- Email: [email protected]
Casein phosphopeptide−amorphous calcium phosphate
Table 2.—Clinical and Radiographic Measurements (Mean [95% CI]) Plus Total Calcium and Vitamin D Intake (Oral Supplementation Plus Diet) Measurement
Takers (n = 23)
Probing depth (mm) 2.18 (2.00 to 2.36) Attachment loss 1.80 (1.39 to 2.20) (mm)y Bleeding sites (%) 60 (52 to 69) Gingival index 0.73 (0.52 to 0.94) Furcation involvement 47 (26 to 68) (%)z CEJ-AC (mm) 1.71 (1.34 to 2.09) Calcium intake 1,769 (1,606 to 1,933) (mg/day) Vitamin D intake 1,049 (781 to 1,317) (IU/day)
Non-Takers (n = 28)
2.33 (2.09 to 2.57)* 2.01 (1.59 to 2.42)* 66 (58 to 74)* 1.00 (0.77 to 1.23)* 72 (42 to 100)* 2.04 (1.63 to 2.45)* 642 (505 to 779)x 156 (117 to 195)x
Abbreviations: CEJ, cementoenamel junction; GM, gingival margin. (Courtesy of Miley DD, Gracia MN, Hildebolt CF, et al: Cross-sectional study of vitamin D and calcium supplementation effects on chronic periodontitis. J Periodontol 80:1433-1439, 2009.) * P > 0.05. y Attachment loss = CEJGM. z Percentage of molar sites with furcation involvement. x P < 0.01.
who was taking supplements had a total calcium intake of only 897 mg/day. The persons taking supplements had been using them for an average of 10.6 years, with a range of 6.3 to 23 years. The differences between the two groups with regard to total daily intake of calcium and vitamin D were significant (Table 2). The subjects who did not take supplements had higher mean scores for all of the clinical measurements of
periodontal health than those taking supplements, indicating a worse periodontal status. CEJ-AC distances were 19% greater, probing depths 7% greater, and attachment loss 12% greater among the nonsupplemented subjects. The differences in the clinical measurements between the two groups were borderline statistically significant on repeated measures multivariate analysis of variance. Discussion.—The subjects who took calcium and vitamin D supplements demonstrated better periodontal health than the subjects who did not took supplements. Probing depth, bleeding sites, gingival index, furcation involvement, attachment loss, and alveolar crest height loss data were more favorable for the supplemented individuals.
Clinical Significance.—Vitamin D and calcium supplementation were associated with better periodontal health in subjects receiving maintenance therapy. Expanded longitudinal studies are needed to analyze the potential of the supplement-periodontal health link.
Miley DD, Gracia MN, Hildebolt CF, et al: Cross-sectional study of vitamin D and calcium supplementation effects on chronic periodontitis. J Periodontol 80:1433-1439, 2009 Reprints available from DD Miley, St Louis Univ Center for Advanced Dental Education, 3320 Rutger St, St Louis, MO 63104; fax: 314/9778617; e-mail: [email protected]
Preventive Dentistry Casein phosphopeptideamorphous calcium phosphate Background.—Casein phosphopeptide (CPP) stabilizes calcium phosphate by binding to amorphous calcium phosphate (ACP), thus forming CPP-ACP clusters. These clusters serve as reservoirs for calcium and phosphate and cling to dental plaque and tooth surfaces. An acidic challenge prompts the release of calcium and phosphate ions, producing a supersaturated mineral environment and enhancing remineralization while minimizing demineralization. Enamel that is remineralized by CPP-ACP is more resistant to acid than normal enamel. CPP-ACP is applied through sugar-free sorbitol- or xylitol-based chewing gum, milk, mouthrinses, lozenges, and dental creams. A systematic review with meta-analysis was conducted to determine if CPP-ACP in the oral environment provides more cariespreventive benefits than other approaches.
