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 Table of Contents  
Year : 2019  |  Volume : 14  |  Issue : 3  |  Page : 171-174

The Effect of Chewing Gum Containing Casein Phosphopeptide–Amorphous Calcium Phosphate on Salivary Streptococcus mutans

Department of Oral Pathology and Microbiology, Datta Meghe Institute of Medical Sciences, Sharad Pawar Dental College, Wardha, Maharashtra, India

Date of Submission10-Jul-2019
Date of Decision22-Aug-2019
Date of Acceptance25-Aug-2019
Date of Web Publication2-May-2020

Correspondence Address:
Prof. Nakul Arora
Department of Oral Pathology and Microbiology, Sharad Pawar Dental College, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jdmimsu.jdmimsu_47_19

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Objectives: The aim of this study was to evaluate the effect of sugar-free chewing gum containing casein phosphopeptide–amorphous calcium phosphate (CPP-ACP) on salivary Streptococcus mutans. Materials and Methods: A total of 25 dental students of 20–25 years old, who volunteered after checking their health condition and signing informed consent, were randomly allocated to receive chewing gum containing CPP-ACP; individuals within the experimental groups were taken the gums 3 times daily after each meal for a period of 2 weeks. Pre- and postintervention unstimulated saliva samples were quantified for S. mutans counts. Results: A statistically significant reduction of salivary S. mutans was displayed with baseline (P < 0.05). Conclusion: Daily consumption of chewing gum containing CPP-ACP significantly reduces the level of salivary S. mutans.

Keywords: Caries, casein phosphopeptide–amorphous calcium phosphate, chewing gum, Streptococcus mutans

How to cite this article:
Arora N, Hande A. The Effect of Chewing Gum Containing Casein Phosphopeptide–Amorphous Calcium Phosphate on Salivary Streptococcus mutans. J Datta Meghe Inst Med Sci Univ 2019;14:171-4

How to cite this URL:
Arora N, Hande A. The Effect of Chewing Gum Containing Casein Phosphopeptide–Amorphous Calcium Phosphate on Salivary Streptococcus mutans. J Datta Meghe Inst Med Sci Univ [serial online] 2019 [cited 2021 Jan 17];14:171-4. Available from: http://www.journaldmims.com/text.asp?2019/14/3/171/283592

  Introduction Top

Bacterial plaque that accumulated on teeth surfaces and composed of native oral flora is the primary etiological agent for periodontal disease and dental caries which may result in tooth loss if left untreated.[1],[2]

Dental caries is the destruction of dental structures by acid product as a product of carbohydrate metabolism by cariogenic bacteria.[3]

Streptococcus mutans, commonly found in human dental plaque, are the primary species associated with dental caries.[4]

S. mutans is now considered to play an important role in the development of dental caries in animals and humans. Extensive research on this microorganism has been done during the last 10 years.[5]

Chewing gum is known to be a useful adjunct to common oral hygiene because of stimulation of salivary flow rate. It is effective in raising plaque pH. The chewing of sugar-free gums after meals and snacks can promote remineralization of enamel and reduce S. mutans rate.[6]

In recent years, casein phosphopeptide–amorphous calcium phosphate (CPP-ACP) noncomplexes have also been demonstrated to have anticariogenic properties in both laboratory animal and human in situ experiments.[7],[8]

CPP containing the cluster sequence − Ser(p)-Ser(p)-Ser (p)-Glu-Glu- has a remarkable ability to stabilize ACP in metastable solution.[9]

When delivered in sugar-free chewing gum, CPP-ACP has also been shown to remineralize enamel subsurface lesion and reduce S. mutans in vivo, independent of chewing frequency and duration.[10],[11],[12],[13],[14],[15],[16],[17],[18],[19],[20],[21],[22],[23],[24],[25]

The aim of the present study was, the CPP-ACP chewing gums, on the level of S. mutans in the saliva of young adults.

