Original Article

Effect of Casein Phosphopeptide Amorphous Calcium Phosphate and Xylitol Chewing Gums, and Probiotic Yogurt on Periodontal Parameters: A Randomized Clinical Trial

Abstract

Objectives: This study aimed to assess the effect of casein phosphopeptide amorphous calcium phosphate (CPP-ACP) and xylitol chewing gums, and probiotic yogurt, as chemical plaque control strategies, on periodontal parameters.

Materials and Methods: This randomized clinical trial evaluated 120 eligible dental students that were randomly divided into four groups (n=30) for use of (I) CPP-ACP chewing gum, (II) xylitol chewing gum, (III) probiotic yogurt, and (IV) chlorhexidine (CHX) mouthwash. The oral hygiene index-simplified (OHI-S), Silness and Loe gingival index (GI), and Silness and Loe modified plaque index (PI) were measured before and on days 15 and 30 after using the products. Paired t-test or its non-parametric equivalent was used to analyze the parameters after the intervention compared with baseline. The study groups were compared using one-way ANOVA or its non-parametric equivalent.

Results: The OHI-S did not change over time, and most participants had a good OHI-S. The CHX group had the most favorable, and the probiotic yogurt group had the least favorable GI. Pairwise comparisons of the groups did not reveal a significant difference in GI between the CPP-ACP gum and CHX groups (P>0.05). CHX caused the greatest improvement in PI, with significant differences with other groups.

Conclusion: CHX was the most effective for improvement of periodontal parameters followed by CPP-ACP, which showed better results compared with other groups.

 