Methods.—Twelve articles were found in a search of seven electronic databases. Five reported in situ randomized control trials (RCTs) that were pooled for metaanalysis. Results.—The pooled results of the in situ trials showed a weighted mean difference of the percentage remineralization scores that favored chewing gum containing 18.8 mg CPP-ACP compared to chewing gum without CPPACP or no intervention over a term of 7 to 21 days. Exposure to 10.0 mg CPP-ACP also conveyed a significantly higher remineralization effect than the other two options. In 2720 subjects followed for 24 months, the odds of a tooth surface progressing to caries was 18% less when 54 mg of CPP-ACP was delivered via sugar-free chewing gum than for control
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Issue 2
2010
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subjects who chewed nonsupplemented gum. In studies involving toothpaste slurries and dental creams, groups using products containing CPP-ACP showed better results than those not containing CPP-ACP in relation to percent remineralization and number of white spot lesions. Discussion.—The meta-analysis determined that CPPACP delivered remineralization effects with 7- to 21-day exposures. In addition, CPP-ACP use for 24 months appeared to have caries-preventive abilities. Confirmation of these findings will require further RCTs.
Clinical Significance.—CPP-ACPaugmented chewing gum appears to be an effective way to improve remineralization, discourage demineralization, prevent caries, and treat white spot lesions. More well-designed in vivo RCTs focused on outcomes of caries, prevention are needed.
Yengopal V, Mickenautsch S: Caries preventive effect of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP): A meta-analysis. Acta Odontol Scand 67:321-332, 2009 Reprints available from S Mickenautsch, Div of Public Oral Health, Univ of the Witwatersrand, 7 York Rd, Parktown/Johannesburg 2193, South Africa; fax: þ27 11 6467614; e-mail: [email protected]
The state of caries management Background.—Antibacterial and probiotic approaches to caries management were evaluated by Discussion Group 2 for the International Conference on Novel Anti-caries and Remineralizing Agents. The primary areas addressed were professional issues, patient/consumer issues, industry perspectives, laboratory research, clinical trials, specific applications, and current and future directions. These major issues were summarized.
symptoms. The group identified two approaches to prevention. The first would deliver remineralizing agents or antimicrobials by promoting minor but frequent changes in daily habits, for example, promoting chewing xylitol-sweetened gum several times a day. The second would deliver more substantive treatments through relatively infrequent professional visits. Neither of these approaches may be available to patients of limited financial means, however.
Professional Issues.—It often takes considerable time for dentists to embrace changes in clinical paradigms, preventive efforts, and treatment strategies. Acceptance is influenced by what is being taught in schools of dentistry and the focus of state and regional licensing examinations. Communication between dentistry and the national regulatory and governmental agencies about oral health and disease definitions has not always been effective. The profession must focus on consistent, realistic, evidence-based expressions of efficacy and safety for products and services. Presentations of preventive modalities to the public and the profession must be evidence-based, which will require additional clinical trials in some cases. Dentistry alone may be unable to provide new in-office treatments to sufficient numbers of persons, especially those who lack financial resources. Pediatricians, school nurses, and other healthcare providers with access to children would serve as adjunct providers, requiring some caries-preventive training. Since some medical professionals already perform treatments and are reimbursed through medical insurance programs, dentistry should investigate how to obtain similar reimbursement for these same procedures.
Industry Perspectives.—Dental product companies are interested in new caries-preventive products and in improving and developing additional features for current products. Products with the potential to quickly become available to the public without a prescription were favored. There is concern about the acceptability of products to consumers. The companies would also like to see strong proof-of-concept studies in the laboratory before funding expensive, time-consuming clinical trials.