  Materials and Methods Top

A total of 25 young adults (14 women and 9 men) who volunteered, after signing informed consent, were selected. Eligible persons were dental students who had healthy condition and were between the ages of 20 and 25 years. Exclusion criteria were any abnormal oral, medical, or mental condition (including any milk-related allergies and medical condition involving the kidneys), a history of systemic antibiotic or topical fluoride treatments within a 4-week period before baseline, individuals with a habitual use of dairy xylitol or Recaldent chewing gums, and any untreated caries lesions or clinical signs of either gingivitis or periodontal disease.

In this clinical trial, each individual chewed three gum pellets 3 times/day for an experimental period of 2 weeks. In individuals consumed three chewing gums containing CPP-ACP 3 times daily after each meal, salivary samples were collected at baseline and 1 day after the final gum consumption. During the experimental period, the individuals were strongly encouraged to reduce their carbohydrate diet and brush their teeth twice a day with fluoride toothpaste.

Each Recaldent pellet (Trident Company, Thailand) [Figure 1] contained 10% CPP-ACP plus gum base. The ingredients of the gums are listed in [Figure 2]. The participants were instructed to actively chew on the assigned gums during 20 min after the meals, in the morning, at noon, and evening.
Figure 1: Trident chewing gum

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Figure 2: Chewing gum contents

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Unstimulated saliva was collected in the morning (9:00 am) on the day before onset and 1 day after the intervention period in a 1.5 cc test tube [Figure 3] and [Figure 4]. The counts of salivary S. mutans were evaluated using Mitis Salivarius Agar (Merck) as described [Figure 5] and [Figure 6]. After cultivation at 37°C with CO2 3% for 48 h, the colony-forming units were identified on the basis of their morphology and counted in a stereomicroscope [Figure 7] with 12–25 times magnification.
Figure 3: 1.5 CC saliva sample tube

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Figure 4: Inoculation of sample in medium setup

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Figure 5: Stereomicroscope

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Figure 6: Mitis Salivarius Agar

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Figure 7: Microscopic image of Streptococcus mutans

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  Results Top

All individuals completed the trial, the compliance was excellent, and no side effects were reported. The pre- and postintervention reports are shown in [Table 1]. All individuals had detectable levels of S. mutans at baseline and 1 day after the 2-week intervention period, and had significantly reduced levels (P < 0.05) of salivary S. mutans by CCP-ACP chewing gum.
Table 1: Serum mutans count

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  Discussion Top

A significant part of studies have been focused on studying the effect various substances for preventing dental caries in the primary stages. S. mutans is the effective bacteria on the beginning of the process of demineralization of enamel and consequently decays; hence, using an appropriate solution for controlling or eliminating these bacteria can prevent the creation of decay.

In the present study, we assessed the effectiveness of CPP-ACP chewing gum in reducing load of S. mutans as cariogenic agents.

Although the usefulness of xylitol for preventing dental caries especially in patients with primary caries has been documents, but since so far, the effectiveness of CPP-ACP chewing gums on the S. mutansrate in saliva have not been done clinically, hence the present study has been developed and conducted.

In the present research, considering the effect of caries on the number of S. mutans of saliva, those individuals with active caries have been eliminated from the study. In addition, with matching the health and nutrition programs such as do not using any other xylitol and CPP-ACP products and mouthwash and fluoride gel, it has been tried to eliminate the intervening variables as much as possible.

In the current study, the time of sampling is 9 am, and when fasting, this method of sampling is consistent with the sampling method provided in the study of Caglar et al.

In this study, the patients were asked to use the provided chewing gums for a time period of 2 weeks, 3 times a day after eating their main meal. Researchers believe that for evaluating the effects of each chewing gum on the counts of S. mutans in saliva, the chewing gums should be used immediately after taking the main meal for 2 weeks.

The individuals were asked to use the chewing gums every time for 20 min. According to the studies of Harris et al. and Iijima et al., after 20 min of chewing the gums, the secretion rate of saliva becomes 3 times and also due to increasing the level of pH and increasing the mineral deposition of calcium and phosphate ions present in saliva, enamel become remineralized.

