CPP-ACP in Milk, Chewing-Gum, and Candies in Dental Caries: Systematic-Review
Objectives: Casein is one of the most studied caries-related proteins, with promising remineralizing effects when used in the form of casein phosphopeptide--amorphous calcium phosphate-nanocomplexes (CPP-ACP). However, there is little evidence on the anticaries potential of CPP-ACP when added to foods, such as milk or candies. Hence, this study aimed to review the available evidence on CPP-ACP added to milk, chewing-gums or candies, and determine its effect on caries. Methods: A systematic review of the literature was conducted by searching three databases (Medline via PubMed, SCOPUS and Web of Science). A predefined searching strategy was developed according to a PICO-question framework. No limits in publication year or language were applied. Study screening, selection and data extraction were carried out independently by two researchers. Eligible in vivo or in situ studies were included. Results: Out of 210 titles found, 23 were selected for full-text review. From those, 16 studies were included (14 in situ, 2 in vivo). Outcomes included enamel remineralization and biofilm activity. Ninety two percent of the studies show enamel remineralizing potential from CPP-ACP. At the biofilm level, CPP-ACP showed an ability to retain within the biofilm and release calcium and phosphate, increasing the proportion of alkali-producing bacteria with an antibacterial activity. The overall quality of the evidence was judged as moderate. Conclusions: The available evidence suggests that CPP-ACP added to milk, chewing-gums or candies has a remineralizing potential in enamel, with biofilm controlling activity. Additional clinical studies are needed to confirm a clinical effect (PROSPERO CRD42020215024).