Patient/Consumer Issues.—Most consumers of dental services delay making changes in caries-promoting behaviors until problems develop. Dentists have difficulty motivating patients to change diet, oral hygiene habits, or the use of caries-preventive products until the patient develops
102
Dental Abstracts
Laboratory Research.—No consensus was reached regarding definitions of a healthy or beneficial biofilm. The most acceptable definition involved a continuum from the less harmful to the more harmful. The biofilm’s cariogenic potential may need to be coupled with risk factor assessment. Appropriate surrogate endpoints for antimicrobial and probiotic products may differ depending on the population or clinical circumstances. Research goals should include identifying factors contributing most to the development of clinical caries lesions and appropriately using them as surrogate endpoints in laboratory evaluations. Through the development of models that can detect synergistic and/or additive effects of antimicrobial, probiotics, and fluoride, new evidence could be found to link surrogate endpoints and clinical caries development. The surrogate endpoints worth further study included (1) decreased
Takers (n = 23)
Probing depth (mm) 2.18 (2.00 to 2.36) Attachment loss 1.80 (1.39 to 2.20) (mm)y Bleeding sites (%) 60 (52 to 69) Gingival index 0.73 (0.52 to 0.94) Furcation involvement 47 (26 to 68) (%)z CEJ-AC (mm) 1.71 (1.34 to 2.09) Calcium intake 1,769 (1,606 to 1,933) (mg/day) Vitamin D intake 1,049 (781 to 1,317) (IU/day)
Non-Takers (n = 28)
2.33 (2.09 to 2.57)* 2.01 (1.59 to 2.42)* 66 (58 to 74)* 1.00 (0.77 to 1.23)* 72 (42 to 100)* 2.04 (1.63 to 2.45)* 642 (505 to 779)x 156 (117 to 195)x
Abbreviations: CEJ, cementoenamel junction; GM, gingival margin. (Courtesy of Miley DD, Gracia MN, Hildebolt CF, et al: Cross-sectional study of vitamin D and calcium supplementation effects on chronic periodontitis. J Periodontol 80:1433-1439, 2009.) * P > 0.05. y Attachment loss = CEJGM. z Percentage of molar sites with furcation involvement. x P < 0.01.
who was taking supplements had a total calcium intake of only 897 mg/day. The persons taking supplements had been using them for an average of 10.6 years, with a range of 6.3 to 23 years. The differences between the two groups with regard to total daily intake of calcium and vitamin D were significant (Table 2). The subjects who did not take supplements had higher mean scores for all of the clinical measurements of
periodontal health than those taking supplements, indicating a worse periodontal status. CEJ-AC distances were 19% greater, probing depths 7% greater, and attachment loss 12% greater among the nonsupplemented subjects. The differences in the clinical measurements between the two groups were borderline statistically significant on repeated measures multivariate analysis of variance. Discussion.—The subjects who took calcium and vitamin D supplements demonstrated better periodontal health than the subjects who did not took supplements. Probing depth, bleeding sites, gingival index, furcation involvement, attachment loss, and alveolar crest height loss data were more favorable for the supplemented individuals.
Clinical Significance.—Vitamin D and calcium supplementation were associated with better periodontal health in subjects receiving maintenance therapy. Expanded longitudinal studies are needed to analyze the potential of the supplement-periodontal health link.
Miley DD, Gracia MN, Hildebolt CF, et al: Cross-sectional study of vitamin D and calcium supplementation effects on chronic periodontitis. J Periodontol 80:1433-1439, 2009 Reprints available from DD Miley, St Louis Univ Center for Advanced Dental Education, 3320 Rutger St, St Louis, MO 63104; fax: 314/9778617; e-mail: [email protected]
Preventive Dentistry Casein phosphopeptideamorphous calcium phosphate Background.—Casein phosphopeptide (CPP) stabilizes calcium phosphate by binding to amorphous calcium phosphate (ACP), thus forming CPP-ACP clusters. These clusters serve as reservoirs for calcium and phosphate and cling to dental plaque and tooth surfaces. An acidic challenge prompts the release of calcium and phosphate ions, producing a supersaturated mineral environment and enhancing remineralization while minimizing demineralization. Enamel that is remineralized by CPP-ACP is more resistant to acid than normal enamel. CPP-ACP is applied through sugar-free sorbitol- or xylitol-based chewing gum, milk, mouthrinses, lozenges, and dental creams. A systematic review with meta-analysis was conducted to determine if CPP-ACP in the oral environment provides more cariespreventive benefits than other approaches.
