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Is there a role for casein phosphopeptide–amorphous calcium phosphate (cpp-acp) in paediatric dentistry? Claire Warner Helen J Rogers Dental Update 2024 48:2, 707-709.
Academic Clinical Fellow in Paediatric Dentistry, Unit of Oral Health and Development, School of Clinical Dentistry, University of Sheffield, Claremont Crescent, Sheffield, S10 2TA, UK.
In the age of minimally invasive dentistry, products with the ability to prevent and reverse common dental diseases are becoming increasingly popular. Casein phosphopeptide–amorphous calcium phosphate (CPP–ACP) contains the compounds casein, phosphate and calcium, which all have the ability to remineralize enamel. Dental caries, visible demineralization following removal of orthodontic appliances, non-carious tooth surface loss and dentine hypersensitivity due to structural anomalies are frequently seen in children and young people. The evidence for CPP–ACP and fluoride-containing CPP–ACP is positive for managing dental caries and non-carious tooth surface loss, specifically erosion, but is less clear in the management of visible demineralization following orthodontic appliance removal and dentine hypersensitivity owing to structural anomalies. When recommending CPP–ACP-containing products, dental practitioners should be aware of medical and social contra-indications that preclude its use.
CPD/Clinical Relevance: CPP–ACP may have a role in the management of common paediatric dental conditions.
Article
Casein phosphopeptide–amorphous calcium phosphate (CPP–ACP) is a calcium-based phosphate system that aids enamel remineralization through promoting apatite formation.1 The CPP–ACP complex (Recaldent) was developed at the School of Dental Science at the University of Melbourne, Victoria, Australia and is marketed in the UK as GC Tooth Mousse or GC MI Paste Plus, which also contains fluoride. A varnish containing both CPP–ACP and fluoride (GC MI varnish) is available, as is a glass ionomer cement with added CPP–ACP (GC Fuji VII EP, GC, Japan), although the latter is currently only available in Australia. Another formulation that incorporates Recaldent is chewing gum (available through BreezeCare UK online).
Calcium, phosphate and the protein casein, which are found in milk products, have the potential to remineralize enamel, but large volumes are required.1 CPP is formed when casein is digested by the enzyme trypsin, then aggregated with calcium phosphate and purified using ultrafiltration.2 While ACP has the potential to remineralize enamel, it is unstable and rapidly crystallizes out, promoting the formation of dental calculus. When CPP is combined with ACP, the multiple phosphoseryl residues from casein bound in CPP stabilize ACP by preventing its precipitation into a crystalline phase. The resulting CPP–ACP complex forms a stable remineralization compound.1
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