In this study, the rate of S. mutans in saliva had a significant reduction (P < 0.001) after 3 weeks of consumption of chewing gums containing CPP-ACP that this finding is in agreement with the study of Subramanian and Naidu and Vashisht et al. In the present study, the rate of S. mutans in saliva after the consumption of the chewing gums has shown a significant decrease; CPP-ACP group due to the antibacterial properties and its buffering effect on plaque and prevention of growth and attachment of Streptococcus strains to the teeth. This study has documented and demonstrated the clinical antibacterial effects of CPP-ACP and its effect as an anticaries agent (in primary caries).

All individuals, especially those who are in danger of the development of dental caries, can use these substances; however, more clinical long-term studies in this regard are required.

  Conclusion Top

Daily consumption of chewing gum containing CPP-ACP reduces the level of salivary S. mutans significantly.

Financial support and sponsorship

The study was financially supported by Sharad Pawar Dental College.

Conflicts of interest

There are no conflicts of interest.

  References Top

Gibbons RJ. Adherent interactions which may affect microbial ecology in the mouth. J Dent Res 1984;63:378-85.  Back to cited text no. 1
Loesche WJ. Role of Streptococcus mutans in human dental decay. Microbiol Rev 1986;50:353-80.  Back to cited text no. 2
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Aksoy A, Duran N, Koksal F.In vitro andin vivo antimicrobial effects of mastic chewing gum against Streptococcus mutans and Mutans streptococci. Arch Oral Biol 2006;51:476-81.  Back to cited text no. 4
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Reynolds EC. 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;66:1120-7.  Back to cited text no. 7
Walker G, Cai F, Shen P, Reynolds C, Ward B, Fone C, et al. Increased remineralization of tooth enamel by milk containing added casein phosphopeptide-amorphous calcium phosphate. J Dairy Res 2006;73:74-8.  Back to cited text no. 8
Reynolds EC, Black CL. Advances in enamel remineralization: Anticariogenic casein phosphopeptide-amorphous calcium phosphate. J Clin Dent 1999;10:86-8.  Back to cited text no. 9
Shen P, Cai F, Nowicki A, Vincent J, Reynolds EC. Remineralization of enamel subsurface lesions by sugar-free chewing gum containing casein phosphopeptide-amorphous calcium phosphate. J Dent Res 2001;80:2066-70.  Back to cited text no. 10
Iijima Y, Cai F, Shen P, Walker G, Reynolds C, Reynolds EC. Acid resistance of enamel subsurface lesions remineralized by a sugar-free chewing gum containing casein phosphopeptide-amorphous calcium phosphate. Caries Res 2004;38:551-6.  Back to cited text no. 11
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Söderling E, Alaräisänen L, Scheinin A, Mäkinen KK. Effect of xylitol and sorbitol on polysaccharide production by and adhesive properties of Streptococcus mutans. Caries Res 1987;21:109-16.  Back to cited text no. 16
Caglar E, Kavaloglu SC, Kuscu OO, Sandalli N, Holgerson PL, Twetman S. Effect of chewing gums containing xylitol or probiotic bacteria on salivary Mutans streptococci and lactobacilli. Clin Oral Investig 2007;11:425-9.  Back to cited text no. 17
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Kolahi J, Soolari A, Ghalayani P, Varshosaz J, Fazilaty M. Newly formulated chlorhexidine gluconate chewing gum that gives both anti-plaque effectiveness and an acceptable taste: A double blind, randomized, placebo-controlled trial. J Int Acad Periodontol 2008;10:38-44.  Back to cited text no. 19
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Thaweboon S, Thaweboon B, Soo-Ampon S. The effect of xylitol chewing gum on Mutans streptococci in saliva and dental plaque. Southeast Asian J Trop Med Public Health 2004;35:1024-7.  Back to cited text no. 21
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Ribelles Llop M, Guinot Jimeno F, Mayné Acién R, Bellet Dalmau LJ. Effects of xylitol chewing gum on salivary flow rate, pH, buffering capacity and presence of Streptococcus mutans in saliva. Eur J Paediatr Dent 2010;11:9-14.  Back to cited text no. 23
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Vashisht R, Indira R, Ramachandran S, Kumar A, Srinivasan MR. Role of casein phosphopeptide amorphous calcium phosphate in remineralization of white spot lesions and inhibition of Streptococcus mutans? J Conserv Dent 2013;16:342-6.  Back to cited text no. 25
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  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]

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