1. Nozawa A, Oshima H, Togawa N, Nozaki T, Murakami S. Development of Oral Care Chip, a novel device for quantitative detection of the oral microbiota associated with periodontal disease. PLoS One. 2020 Feb;15(2):e0229485.
2. Mishra R, Chandrashekar KT, Tripathi VD, Hazari A, Sabu BS, Sahu A. Comparative evaluation of efficacy of 0.2% sodium hypochlorite (Hi Wash) mouthwash with 0.2% chlorhexidine mouthwash on plaque-induced gingivitis: A clinical trial. J Indian Soc Periodontol. 2019 Nov;23(6):534-8.
3. Badar SB, Zafar K, Ghafoor R, Khan FR. Comparative evaluation of Chlorhexidine, Metronidazole and combination gels on gingivitis: A randomized clinical trial. Int J Surg Protoc. 2019 Apr;14:30-3.
4. Abdulkareem AA, Al Marah ZA, Abdulbaqi HR, Alshaeli AJ, Milward MR. A randomized double-blind clinical trial to evaluate the efficacy of chlorhexidine, antioxidant, and hyaluronic acid mouthwashes in the management of biofilm-induced gingivitis. Int J Dent Hyg. 2020 Aug;18(3):268-77.
5. Khairnar MR, Karibasappa GN, Dodamani AS, Vishwakarma P, Naik RG, Deshmukh MA. Comparative assessment of Cranberry and Chlorhexidine mouthwash on streptococcal colonization among dental students: A randomized parallel clinical trial. Contemp Clin Dent. 2015 Jan;6(1):35-9.
6. Vantipalli UK, Avula SSJ, Enuganti S, Bandi S, Kakarla P, Kuravadi RV. Effect of three commercially available chewing gums on salivary flow rate and pH in caries-active and caries-free children: An in vivo study. J Indian Soc Pedod Prev Dent. 2017 Jul-Sep;35(3):254-9.
7. Saheer PA, Parmar P, Majid SA, Bashyam M, Kousalya PS, Marriette TM. Effect of sugar-free chewing gum on plaque and gingivitis among 14-15-year-old school children: A randomized controlled trial. Indian J Dent Res. 2019 Jan-Feb;30(1):61-6.
8. Meena Syed RC, Vandana Shrivastava, Vinod Sachdev. Comparative evaluation of 0.2% Chlorhexidine Mouthwash, Xylitol Chewing Gum, and Combination of 0.2% Chlorhexidine Mouthwash and Xylitol Chewing Gum on Salivary Streptococcus mutans and Biofilm Levels in 8- to 12-Year-Old Children. Int J Clin Pediatr Dent. 2016 Oct-Dec;9(4):313-9.
9. Keukenmeester RS, Slot DE, Rosema NA, Van Loveren C, Van der Weijden GA. Effects of sugar-free chewing gum sweetened with xylitol or maltitol on the development of gingivitis and plaque: a randomized clinical trial. Int J Dent Hyg. 2014 Nov;12(4):238-44.
10. Oza S, Patel K, Bhosale S, Mitra R, Gupta R, Choudhary D. To Determine the Effect of Chewing Gum Containing Xylitol and Sorbitol on Mutans Streptococci and Lactobacilli Count in Saliva, Plaque, and Gingival Health and to Compare the Efficacy of Chewing Gums. J Int Soc Prev Community Dent. 2018 Jul-Aug;8(4):354-60.
11. Guclu ZA, Alacam A, Coleman NJ. A 12-Week Assessment of the Treatment of White Spot Lesions with CPP-ACP Paste and/or Fluoride Varnish. Biomed Res Int. 2016 Oct;2016:8357621.
12. Sugiura M, Kitasako Y, Sadr A, Shimada Y, Sumi Y, Tagami J. White spot lesion remineralization by sugar-free chewing gum containing bio-available calcium and fluoride: A double-blind randomized controlled trial. J Dent. 2016 Nov;54:86-91.
13. Samuel V, Ramakrishnan M, Halawany HS, Abraham NB, Jacob V, Anil S. Comparative evaluation of the efficacy of tricalcium phosphate, calcium sodium phosphosilicate, and casein phosphopeptide - amorphous calcium phosphate in reducing Streptococcus mutans levels in saliva. Niger J Clin Pract. 2017 Nov;20(11):1404-10.
14. Padminee K, Poorni S, Diana D, Duraivel D, Srinivasan MR. Effectiveness of casein phosphopeptide-amorphous calcium phosphate and xylitol chewing gums on salivary pH, buffer capacity, and Streptococcus mutans levels: An interventional study. Indian J Dent Res. 2018 Sep-Oct;29(5):616-21.
15. Invernici MM, Salvador SL, Silva PHF, Soares MSM, Casarin R, Palioto DB, et al. Effects of Bifidobacterium probiotic on the treatment of chronic periodontitis: A randomized clinical trial. J Clin Periodontol. 2018 Oct;45(10):1198-210.
16. Hadj-Hamou R, Senok AC, Athanasiou AE, Kaklamanos EG. Do probiotics promote oral health during orthodontic treatment with fixed appliances? A systematic review. BMC Oral Health. 2020 Apr;20(1):126.
17. Akram Z, Shafqat S, Aati S, Kujan O, Fawzy A. Clinical efficacy of probiotics in the treatment of gingivitis: A systematic review and meta-analysis. Aust Dent J. 2020 Mar;65(1):12-20.
18. Rindom Schiott C, Loe H, Borglum Jensen S, Kilian M, Davies RM, Glavind K. The effect of chlorhexidine mouthrinses on the human oral flora. J Periodontal Res. 1970 Apr;5(2):84-9.
19. Schmitter T, Fiebich BL, Fischer JT, Gajfulin M, Larsson N, Rose T, et al. Ex vivo anti-inflammatory effects of probiotics for periodontal health. J Oral Microbiol. 2018 Jul;10(1):1502027.
20. Jasberg H, Soderling E, Endo A, Beighton D, Haukioja A. Bifidobacteria inhibit the growth of Porphyromonas gingivalis but not of Streptococcus mutans in an in vitro biofilm model. Eur J Oral Sci. 2016 Jun;124(3):251-8.
21. Vohra F, Bukhari IA, Sheikh SA, Albaijan R, Naseem M, Hussain M. Effectiveness of scaling and root planing with and without adjunct probiotic therapy in the treatment of chronic periodontitis among shamma users and non-users: A randomized controlled trial. J Periodontol. 2020 Sep;91(9):1177-85.
22. Vives-Soler A, Chimenos-Küstner E. Effect of probiotics as a complement to non-surgical periodontal therapy in chronic periodontitis: a systematic review. Med Oral Patol Oral Cir Bucal. 2020 Mar;25(2):e161-e7.
23. Lynch MC, Cortelli SC, McGuire JA, Zhang J, Ricci-Nittel D, Mordas CJ, et al. The effects of essential oil mouthrinses with or without alcohol on plaque and gingivitis: a randomized controlled clinical study. BMC Oral Health. 2018 Jan;18(1):6.
24. Kakodkar P, Mulay S. Effect of sugar-free gum in addition to tooth brushing on dental plaque and interdental debris. Dent Res J (Isfahan). 2010 Summer;7:64-9.
25. James P, Worthington HV, Parnell C, Harding M, Lamont T, Cheung A, et al. Chlorhexidine mouthrinse as an adjunctive treatment for gingival health. Cochrane Database Syst Rev. 2017 Mar;3(3):Cd008676.
26. Ahmadi Zenouz G, Ezoji F, Enderami SA, Khafri S. Effect of fluoride, casein phosphopeptide-amorphous calcium phosphate and casein phosphopeptide-amorphous calcium phosphate fluoride on enamel surface microhardness after microabrasion: An in vitro study. J Dent (Tehran). 2015 Oct;12(10):705-11.
27. Ma X, Lin X, Zhong T, Xie F. Evaluation of the efficacy of casein phosphopeptide-amorphous calcium phosphate on remineralization of white spot lesions in vitro and clinical research: a systematic review and meta-analysis. BMC Oral Health. 2019 Dec;19(1):295.
28. Hegde RJ, Thakkar JB. Comparative evaluation of the effects of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and xylitol-containing chewing gum on salivary flow rate, pH and buffering capacity in children: An in vivo study. J Indian Soc Pedod Prev Dent. 2017 Oct-Dec;35(4):332-7.
29. Holgerson PL, Sjostrom I, Stecksen-Blicks C, Twetman S. Dental plaque formation and salivary mutans streptococci in schoolchildren after use of xylitol-containing chewing gum. Int J Paediatr Dent. 2007 Mar;17(2):79-85.
30. Kaur K, Nekkanti S, Madiyal M, Choudhary P. Effect of chewing gums containing probiotics and xylitol on oral health in children: A randomized controlled trial. J Int Oral Health. 2018 Sep;10:237.
31. Simons D, Beighton D, Kidd EA, Collier FI. The effect of xylitol and chlorhexidine acetate/xylitol chewing gums on plaque accumulation and gingival inflammation. J Clin Periodontol. 1999 Jun;26(6):388-91.
32. Benic GZ, Farella M, Morgan XC, Viswam J,

