Anticariogenicity of calcium phosphate complexes of tryptic casein phosphopeptides in the rat

Shear bond strength of an amorphous calcium-phosphate–containing orthodontic resin cement

INTRODUCTION

Amorphous calcium phosphate (ACP) materials have recently been introduced with the promise of reducing demineralization around orthodontic brackets. The purpose of this in vitro study was to compare the shear bond strength of orthodontic brackets bonded with enamel using a commercially available orthodontic adhesive containing ACP to that of brackets bonded with a conventional resin-based orthodontic adhesive.

METHODS

Thirty extracted molars were collected. The first group of 30 brackets was bonded to either the mesiobuccal or distobuccal tooth surface with a conventional resin-based composite adhesive. The second group of 30 brackets was bonded with the ACP adhesive to the buccal cusp that was not used by the first group. Each tooth received 2 brackets; 1 bonded with a conventional resin-based composite adhesive and the other with the ACP-containing orthodontic adhesive. Specimens were stored in water at 37 degrees C for 24 hours and then tested for shear bond strength in an Instron universal testing machine. A paired t-test was used to compare the mean shear bond strength between the 2 adhesives. The ARI scores were analyzed using the chi-squared test. All statistical tests were performed at alpha =.05.

RESULTS

The t-test detected a highly significant difference in the mean shear bond strength between the 2 groups (P <.001). There was no evidence to suggest a statistical difference between the groups' ARI scores (P = .37).

CONCLUSIONS

Under the conditions of this in vitro study, orthodontic brackets bonded to teeth with an ACP-containing composite material failed at significantly lower forces than brackets bonded to teeth with the conventional resin-based composite orthodontic cement.

The cryptome: a subset of the proteome, comprising cryptic peptides with distinct bioactivities

There is increasing evidence that proteolytic cleavage gives rise to 'hidden' peptides with bioactivities that are often unpredicted and totally distinct to the parent protein. So far, the liberation of these cryptic peptides, or crypteins, has been shown to be prevalent in proteins associated with endocrine signalling, the extracellular matrix, the complement cascade and milk. A broad spectrum of proteases has been implicated in the generation of natural crypteins that appear to play a role in modulating diverse biological processes, such as angiogenesis, immune function and cell growth. The proteolytic liberation of crypteins with novel activities represents an important mechanism for increasing diversity of protein function and potentially offers new opportunities for protein-based therapeutics.

Sucrose substitutes and their role in caries prevention

Many non- or low-cariogenic sucrose substitutes are currently available and are found as ingredients of a variety of candy, chewing gum, and drinks. Recently the role of sugar alcohols in promoting remineralisation of enamel has attracted much attention. Thus, the dental profession needs to understand the general characteristics and features of sugar substitutes to provide advice on oral health to patients as well as the general public. There are two critical requirements for sucrose substitutes, namely, being nutritionally appropriate and not being detrimental to the overall general health of the individual. The use of a greater variety of confectionary containing sucrose substitutes and the development of new substitutes with high nutritional value are essential in the battle against caries. In this paper we review in detail the characteristics of sucrose substitutes currently in use, their role in caries prevention and promotion of oral health.

Dentifrices, mouthwashes, and remineralization/caries arrestment strategies

While our knowledge of the dental caries process and its prevention has greatly advanced over the past fifty years, it is fair to state that the management of this disease at the level of the individual patient remains largely empirical. Recommendations for fluoride use by patients at different levels of caries risk are mainly based on the adage that more is better. There is a general understanding that the fluoride compound, concentration, frequency of use, duration of exposure, and method of delivery can influence fluoride efficacy. Two important factors are (1) the initial interaction of relatively high concentrations of fluoride with the tooth surface and plaque during application and (2) the retention of fluoride in oral fluids after application. Fluoride dentifrices remain the most widely used method of delivering topical fluoride. The efficacy of this approach in preventing dental caries is beyond dispute. However, the vast majority of currently marketed dentifrice products have not been clinically tested and have met only the minimal requirements of the FDA monograph using mainly laboratory testing and animal caries testing. Daily use of fluoride dental rinses as an adjunct to fluoride dentifrice has been shown to be clinically effective as has biweekly use of higher concentration fluoride rinses. The use of remineralizing agents (other than fluoride), directed at reversing or arresting non-cavitated lesions, remains a promising yet largely unproven strategy. High fluoride concentration compounds, e.g., AgF, Ag(NH3)2F, to arrest more advanced carious lesions with and without prior removal of carious tissue are being used in several countries as part of the Atraumatic Restorative Treatment (ART) approach. Most of the recent innovations in oral care products have been directed toward making cosmetic marketing claims. There continues to be a need for innovation and collaboration with other scientific disciplines to fully understand and prevent dental caries.

