The erosion-protective effect of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) is controversial. This study aimed to investigate the ability of CPP-ACP chewing gum to prevent a single event of erosive demineralization in situ. Bovine enamel blocks (n = 120) were randomly assigned to 3 phases according to the baseline surface hardness: phase I (PI) - chewing gum with CPP-ACP, phase II (PII) - chewing gum without CPP-ACP, and control phase (PIII) - salivary effect without stimulation (no gum). Nineteen volunteers participated in this study during 3 crossover phases of 2 h. In PI and PII, the volunteers wore intraoral palatal appliances for 120 min and chewed a unit of the corresponding chewing gum for the final 30 min. In the control phase the volunteers wore the appliance for 2 h, without chewing gum. Immediately after intraoral use, the appliances were extraorally immersed in a cola drink for 5 min to promote erosive demineralization. The percentage of surface hardness loss was calculated. The data were analyzed by ANOVA models and Tukey's test. Lower enamel hardness loss was found after the use of chewing gum with CPP-ACP (PI: 32.7%) and without CPP-ACP (PII: 33.5%) compared to the salivary effect without stimulation (PIII: 39.8%) (p < 0.05). There was no difference between PI and PII (p > 0.05). The results suggest that the use of chewing gum immediately before an erosive demineralization can diminish enamel hardness loss. However, the presence of CPP-ACP in the chewing gum cannot enhance this protective effect.

Keywords:
Amorphous calcium phosphate, Bovine enamel, Chewing gum, In situ study, Dental erosion
1.
Abdulah AZ, Ireland AJ, Sandy JR, Barbour ME: A nanomechanical investigation of three putative anti-erosion agents: remineralisation and protection against demineralisation. Int J Dent 2012;2012:768126.
2.
Alencar CR, Magalhães AC, de Andrade Moreira Machado MA, de Oliveira TM, Honório HM, Rios D: In situ effect of a commercial CPP-ACP chewing gum on the human enamel initial erosion. J Dent 2014;42:1502-1507.
3.
Amaechi BT, Higham SM: In vitro remineralisation of eroded enamel lesions by saliva. J Dent 2001;29:371-376.
4.
Barbour ME, Shellis RP, Parker DM, Allen GC, Addy M: Inhibition of hydroxyapatite dissolution by whole casein: the effects of pH, protein concentration, calcium, and ionic strength. Eur J Oral Sci 2008;116:473-478.
5.
Boskey AL, Posner AS: Conversion of amorphous calcium phosphate to microcrystalline hydroxyapatite: a pH-dependent, solution-mediated, solid-solid conversion. J Agric Food Chem 1973;77:2313-2317.
6.
Brevik SC, Lussi A, Rakhmatullina E: A new optical detection method to assess the erosion inhibition by in vitro salivary pellicle layer. J Dent 2013;41:428-435.
7.
Buzalaf MA, Magalhães AC, Wiegand A: Alternatives to fluoride in the prevention and treatment of dental erosion. Monogr Oral Sci 2014;25:244-252.
8.
Cai F, Shen P, Morgan MV, Reynolds EC: Remineralization of enamel subsurface lesions in situ by sugar-free lozenges containing casein phosphopeptide-amorphous calcium phosphate. Aust Dent J 2003;48:240-243.
9.
Cheaib Z, Lussi A: Impact of acquired enamel pellicle modification on initial dental erosion. Caries Res 2011;45:107-112.
10.
Cochrane NJ, Saranathan S, Cai F, Cross KJ, Reynolds EC: Enamel subsurface lesion remineralisation with casein phosphopeptide stabilised solutions of calcium, phosphate and fluoride. Caries Res 2008;42:88-97.
11.
Cross KJ, Huq NL, O'Brien-Simpson M, Perich JW, Attard TJ, Reynolds EC: The role of multiphosphoserylated peptides in mineralised tissue regeneration. Int J Pept Res Ther 2007;13:475-479.
12.
Devold TG, Rykke M, Isabey D, Sørensen ES, Christiensen B, Langsrud T, Svenning C, Borch-Iohnsen B, Karlsen J, Vegarud GE: In vitro studies of adsorption of milk proteins onto tooth enamel. Int Dairy J 2006;16:1013-1017.
13.
Ganss C, Lussi A, Schlueter N: The histological features and physical properties of eroded dental hard tissues. Monogr Oral Sci 2014;25:99-107.
14.
Gupta R, Prakash V: CPP-ACP complex as a new adjunctive agent for remineralisation: a review. Oral Health Prev Dent 2011;9:151-165.
15.
Hannig M: The protective nature of the salivary pellicle. Int Dent J 2002;52:417-423.
16.
Hannig M, Hannig C: The pellicle and erosion. Monogr Oral Sci 2014;25:206-214.
17.
Hannig M, Hess NJ, Hoth-Hannig W, De Vrese M: Influence of salivary pellicle formation time on enamel demineralization - an in situ pilot study. Clin Oral Investig 2003;7:158-161.
18.
Hara A, Ando M, Gonzalez-Cabezas C, Cury J, Serra M, Zero D: Protective effect of the dental pellicle against erosive challenges in situ. J Dent Res 2006;85:612-616.
19.
Hemingway CA, White AJ, Shellis RP, Addy M, Parker DM, Barbour ME: Enamel erosion in dietary acids: inhibition by food proteins in vitro. Caries Res 2010;44:525-530.
20.
Honório HM, Rios D, Santos CF, Magalhães AC, Buzalaf MA, Machado MA: Effects of erosive, cariogenic or combined erosive/cariogenic challenges on human enamel: an in situ/ex vivo study. Caries Res 2008;42:454-459.
