irrespective of whether gauze was used to promote plaque formation or not.
References
1.
Addy M, Perriam E, Sterry A: Effects of sugared and sugar-free chewing gum on the accumulation of plaque and debris on the teeth. J Clin Periodontol 1982;9:346–354.
2.
Angmar B, Carlstrom D, Glas JE: Studies on the ultrastructure of dental enamel. IV. The mineralization of normal human enamel. J Ultrastruct Res 1963;8:12–23.
[PubMed]
3.
Beiswanger BB, Boneta AE, Mau MS, Katz BP, Proskin HM, Stookey GK: The effect of chewing sugar-free gum after meals on clinical caries incidence. J Am Dent Assoc 1998;129:1623–1626.
[PubMed]
4.
Cai F, Manton DJ, Shen P, Walker GD, Cross KJ, Yuan Y, Reynolds C, Reynolds EC: Effect of citric acid and casein phosphopeptide-amorphous calcium phosphate to a sugar-free chewing gum on enamel remineralization in situ. Caries Res 2007;41:377–383.
[PubMed]
5.
Chen T, Yu WH, Izard J, Baranova OV, Lakshmanan A, Dewhirst FE: The human oral microbiome database: a web accessible resource for investigating oral micobe taxonomic and genomic information. Database (Oxf) 2010;2010:baq013.
6.
Cochrane NJ, Cai F, Huq NL, Burrow MF, Reynolds EC: New approaches to enhanced remineralization of tooth enamel. J Dent Res 2010;89:1187–1197.
[PubMed]
7.
Corpron RE, More FG, Clark JW, Korytnicki D, Kowalski CJ: In vivo remineralization of artificial enamel lesions by a fluoride dentifrice or mouthrinse. Caries Res 1986;20:48–55.
8.
Dawes C, Dong C: The flow rate and electrolyte composition of whole saliva elicited by the use of sucrose-containing and sugar-free chewing-gums. Arch Oral Biol 1995;40:699–705.
[PubMed]
9.
Dawes C, Watanabe S, Biglow-Lecomte P, Dibdin GH: Estimation of the velocity of the salivary film at some different locations in the mouth. J Dent Res 1989;68:1479–1482.
[PubMed]
10.
Dijkman AG, Schuthof J, Arends J: In vivo remineralization of plaque-induced initial enamel lesions – a microradiographic investigation. Caries Res 1986;20:202–208.
[PubMed]
11.
Iijima Y, Cai F, Shen P, Walker G, Reynolds C, Reynolds EC: Acid resistance of enamel subsurface lesions remineralized by a sugar-free chewing gum containing casein phosphopeptide-amorphous calcium phosphate. Caries Res 2004;38:551–556.
[PubMed]
12.
Jenkins GN, Edgar WM: The effect of daily gum-chewing on salivary flow rates in man. J Dent Res 1989;68:786–790.
13.
Kandelman D, Gagnon G: A 24-month clinical study of the incidence and progression of dental caries in relation to consumption of chewing gum containing xylitol in school preventive programs. J Dent Res 1990;69:1771–1775.
[PubMed]
14.
Leach SA, Lee GT, Edgar WM: Remineralization of artificial caries-like lesions in human enamel in situ by chewing sorbitol gum. J Dent Res 1989;68:1064–1068.
[PubMed]
15.
Lee ZM, Bussema C 3rd, Schmidt TM: RRNDB: documenting the number of rRNA and tRNA genes in bacteria and archaea. Nucleic Acids Res 2009;37:D489–D493.
16.
Macpherson LM, Dawes C: An in vitro stimulation of the effects of chewing sugar-free and sugar-containing chewing gums on pH changes in dental plaque. J Dent Res 1993;72:1391–1397.
17.
Makinen KK, Bennett CA, Hujoel PP, Isokangas PJ, Isotupa KP, Pape HR, Makinen PL: Xylitol chewing gums and caries rates: a 40-month cohort study. J Dent Res 1995;74:1904–1913.
[PubMed]
18.
