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      CPP–ACP and Fluoride: A Synergism to Combat Caries

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          ABSTRACT

          Aims

          The aim of this study is to evaluate and compare the demineralization inhibitory effect, fluoride release at varying time intervals, and antibacterial property of MI varnish and fluor protector varnish.

          Materials and methods

          Twenty-four extracted human premolars were sectioned mesiodistally. The buccal and the lingual halves of the teeth were utilized to evaluate the demineralization inhibitory effect and fluoride release of MI varnish and fluor protector varnish, respectively. To evaluate the demineralization inhibitory effect, 150-μm axial longitudinal section was obtained that was photographed and evaluated under a polarized light microscope. To evaluate the fluoride release, a fluoride-specific ion electrode was used. To evaluate the antibacterial susceptibility, the disk diffusion test (Kirby–Bauer method) was done.

          Results

          Statistical analysis was done using the Students unpaired t test for intergroup comparison and the p value <0.01 was obtained for all the three parameters, i.e., demineralization inhibitory effect, antimicrobial property, and fluoride releasing property at different time intervals.

          Conclusion

          A combination of casein phosphopeptide (CPP)–amorphous calcium phosphate (ACP) in fluoride varnish seems to enhance the caries preventive potential of fluoride varnish and antibacterial activity against Streptococcus mutans.

          Clinical significance

          MI varnish, a combination of CPP–ACP and fluoride varnish could be the future of minimally invasive dentistry as it is minimally invasive yet an effective modality for caries prevention.

          How to cite this article

          Attiguppe P, Malik N, et al. CPP–ACP and Fluoride: A Synergism to Combat Caries. Int J Clin Pediatr Dent 2019;12(2):120–125.

          Related collections

          Most cited references32

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          Genome sequence of Streptococcus mutans UA159, a cariogenic dental pathogen.

          Streptococcus mutans is the leading cause of dental caries (tooth decay) worldwide and is considered to be the most cariogenic of all of the oral streptococci. The genome of S. mutans UA159, a serotype c strain, has been completely sequenced and is composed of 2,030,936 base pairs. It contains 1,963 ORFs, 63% of which have been assigned putative functions. The genome analysis provides further insight into how S. mutans has adapted to surviving the oral environment through resource acquisition, defense against host factors, and use of gene products that maintain its niche against microbial competitors. S. mutans metabolizes a wide variety of carbohydrates via nonoxidative pathways, and all of these pathways have been identified, along with the associated transport systems whose genes account for almost 15% of the genome. Virulence genes associated with extracellular adherent glucan production, adhesins, acid tolerance, proteases, and putative hemolysins have been identified. Strain UA159 is naturally competent and contains all of the genes essential for competence and quorum sensing. Mobile genetic elements in the form of IS elements and transposons are prominent in the genome and include a previously uncharacterized conjugative transposon and a composite transposon containing genes for the synthesis of antibiotics of the gramicidin/bacitracin family; however, no bacteriophage genomes are present.
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            Changing paradigms in concepts on dental caries: consequences for oral health care.

            Kuhn proposed in his Structure of Scientific Revolutions (1962) that the theoretical framework of a science (paradigm) determines how each generation of researchers construes a causal sequence. Paradigm change is infrequent and revolutionary; thereafter previous knowledge and ideas become partially redundant. This paper discusses two paradigms central to cariology. The first concerns the most successful caries-preventive agent: fluoride. When it was thought that fluoride had to be present during tooth mineralisation to 'improve' the biological apatite and the 'caries resistance' of the teeth, systemic fluoride administration was necessary for maximum benefit. Caries reduction therefore had to be balanced against increasing dental fluorosis. The 'caries resistance' concept was shown to be erroneous 25 years ago, but the new paradigm is not yet fully adopted in public health dentistry, so we still await real breakthroughs in more effective use of fluorides for caries prevention. The second paradigm is that caries is a transmittable, infectious disease: even one caused by specific microorganisms. This paradigm would require caries prevention by vaccination, but there is evidence that caries is not a classical infectious disease. Rather it results from an ecological shift in the tooth-surface biofilm, leading to a mineral imbalance between plaque fluid and tooth and hence net loss of tooth mineral. Therefore, caries belongs to common 'complex' or 'multifactorial' diseases, such as cancer, cardiovascular diseases, diabetes, in which many genetic, environmental and behavioural risk factors interact. The paper emphasises how these paradigm changes raise new research questions which need to be addressed to make caries prevention and treatment more cost-effective. Copyright 2004 S. Karger AG, Basel
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              New approaches to enhanced remineralization of tooth enamel.

              Dental caries is a highly prevalent diet-related disease and is a major public health problem. A goal of modern dentistry is to manage non-cavitated caries lesions non-invasively through remineralization in an attempt to prevent disease progression and improve aesthetics, strength, and function. Remineralization is defined as the process whereby calcium and phosphate ions are supplied from a source external to the tooth to promote ion deposition into crystal voids in demineralized enamel, to produce net mineral gain. Recently, a range of novel calcium-phosphate-based remineralization delivery systems has been developed for clinical application. These delivery systems include crystalline, unstabilized amorphous, or stabilized amorphous formulations of calcium phosphate. These systems are reviewed, and the technology with the most scientific evidence to support its clinical use is the remineralizing system utilizing casein phosphopeptides to stabilize and deliver bioavailable calcium, phosphate, and fluoride ions. The recent clinical evidence for this technology is presented and the mechanism of action discussed. Biomimetic approaches to stabilization of bioavailable calcium, phosphate, and fluoride ions and the localization of these ions to non-cavitated caries lesions for controlled remineralization show promise for the non-invasive management of dental caries.
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                Author and article information

                Journal
                Int J Clin Pediatr Dent
                Int J Clin Pediatr Dent
                IJCPD
                International Journal of Clinical Pediatric Dentistry
                Jaypee Brothers Medical Publishers
                0974-7052
                0975-1904
                Mar-Apr 2019
                : 12
                : 2
                : 120-125
                Affiliations
                [1–4 ]Department of Pedodontics and Preventive Dentistry, Bapuji Dental College and Hospital, Davangere, Karnataka, India
                Author notes
                Neetu Malik, Department of Pedodontics and Preventive Dentistry, Bapuji Dental College and Hospital, Davangere, Karnataka, India, Phone: +91 9741608625, e-mail: neetumalik89@ 123456gmail.com
                Article
                10.5005/jp-journals-10005-1608
                6749876
                31571784
                b8931754-77ad-4ae7-af17-5c7e1abc4e65
                Copyright © 2019; Jaypee Brothers Medical Publishers (P) Ltd.

                © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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                Categories
                Original Article

                casein phosphopeptide–amorphous calcium phosphate (cpp–acp),fluoride,fluoride varnish,mi varnish

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