21.
Honório HM, Rios D, Santos CF, Magalhães AC, Delbem AC, Buzalaf MA, Machado MA: Cross-sectional microhardness of human enamel subjected to erosive, cariogenic or combined erosive/cariogenic challenges. Caries Res 2010;44:29-32.
22.
Huysmans MC, Young A, Ganss C: The role of fluoride in erosion therapy. Monogr Oral Sci 2014;25:230-243.
23.
Kumar VL, Itthagarun A, King NM: The effect of casein phosphopeptide-amorphous calcium phosphate on remineralization of artificial caries-like lesions: an in vitro study. Aust Dent J 2008;53:34-40.
24.
Lussi A: Dental erosion-novel remineralizing agents in prevention and repair. Adv Dent Res 2009;21:13-16.
25.
Lussi A, Carvalho TS: Erosive tooth wear: a multifactorial condition of growing concern and increasing knowledge. Monogr Oral Sci 2014;25:1-15.
26.
Manton DJ, Cai F, Yuan Y, Walker GD, Cochrane NJ, Reynolds C, Brearley-Messer LJ, Reynolds EC: Effect of casein phosphopeptide-amorphous calcium phosphate added to acidic beverages on enamel erosion in vitro. Aust Dent J 2010;55:275-279.
27.
Nongonierma AB, Fitzgerald RJ: Biofunctional properties of caseinophosphopeptides in the oral cavity. Caries Res 2012;46:234-267.
28.
Poggio C, Lombardini M, Dagna A, Chiesa M, Bianchi S: Protective effect on enamel demineralization of a CPP-ACP paste: an AFM in vitro study. J Dent 2009;37:949-954.
29.
Poggio C, Lombardini M, Vigorelli P, Ceci M: Analysis of dentin/enamel remineralization by a CPP-ACP paste: AFM and SEM study. Scanning 2013;35:366-374.
30.
Prestes L, Souza BM, Comar LP, Salomão PA, Rios D, Magalhães AC: In situ effect of chewing gum containing CPP-ACP on the mineral precipitation of eroded bovine enamel-a surface hardness analysis. J Dent 2013;41:747-751.
31.
Ranjitkar S, Kaidonis JA, Richards LC, Townsend GC: The effect of CPP-ACP on enamel wear under severe erosive conditions. Arch Oral Biol 2009a;54:527-532.
32.
Ranjitkar S, Narayana T, Kaidonis JA, Hughes TE, Richards LC, Townsend GC: The effect of casein phosphopeptide-amorphous calcium phosphate on erosive dentine wear. Aust Dent J 2009b;54:101-107.
33.
Ranjitkar S, Rodriguez JM, Kaidonis JA, Richards LC, Townsend GC, Bartlett DW: The effect of casein phosphopeptide-amorphous calcium phosphate on erosive enamel and dentine wear by toothbrush abrasion. J Dent 2009c;37:250-254.
34.
Rees J, Loyn T, Chadwick B: Pronamel and tooth mousse: an initial assessment of erosion prevention in vitro. J Dent 2007;35:355-357.
35.
Reynolds EC: Casein phosphopeptide-amorphous calcium phosphate: the scientific evidence. Adv Dent Res 2009;21:25-29.
36.
Reynolds EC, Cai F, Cochrane NJ, Shen P, Walker GD, Morgan MV, Reynolds C: Fluoride and casein phosphopeptide-amorphous calcium phosphate. J Dent Res 2008;87:344-348.
37.
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.
38.
Rios D, Honório HM, Magalhães AC, Delbem AC, Machado MA, Silva SM, Buzalaf MA: Effect of salivary stimulation on erosion of human and bovine enamel subjected or not to subsequent abrasion: an in situ/ex vivo study. Caries Res 2006;40:218-223.
39.
Rios D, Honório HM, Magalhães AC, Silva SM, Delbem AC, Machado MA, Buzalaf MA: Scanning electron microscopic study of the effect of salivary stimulation on erosion and abrasion in human and bovine enamel. Braz Oral Res 2008;22:132-138.
40.
Rykke M, Smistad G, Rölla G, Karsen J: Micelle-like structures in human saliva. Colloids Surf B Biointerfaces 1995;4:33-44.
41.
Shellis RP, Featherstone JD, Lussi A: Understanding the chemistry of dental erosion. Monogr Oral Sci 2014;25:163-179.
42.
Skrtic D, Antonucci JM, Eanes ED: Amorphous calcium phosphate-based bioactive polymeric composites for mineralizes tissue regeneration. J Res Natl Inst Stand Technol 2003;108:167-182.
43.
Wang X, Megert B, Hellwig E, Neuhaus KW, Lussi A: Preventing erosion with novel agents. J Dent 2011;39:163-170.
44.
Wegehaupt FJ, Attin T: The role of fluoride and casein phosphopeptide/amorphous calcium phosphate in the prevention of erosive/abrasive wear in an in vitro model using hydrochloric acid. Caries Res 2010;44:358-363.
45.
Wegehaupt FJ, Tauböck TT, Stillhard A, Schmidlin PR; Attin T: Influence of extra- and intra-oral application of CPP-ACP and fluoride on re-hardening of eroded enamel. Acta Odontol Scand 2012;70:177-183.
46.
White AJ, Gracia LH, Barbour ME: Inhibition of dental erosion by casein and casein-derived proteins. Caries Res 2011;45:13-20.
47.
Wiegand A, Attin T: Randomised in situ trial on the effect of milk and CPP-ACP on dental erosion. J Dent 2014;42:1210-1215.
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