Effect of CPP-ACP added to Milk, Chewing Gum and Candy on Dental Caries: a Systematic Review

Casein is one of the most studied proteins with activity against dental caries. In particular, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) has shown promising remineralizing properties. In vivo evidence on the anticaries potential of CPP-ACP added to foodstuffs is elusive, nonetheless. Hence, this systematic review aimed at determining whether the use of CPP-ACP added to foodstuffs has a remineralizing or inhibitory action on dental demineralization either in vivo or in situ. The review protocol followed the PRISMA-P criteria and was registered in PROSPERO. PubMed, SCOPUS, and Web of Science databases were searched using predefined criteria, based on the PICO question; Is there an effect on dental caries upon adding CPP-ACP to milk, chewing gums, or candies ? No year or language limits were applied. Article selection and data extraction were carried out independently by 2 investigators.Two hundred-ten titles were examined, 23 selected for full-text review and 16 studies included (2 in vivo, and 14 in situ). In 2 studies, CPP-ACP was added in candy, in 2 to milk and in 12 to chewing gum. The main outcomes included enamel remineralization and activity against dental biofilm. The overall quality of the evidence was classified as moderate. The available evidence suggests that CPP-ACP added to milk, chewing gum or candy has a potential remineralizing activity on tooth enamel, with some additional antibacterial activity on the dental biofilm. Further clinical studies are needed to verify if this effect is clinically significant in reducing the caries lesion incidence or to revert the demineralizing process.

Automated summary

This systematic review aimed to determine the remineralizing or inhibitory action of CPP-ACP added to foodstuffs on dental demineralization. The findings suggest that CPP-ACP added to milk, chewing gum or candy has a potential remineralizing activity on tooth enamel, with some additional antibacterial activity on the dental biofilm. Further clinical studies are needed to confirm these effects.