Reversal of root caries using CPP-ACP in dry mouth patients

Objectives: The aim of this study was to investigate the efficacy of a dental varnish containing Casein Phosphopeptide–Amorphous Calcium Phosphate (CPP-ACP) and 5% sodium fluoride (NaF) compared with a varnish containing 5% NaF in reversing root caries in dry-mouth patients over six months.
Methods: 72 dry-mouth patients with at least one primary root caries (n=168) with unstimulated salivary flow rate of <0.02 ml/min and age range 45-92 years, were randomly allocated to one of two groups: Group 1 (n=36) had 73 lesions received CPP-ACP+ NaF varnish (MI varnish, GC, Japan) (n=95), Group 2 (n=36) had 95 lesions received NaF varnish (NUPRO White, Dentsply Sirona, USA). The varnish was applied on 3 visits at a 3-monthly interval. Severity index (SI), clinical criteria for root caries and DIAGNOdent measurements were carried out at each of the visits. Oral hygiene instructions and standardised dentifrice containing 1,450 ppm NaF (Oral-B, UK) were provided to the study subjects.
Results: The root carious lesions in Group 1 became hard with SI of 0 (n=47, 64.38%) significantly higher than Group 2 (n=41, 43.16%) (p=0.04). After six months, Group 1 had more lesions shifted to SI score 0 (n=61, 83.56%), compared with Group 2 (n=72, 75.79%) but the difference was not statistically significant (p=0.2). In both groups, non-cavitated lesions were more likely to change from leathery to hard texture when compared with cavitated lesions. Significantly more lesions in Group 1 changed from rough to smooth texture compared with Group 2 (p=0.01). In both groups, there was significant decrease in plaque index, surface roughness, lesion dimension, DIAGNOdent readings, and significant increase in lesion distance from the gingival margin (p<0.05).
Conclusions: Fluoride dental varnish with or without calcium and phosphate, applied once every three months has the potential to arrest/reverse root caries, especially in non-cavitated lesions, in patients with dry mouth.