Manton DJ, Walker GD, Cai F, Cochrane NJ, Shen P, Reynolds EC: Remineralization of enamel subsurface lesions in situ by the use of three commercially available sugar-free gums. Int J Paediatr Dent 2008;18:284–290.
[PubMed]
19.
Mellberg JR: Hard-tissue substrates for evaluation of cariogenic and anti-cariogenic activity in situ. J Dent Res 1992;71(Spec No):913–919.
[PubMed]
20.
Morgan MV, Adams GG, Bailey DL, Tsao CE, Fischman SL, Reynolds EC: The anticariogenic effect of sugar-free gum containing CPP-ACP nanocomplexes on approximal caries determined using digital bitewing radiography. Caries Res 2008;42:171–184.
[PubMed]
21.
Neeser JR, Golliard M, Woltz A, Rouvet M, Dillmann ML, Guggenheim B: In vitro modulation of oral bacterial adhesion to saliva-coated hydroxyapatite beads by milk casein derivatives. Oral Microbiol Immunol 1994;9:193–201.
22.
Rahiotis C, Vougiouklakis G, Eliades G: Characterization of oral films formed in the presence of CPP-ACP agent: an in situ study. J Dent 2008;36:272–280.
23.
Reynolds EC, Cai F, Cochrane NJ, Shen P, Walker G, Morgan MV, Reynolds C: Fluoride and casein phosphopeptide-amorphous calcium phosphate. J Dent Res 2008;87:344–348.
[PubMed]
24.
Reynolds EC, Cai F, Shen P, Walker GD: Retention in plaque and remineralization of enamel lesions by various forms of calcium in a mouthrinse or sugar-free chewing gum. J Dent Res 2003;82:206–211.
[PubMed]
25.
Rose RK: Binding characteristics of Streptococcus mutans for calcium and casein phosphopeptide. Caries Res 2000;34:427–431.
[PubMed]
26.
Shen P, Cai F, Nowicki A, Vincent J, Reynolds EC: Remineralization of enamel subsurface lesions by sugar-free chewing gum containing casein phosphopeptide-amorphous calcium phosphate. J Dent Res 2001;80:2066–2070.
[PubMed]
27.
Shen P, Manton DJ, Cochrane NJ, Walker GD, Yuan Y, Reynolds C, Reynolds EC: Effect of added calcium phosphate on enamel remineralization by fluoride in a randomized controlled in situ trial. J Dent 2011;39:518–525.
28.
ten Cate JM, Dundon KA, Vernon PG, Damato FA, Huntington E, Exterkate RA, Wefel JS, Jordan T, Stephen KW, Roberts AJ: Preparation and measurement of artificial enamel lesions, a four-laboratory ring test. Caries Res 1996;30:400–407.
[PubMed]
29.
Verbeke G, Molenberghs G: Linear Mixed Models for Longitudinal Data. New York, Springer, 2000.
30.
Walker GD, Cai F, Shen P, Adams GG, Reynolds C, Reynolds EC: Casein phosphopeptide-amorphous calcium phosphate incorporated into sugar confections inhibits the progression of enamel subsurface lesions in situ. Caries Res 2009;44:33–40.
31.
White DJ: Use of synthetic polymer gels for artificial carious lesion preparation. Caries Res 1987;21:228–242.
[PubMed]
32.
Xu P, Alves JM, Kitten T, Brown A, Chen Z, Ozaki LS, Manque P, Ge X, Serrano MG, Puiu D, Hendricks S, Wang Y, Chaplin MD, Akan D, Paik S, Peterson DL, Macrina FL, Buck GA: Genome of the opportunistic pathogen Streptococcus sanguinis. J Bacteriol 2007;189:3166–3175.
33.
Yankell SL, Emling RC: Clinical study to evaluate the effects of three marketed sugarless chewing gum products on plaque pH, pCa, and swallowing rates. J Clin Dent 1989;1:70–74.
34.
Zero DT: In situ caries models. Adv Dent Res 1995;9:214–230, discussion 231–214.
[PubMed]
© 2012 S. Karger AG, Basel
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
2012
You do not currently have access to this content.