Heng NC, Cannon RD, et al. Oral probiotics reduce halitosis in patients wearing orthodontic braces: a randomized, triple-blind, placebo-controlled trial. J Breath Res. 2019 May;13(3):036010.
33. Kuru BE, Laleman I, Yalnizoglu T, Kuru L, Teughels W. The Influence of a Bifidobacterium animalis Probiotic on Gingival Health: A Randomized Controlled Clinical Trial. J Periodontol. 2017 Nov;88(11):1115-23.
34. Kohar N, Emmanuel V, Astuti L. Comparison between probiotic lozenges and drinks towards periodontal status improvement of orthodontic patients. Dent J (Majalah Kedokteran Gigi). 2015 Sep;48:126.
35. Barboza EP, Arriaga PC, Luz DP, Montez C, Vianna KC. Systematic review of the effect of probiotics on experimental gingivitis in humans. Braz Oral Res. 2020 Mar;34:e031.
36. Haukioja A, Yli-Knuuttila H, Loimaranta V, Kari K, Ouwehand AC, Meurman JH, et al. Oral adhesion and survival of probiotic and other lactobacilli and bifidobacteria in vitro. Oral Microbiol Immunol. 2006 Oct;21(5):326-32.
37. Barzegari A, Kheyrolahzadeh K, Hosseiniyan Khatibi SM, Sharifi S, Memar MY, Zununi Vahed SA-O. The battle of probiotics and their derivatives against biofilms. Infect Drug Resist. 2020 Feb;13:659-72.
IssueVol 18 (Continuously Published Article-Based) QRcode
SectionOriginal Article
DOI https://doi.org/10.18502/fid.v18i35.7339
Keywords
Casein phosphopeptide-amorphous calcium phosphate nanocomplex; Xylitol; Probiotics; Periodontal Diseases; Chlorhexidine

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Barati V, Mehrabkhani M, Parisay I, Mastoori N. Effect of Casein Phosphopeptide Amorphous Calcium Phosphate and Xylitol Chewing Gums, and Probiotic Yogurt on Periodontal Parameters: A Randomized Clinical Trial. Front Dent. 2021;18.