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Anti-caries effect of CPP-ACP in irradiated nasopharyngeal carcinoma patients

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Abstract

Objective

The aim of this study was to determine the effect of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) on caries progression in irradiated nasopharyngeal carcinoma (NPC) patients.

Methods

Twenty-one males and three females (median age, 50 years) were randomized into two groups before radiotherapy. Subjects had at least eight teeth after oral health clearance. The test group used 0.4 % stannous fluoride gel and a crème containing 10 % CPP-ACP daily; the control group used a similar crème without CPP-ACP and otherwise identical care. Subjects applied the crème three times daily and fluoride gel once daily. Caries status, saliva and plaque parameters were measured pre-radiotherapy, at 2 weeks and 3 months post-radiotherapy.

Results

Baseline International Caries Detection and Assessment System (ICDAS) scores were 0–1126 surfaces (93.9 %), 1–28 surfaces (2.3 %), 2–40 surfaces (3.3 %) and 3–6 surfaces (0.5 %) for the control and 0–1186 surfaces (95.6 %), 1–31 surfaces (2.5 %), 2–15 surfaces (1.2 %) and 3–8 surfaces (0.7 %) for the test group. Twenty-two subjects returned at 3 months post-radiotherapy with reduced plaque pH, salivary flow, pH and buffering capacity. Nine test and 8 control subjects developed 32 and 59 new caries lesions, respectively. Test subjects showed lower caries progression than the controls: all surfaces (OR 0.51, 95 % CI 0.17∼1.59), occlusal (OR 0.20, 95 % CI 0.03∼1.29) and smooth surfaces (OR 0.61, 95 % CI 0.16∼2.38). The difference was not statistically significant.

Conclusion

Application of CPP-ACP did not significantly reduce caries progression in NPC patients in the first 3 months after radiotherapy as compared to controls.

Clinical relevance

Adjunct use of CPP-ACP with stannous fluoride gel in irradiated NPC patients gave comparable results compared to stannous fluoride gel alone in reducing caries progression.

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Acknowledgments

The contributions by Drs KW Fong, T Tan and SL Cheah from the National Cancer Centre Singapore and Drs JR Yang, MM Lim, S Ashok and J Lu from the National Dental Centre Singapore are highly acknowledged. Likewise, the support and encouragement of Clinical Assoc Prof KH Teoh at the National Dental Centre Singapore is appreciated. This research was supported by the National Dental Centre of Singapore Research Fund/National Medical Research Council Enabling Grant. GC Asia (Tokyo, Japan) provided the test products. The funding body and GC Asia had no involvement in the study design, collection, analysis and interpretation of data, and the writing and submission of the manuscript.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Restorative Dentistry, National Dental Centre Singapore, 5 Second Hospital Avenue, Singapore, 168938, Singapore

    Christina P. C. Sim

  2. Department of Radiation Oncology, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore

    Joseph Wee & Yoke-Lim Soong

  3. Centre for Quantitative Medicine, Office of Clinical Sciences, Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857, Singapore

    Ying Xu & Yin-Bun Cheung

  4. Department of Biostatistics, Singapore Clinical Research Institute, 31 Biopolis Way, Nanos #02-01, Singapore, 138669, Singapore

    Ying Xu

  5. Department of International Health, University of Tampere, 33014, Tampere, Finland

    Yin-Bun Cheung

  6. Oral Health Cooperative Research Centre, Melbourne Dental School, University of Melbourne, 720 Swanston St, Melbourne, Victoria, 3010, Australia

    David J. Manton

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  1. Christina P. C. Sim
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  2. Joseph Wee
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Correspondence to Christina P. C. Sim.

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Sim, C.P.C., Wee, J., Xu, Y. et al. Anti-caries effect of CPP-ACP in irradiated nasopharyngeal carcinoma patients. Clin Oral Invest 19, 1005–1011 (2015). https://doi.org/10.1007/s00784-014-1318-y

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  • DOI: https://doi.org/10.1007/s00784-014-1318-y

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