This document summarizes research on Casein Phospho Peptide (CPP) and its potential role in remineralizing tooth enamel and preventing dental caries. CPP works by releasing calcium and phosphate ions and forming amorphous calcium phosphate when the pH is low, helping remineralize enamel. Studies have found CPP can remineralize enamel lesions in both animals and humans when delivered in chewing gum, mouthwashes, and other dental products. CPP has shown promise as an alternative to fluoride for dental caries prevention and treatment.

1. 41st IDA KERALA STATE CONFERENCE
November 21,22,23 2008. Nedumbassery
Scientific Paper Presentation

2. Herbals in Dentistry

3. CASEIN PHOSPHO PEPTIDE(CPP)
The new anticariogenic agent

4. Caries is irreversible ?
It has now been recognized that demineralized but
non-cavitated enamel and dentin
can be healed !
– Martin J. Tyas, Graham J. Mount (2000)

5. Achieving Remineralization
ORAL HYGIENE DIET COUNSELLING

6. Fluorides

7. Search For A Safer Alternative

8. CASEIN PHOSPO-PEPTIDE (CPP)
“ CPP unlike fluorides is completely non-toxic ”
-Reynolds EC, 2000

9. What is casein phospho-peptide ?
Casein CPP
Proteolytic
Enzyme (trypsin)

10. Properties of CPP
Without CPP
Ca+2 + Po4
-3 crystals
In presence of CPP
CPP + Ca +2 + Po4
-3 CPP- ACP

11. Anticariogenicity of CPP – ACP
On dissociation ACP Ca+2 & Po4
-3
pH CPP – ACP bond stronger
pH CPP – ACP bond weaker

12. The Possibilities With CPP

13. Anticariogenicity of CPP– ACP
1.Remineralization
- Reynolds E.C.2001
- Reynolds E.C.2003

14. 1
Plaque
Tooth
Surface
CPP - ACP
3 Saturation of plaque with free
Calcium & Phosphate
2 Acid Attack
4 Gain of Calcium & Phosphate
3 Loss of Calcium & Phosphate
DEMINERALIZATION
REMINERALIZATION

15. 2. Inhibition of demineralization
* Providing calcium binding site
* Modulating plaque composition
* Buffering capacity
-Vernon.P.G, HuntingtonE(1992)
-Roberts.A.J. (1995)

16. 3. Potential of CPP to inhibit plaque formation
* CPP binds to both
tooth surface and plaque bacteria.
-Guggenheim et al.(1994)
-Schupbach et al.(1996)

17. CPP-ACP has been demonstrated to have
anti cariogenic potential in laboratory,
animals and human in-situ experiments.

18. 1% CPP-ACP solution = 500 ppm fluoride
(Reynold EC & Riley PF 1997)
Fluoride + CPP-ACP = ?

19. In vivo Studies
• CHEWING GUM STUDY
Sugar free gum containing 18.8mg CPP-ACP
produced 17.9 % enamel subsurface
remineralization compared with 9% by control
sugar free gum.
(Reynolds et al 2001,2004)

20. • MOUTH RINSE STUDY
Results of mouth rinse study showed that
CPP-ACP rinses significantly increased the
plaque calcium and phosphate levels,
produced more than twice the level of
remineralization
( Reynolds et al, 2003)

21. Animal Studies
• SOLUTION CONTAINING CPP
CPP-ACP solutions applied to the molar teeth
of the rats thrice daily significantly reduced
caries activity in a dose response fashion.
(Reynolds et al, 1995)

22. Invitro Studies
• DENTIFRICE STUDY
Dentifrice containing 5% w/w CPP was compared
with identical CPP-free
CPP containing dentifrice, reduced the surface
softening by 20% compared with the placebo group.
(Vernon P.G, Huntington E 1992)

23. • MOUTH RINSE STUDY
1.0% CPP-ACPsolution produced 63.9%
remineralization of enamel subsurface
lesions over 10-day period .
(Reynolds et al, 1997)

24. • STUDY ON GIC WITH CPP
Results suggests that Fuji IX G P
containing CPP-ACP will provide
enhanced protection against secondary
caries, when compared with conventional
Glass ionomer.
(E.C.Reynolds 2003)

25. In vivo Studies
• MOUTH RINSE STUDY
It was conclude that CPP preparation hold
promise as caries preventive agent for
individuals with dry mouth.
( David Hays 2002)

26. • DENTIFRICE STUDY
The results demonstrate that CPP (1%)
containing tooth paste significantly lower
caries increment compared to SMFP and
plain tooth paste.
[SreeVidya.K, 2006]

27. Commercially Available Products
Trident Chewing Gum ( Recaldent )comes in two
gum flavors - a strong mint and a more fruity
tropical flavor.
MI paste(Recaldent) is a topical paste, which is
water based and sugar free cream. It is applied
during polishing of teeth after oral prophylaxis.

29. Lets Consider The Help At Hand

30. References
1. Oral health in america- a report of surgeon general (executive
summary).2000: pg-4
2. Shoba Tandon and Shetty. Prevalence of Dental Caries among 5-1:3
year old in Mangalore city. JISPPD 2005; 23: 74-79
3. Mishra F. M. and Shee P.K, Prevalence of Dental Caries in School
Going children in an Urban Area of South Orissa. JIDA 1979;51: 267-
270
4. P.Shen, F.Cai, a.Nowicki, J.Vincet and E.C.Reynolds.
Remineralization of enamel subsurface lesions by sugar free chewing
gum containing CPP-ACP. JDR. 2001; 80(12): 2066-70
5. Y.Lijima, F.Cai. Acid resistance of enamel sub-surface lesions
remineralized by a sugar-free chewing gum containing CPP-ACP.
Caries research 2004; 38: 551-58

31. 6. RenoyldS E,C. Remineralization ofenamcl subsurface lesions by
caseinphosphopeptide-stabilized calcium phosphate solutions.
J. Dent. Res. 1997;76:1587-1595.
7. E.C.Reynolds, C.J.Cain, F.L.Weber. Anticariogenecity of calcium
phosphate complexes of tryptic CPP in the rat. Jornal of Dental
Research 1995; 74(6):1272-79
8. Vernon P.G, Huntington E. An intra-oral model to monitor the
effect of dentifrice on surface softening of enamel in-situ. Jornal
of Dental Research 1992; 71: 597-600
9. RenoyldS E,C. The prevention of subsurface lesions of bovine
enamel and change in plaque composition by casein in intra-oral
model. J. Dent. Res. 1997;66:1120-1127.

32. 10. S.A.Mazzaoui, M.F.Burrow, M.J.Tyas and E.C.Reynolds.
Incorporation CPP-ACP in to glass ionomer cement. JDR 2003;
11: 914-18
11. K.David. A clinical trial of the anticaries efficacy of casein
derivatives complexed with calcium phosphte in patients with
salivary gland dysfunction. Oral surg oral med oral pathol. 2002;
93: 271-75
12. Neeser J. R., Golliard M., Woltz A., Dillmann M. and
Guggenheim, B. In vitro modulation of oral bacterial adhesion to
saliva coated hydroxyapatite beads by milk casein
derivatives.Oral Microbiol. Immunol. 1994;9: 193-20 1.
13. Shupbach P., Neeser J-R., Golliard M., Rouvet M. and
Guggenheim B. Incorporation of caseinoglycomacropeptide and
caseinphosphopeptide into the salivary pellicle inhibits
adherence of Streptococcus mutans.J. Dent. Res. 1996:75:
1779-1788.