The Journal of Contemporary Dental Practice

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 10 , ISSUE 3 ( May, 2009 ) > List of Articles


Anticariogenicity of Casein Phosphopeptide-amorphous Calcium Phosphate: A Review of the Literature

Carmen Llena, Leopoldo Forner, Pilar Baca

Citation Information : Llena C, Forner L, Baca P. Anticariogenicity of Casein Phosphopeptide-amorphous Calcium Phosphate: A Review of the Literature. J Contemp Dent Pract 2009; 10 (3):1-9.

DOI: 10.5005/jcdp-10-3-1

License: CC BY-NC 3.0

Published Online: 01-06-2012

Copyright Statement:  Copyright © 2009; The Author(s).



This review of the literature examines the role of the natural components of saliva in maintaining tooth mineralization and the role of different casein phosphopeptide amorphous calcium phosphate-based (CPP-ACP) compounds in controlling demineralization/ remineralization and their clinical applications.


A group of peptides, known as CPP, have been shown to stabilize calcium and phosphate preserving them in an amorphous or soluble form known as amorphous calcium phosphate (ACP). Calcium and phosphate are essential components of enamel and dentine and form highly insoluble complexes, but in the presence of CPP they remain soluble and biologically available. This CPP-ACP complex applied to teeth by means of chewing-gum, toothpaste, lozenges, mouth rinses, or sprays is able to adhere to the dental biofilm and enamel hydroxyapatite providing bioavailable calcium and phosphate ions.

Review Results

Significantly high levels of calcium and phosphate have been found in both biofilm and subsurface incipient caries lesions and in lower level demineralization of enamel or dentine surfaces previously treated with CPP-ACP based compounds. When placed on the surface of a tooth with early carious lesions, pastes with CPP-ACP complexes can prevent tooth demineralization and improve enamel remineralization and enhance fluoride activity.


Remineralization of white spot lesions has been achieved clinically by applying pastes based on these compounds, and a similar effect to self-applied fluorides has been observed in reducing the appearance of new caries lesions in patients with xerostomia.

Clinical Significance

Use of CPP-ACP based compounds offers a potential for use in the prevention of dental caries.


Llena C, Forner L, Baca P. Anticariogenicity of Casein Phosphopeptide-amorphous Calcium Phosphate: A Review of the Literature. J Contemp Dent Pract 2009 May; (10)3:001-009.

PDF Share
  1. Present and future approaches for the control of caries. J Dent Educ. 2005 May; 69(5):538-54.
  2. Salivary clinical data and dental caries susceptibility: is there a relationship? Bull Group Int Rech Sci Stomatol Odontol. 2006 Mar; 47(1):27-33.
  3. The erosive potential of soft drinks on enamel surface substrate: an in vitro scanning electron microscopy investigation. J Contemp Dent Pract. 2007 Nov; 18(7):11-20.
  4. Dental caries and childhood obesity: roles of diet and socioeconomic status. Community Dent Oral Epidemiol. 2007 Dec; 35(6):449-58.
  5. Bioactive properties of milk proteins focus on anticariogenesis. J Nutr. 2004 Apr;134(4):989S-95S.
  6. The prevention of sub-surface demineralization of bovine enamel and change in plaque composition by casein in an intra-oral model. J Dent Res. 1987 Jun; 66(6):1120-7.
  7. The rôle of saliva in maintaining oral health and as an aid to diagnosis. Med Oral Patol Oral Cir Bucal. 2006 Aug;11(5):E449-55.
  8. The role of salivary peptides in dental caries. Biomed Chromatogr. 2005 Apr; 19(3):214-22.
  9. Host-derived pentapeptide affecting adhesion, proliferation, and local pH in biofilm communities composed of Streptococcus and Actinomyces species. Infect Immun. 2006 Nov; 74(11):6293-9.
  10. Casein phosphopeptides in oral health-chemistry and clinical applications. Curr Pharm Des. 2007; 13(8):793-800.
  11. Incorporation of caseinoglycomacropeptide and caseinophosphopeptide into the salivary pellicle inhibits adherence of mutans streptococci. J Dent Res. 1996 Oct; 75(10):1779-88.
  12. Physicochemical characterization of casein phosphopeptide-amorphous calcium phosphate nanocomplexes. J Biol Chem. 2005 Apr 15;280(15):15362-9.
  13. Anticariogenic complexs of amorphous calcium phosphate stabilized by casein phosphopeptides: a review. Spec Care Dentis. 1998 Jan-Feb; 18(1):8-16.
  14. Remineralization of enamel subsurface lesions by casein phosphopeptide-stabilized calcium phosphate solutions. J Dent Res. 1997 Sep; 76(9):1587-95.
  15. Pronamel and tooth mousse: an initial assessment of erosion prevention in vitro. J Dent. 2007 Apr; 35(4):355-7.
  16. Change in surface hardness of enamel by a cola drink and a CPP-ACP paste. J Dent. 2008 Jan; 36(1):74-9.
  17. Adding casein phosphopeptide-amorphous calcium phosphate to sports drinks to eliminate in vitro erosion. Pediatr Dent. 2005 Jan-Feb; 27(1):61-7.
  18. Minimally invasive dentistry: a review and update. Shanghai Kou Qiang Yi Xue. 2006 Jun; 15(3):225-49.
  19. Effect of CPP-ACP paste on tooth mineralization: an FE-SEM study. J Oral Sci. 2007 Jun; 49(2):115-20.
  20. Effect of a CPP-ACP agent on the demineralization and remineralization of dentine in vitro. J Dent. 2007 Aug; 35(8):695-8.
  21. Prevention of demineralization around orthodontic brackets in vitro. Am J Orthod Dentofacial Orthop. 2007 Jun;131(6):705.e1-9.
  22. Remineralization of enamel subsurface lesions by sugar-free chewing gum containing casein phosphopeptide-amorphous calcium phosphate. J Dent Res. 2001 Dec; 80(12):2066-70.
  23. The effect of chewing gums containing calcium phosphates on the remineralization of artificial caries-like lesions in situ. Caries Res. 2005 May-Jun; 39(3):251-4.
  24. Remineralization of enamel subsurface lesions in situ by sugar-free lozenges containing casein phosphopeptide-amorphous calcium phosphate. Aust Dent J. 2003 Dec; 48(4):240-3.
  25. Effect of a dental cream containing amorphous cream phosphate complexes on white spot lesion regression assessed by laser fluorescence. Oral Health Prev Dent. 2007 5;(3):229-33.
  26. Combined CPP-ACP and photoactivated disinfection (PAD) therapy in arresting root surface caries: a case report. Br Dent J. 2007 Oct 27;203(8):457-9.
  27. Minimally invasive treatment of white spot enamel lesions. Quintessence Int. 2007 Sep; 38(8):633-6.
  28. Retention in plaque and remineralization of enamel lesions by various forms of calcium in a mouthrinse or sugar-free chewing gum. J Dent Res. 2003 Mar; 82(3):206-11.
  29. Effects of an anticariogenic casein phosphopeptide on calcium diffusion in streptococcal model dental plaques. Arch Oral Biol. 2000 Jul; 45(7):569-75.
  30. A clinical trial of the anticaries efficacy of casein derivatives complexed with calcium phosphate in patients with salivary gland dysfunction. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002 Mar; 93(3):271-5.
  31. Fluoride and casein phosphopeptide-amorphous calcium phosphate. J Dent Res. 2008 Apr; 87(4):344-8.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.