Methods.—Twelve articles were found in a search of seven electronic databases. Five reported in situ randomized control trials (RCTs) that were pooled for metaanalysis. Results.—The pooled results of the in situ trials showed a weighted mean difference of the percentage remineralization scores that favored chewing gum containing 18.8 mg CPP-ACP compared to chewing gum without CPPACP or no intervention over a term of 7 to 21 days. Exposure to 10.0 mg CPP-ACP also conveyed a significantly higher remineralization effect than the other two options. In 2720 subjects followed for 24 months, the odds of a tooth surface progressing to caries was 18% less when 54 mg of CPP-ACP was delivered via sugar-free chewing gum than for control
Volume 55
Issue 2
2010
101
subjects who chewed nonsupplemented gum. In studies involving toothpaste slurries and dental creams, groups using products containing CPP-ACP showed better results than those not containing CPP-ACP in relation to percent remineralization and number of white spot lesions. Discussion.—The meta-analysis determined that CPPACP delivered remineralization effects with 7- to 21-day exposures. In addition, CPP-ACP use for 24 months appeared to have caries-preventive abilities. Confirmation of these findings will require further RCTs.
Clinical Significance.—CPP-ACPaugmented chewing gum appears to be an effective way to improve remineralization, discourage demineralization, prevent caries, and treat white spot lesions. More well-designed in vivo RCTs focused on outcomes of caries, prevention are needed.
Yengopal V, Mickenautsch S: Caries preventive effect of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP): A meta-analysis. Acta Odontol Scand 67:321-332, 2009 Reprints available from S Mickenautsch, Div of Public Oral Health, Univ of the Witwatersrand, 7 York Rd, Parktown/Johannesburg 2193, South Africa; fax: þ27 11 6467614; e-mail: [email protected]
The state of caries management Background.—Antibacterial and probiotic approaches to caries management were evaluated by Discussion Group 2 for the International Conference on Novel Anti-caries and Remineralizing Agents. The primary areas addressed were professional issues, patient/consumer issues, industry perspectives, laboratory research, clinical trials, specific applications, and current and future directions. These major issues were summarized.
symptoms. The group identified two approaches to prevention. The first would deliver remineralizing agents or antimicrobials by promoting minor but frequent changes in daily habits, for example, promoting chewing xylitol-sweetened gum several times a day. The second would deliver more substantive treatments through relatively infrequent professional visits. Neither of these approaches may be available to patients of limited financial means, however.
Professional Issues.—It often takes considerable time for dentists to embrace changes in clinical paradigms, preventive efforts, and treatment strategies. Acceptance is influenced by what is being taught in schools of dentistry and the focus of state and regional licensing examinations. Communication between dentistry and the national regulatory and governmental agencies about oral health and disease definitions has not always been effective. The profession must focus on consistent, realistic, evidence-based expressions of efficacy and safety for products and services. Presentations of preventive modalities to the public and the profession must be evidence-based, which will require additional clinical trials in some cases. Dentistry alone may be unable to provide new in-office treatments to sufficient numbers of persons, especially those who lack financial resources. Pediatricians, school nurses, and other healthcare providers with access to children would serve as adjunct providers, requiring some caries-preventive training. Since some medical professionals already perform treatments and are reimbursed through medical insurance programs, dentistry should investigate how to obtain similar reimbursement for these same procedures.
Industry Perspectives.—Dental product companies are interested in new caries-preventive products and in improving and developing additional features for current products. Products with the potential to quickly become available to the public without a prescription were favored. There is concern about the acceptability of products to consumers. The companies would also like to see strong proof-of-concept studies in the laboratory before funding expensive, time-consuming clinical trials.
Patient/Consumer Issues.—Most consumers of dental services delay making changes in caries-promoting behaviors until problems develop. Dentists have difficulty motivating patients to change diet, oral hygiene habits, or the use of caries-preventive products until the patient develops
102
Dental Abstracts
Laboratory Research.—No consensus was reached regarding definitions of a healthy or beneficial biofilm. The most acceptable definition involved a continuum from the less harmful to the more harmful. The biofilm’s cariogenic potential may need to be coupled with risk factor assessment. Appropriate surrogate endpoints for antimicrobial and probiotic products may differ depending on the population or clinical circumstances. Research goals should include identifying factors contributing most to the development of clinical caries lesions and appropriately using them as surrogate endpoints in laboratory evaluations. Through the development of models that can detect synergistic and/or additive effects of antimicrobial, probiotics, and fluoride, new evidence could be found to link surrogate endpoints and clinical caries development. The surrogate endpoints worth further study included (1) decreased