Effects of three commercial toothpastes incorporating “chitosan, casein phosphopeptide‑amorphous calcium phosphate, sodium monofluorophosphate, and sodium fluoride” on remineralization of incipient enamel caries in the primary dentition: A preliminary in

Leila Basir, Raziye Meshki, Hilda Aghababa, Vahid Rakhshan


Background: Given the importance of primary dental caries, assessment of new preventive/
therapeutic materials is necessary. In light of the scarcity of such studies on the role of new agents
in primary dentition, this study assessed the efficacy of three commercial toothpastes with different
ingredients on remineralization of early caries in the primary dentition.
Materials and Methods: Thirty‑nine intact primary canines were used in this in vitro experimental
study. The baseline microhardness of enamel was measured. Particular demineralizer was used for
96 h and then secondary microhardness was measured. Then, samples were divided into three
groups treated by toothpastes with sodium fluoride, chitosan, and casein phosphopeptide‑amorphous
calcium phosphate and sodium monofluorophosphate (CPP‑ACP+SMFP). Each group was incubated
and pH‑cycled. Subsequently, they were demineralized and remineralized using toothpastes. Eventually,
tertiary microhardness was measured. Percent of enamel microhardness recovery (EMHR%) and
efficacy of toothpastes in remineralization were established. Data were analyzed using paired t‑test,
repeated‑measures test, Kruskal–Wallis, and Mann–Whitney U‑test (α = 0.05, 0.017).
Results: Demineralization significantly reduced microhardness from 316.2 to 248.5 Vickers
hardness number (VHN) (P = 0.000). All toothpastes succeeded to remineralize the enamel
significantly (P = 0.000). The efficacies of toothpastes differed significantly (P < 0.05). Mean
EMHR percentages of toothpastes incorporating NaF, chitosan, and CPP‑ACP+SMFP were 75.1%,
52.5%, and 55.8%, respectively. The highest increases in enamel microhardness were observed
after using NaF‑containing toothpaste (~53 VHN) which was significantly superior to other
toothpastes (P ≤ 0.001). However, there was no statistically significant difference between EMHR
percentages of toothpastes including chitosan and CPP‑ACP+SMFP (P = 0.739).
Conclusion: Although all three toothpastes could increase the microhardness of primary enamel, NaF
toothpaste was superior to others. Toothpastes having chitosan and CPP‑ACP+SMFP acted rather similarly.


Casein phosphopeptide‑amorphous calcium phosphate, chitosan, fluorophosphate, hardness tests, primary dentition, sodium fluoride, toothpastes

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