Methods: This cross-over in situ model involved five healthy adult subjects and four randomized treatments: tooth creme containing 10% CPP-ACP, (Tooth Mousse, GC Corporation; TM), creme containing 10% CPP-ACP plus 900ppm Fluoride (TMP), placebo creme without CPP-ACP and fluoride, and a professional paste containing 950 ppm fluoride. Enamel subsurface lesions (2.5 x 1 mm2) on polished bovine tooth slabs (10 x 5 x 1 mm3) were created by exposure to a lactic acid gel (0.1 M, pH 5.1 with 3 mM CaCl2, 1.8 mM KH2PO4 and 5% HEC) at 37 degree Celsius for 5 days. The slabs were then mounted in a buccal flange on a removable maxillary appliance (4 lesions/appliance). Subjects were instructed to brush their teeth after lunch with a fluoride toothpaste (900 ppm), cover the lesions with the tooth creme, wear the appliance for 30 min, rinse the lesions with water, and keep the appliance in the mouth for four more hours. This was repeated every day for seven days. The appliance was kept in a humidified environment when outside the mouth. The lesions were subjected to analysis using an X-Ray CT scanner (TOSCANER-30000mhd, Toshiba) and Scion Image for Windows before and after intraoral treatments.
Results: The mean percentage remineralization for the placebo, fluoride paste, TM, TMP was 5.76 ± 10.13, 12.14 ± 14.17, 12.73 ± 11.80, and 27.07 ± 14.57 respectively. TMP was superior to all other formulations (p < 0.01).
Conclusion: This study demonstrated significant subsurface enamel remineralization by CPP-ACP tooth creme in the mouth, with a synergistic effect of CPP-ACP and fluoride.