The effect of different milk formulas on dental plaque pH

OBJECTIVES

The purposes of this study were (1) to investigate the effect of different milk formulas on dental plaque pH after rinsing with these three categories, type of protein-based formulas (milk-based, soy-based, protein hydrolysate), type of sugar (only lactose, lactose and other sugars, only non-milk extrinsic sugars), and casein ratio (high and low casein), and (2) to observe organic acids formed by different milk formulas.

METHODS

Baseline plaque pH and plaque pH at 2, 5, 10, 15, 20, 25, 30, and 60 min after rinsing with milk formulas were recorded by a combination electrode in 14 healthy subjects. Deionized water and 10% sucrose were used as a negative and positive control. The plaque sample was also analysed to identify and quantify the organic acids using a high-performance liquid chromatography. Parameters including minimum pH, maximum pH drop, and area under curve were compared by RMANOVA and paired t-test.

RESULTS

The minimum pH was not significantly different among different protein-based formulas, whereas, the maximum plaque pH drop of soy-based and milk-based formula was significantly higher than that produced by protein hydrolysate formula (P=0.022 and 0.03, respectively). Area under curve produced by soy-based and milk-based formulas was significantly larger than that created by protein hydrolysate formula (P=0.025 and<0.001, respectively). Milk formulas containing only lactose caused significantly less plaque pH change in minimum pH (P<0.001), maximum pH drop (P=0.003), and area under curve (P<0.001) when compared with formulas containing lactose and other sugar but not with special formulas containing only non-milk extrinsic sugar. Similarly, special formulas containing non-milk extrinsic sugar produced significantly lower minimum pH and smaller area under curve than formulas containing lactose and other sugar did (P=0.044 and 0.009, respectively). No different results were found between high and low casein follow-on formulas. Lactic acid was produced more by rinsing with formulas containing lactose and other sugars than that produced by formulas containing only lactose.

CONCLUSIONS

This study suggests that milk formulas containing added other sugars tend to cause a decrease in plaque pH.

Effect of a Casein/Calcium Phosphate-Containing Tooth Cream and Fluoride on Enamel Erosion in vitro

The aim of this study was to determine whether a tooth cream containing casein/calcium phosphate (CasCP) protects enamel against erosion. Sixty bovine enamel specimens were prepared for profilometry and distributed into five groups. Specimens were rinsed with artificial saliva interrupted by 1% citric acid (pH 2.3) for 30 s 6 times daily for 14 days. Group 1 (n=12) was not treated (control); in group 2 (n=12) CasCP was applied for 120 s twice daily; in group 3 (n=12) 250 ppm fluoride as NaF was applied for 120 s twice daily; in group 4 (n=12) CasCP was applied for 120 s, then 250 ppm fluoride for 120 s twice daily, and in group 5 (n=12) amine fluoride (AmF) gel (12,500 ppm fluoride) was applied for 120 s twice daily. Differences between groups with respect to erosive enamel loss (profilometrically determined depth after 7 and 14 days) were tested by the Mann-Whitney test (alpha=0.05). After 7/14 days' erosive cycling, specimens treated with AmF gel showed significantly less enamel loss (18.5/35.5 microm; medians) than those treated with CasCP (25.5/46.9 microm), 250 ppm fluoride (25.0/ 40.9 microm), CasCP and 250 ppm fluoride (23.9/47.4 microm) or with no treatment (26.3/49.8 microm). It is concluded that highly fluoridated acidic AmF gel can protect enamel against erosion while CasCP, 250 ppm fluoride or a combination of CasCP and 250 ppm fluoride provide little protection.

Physicochemical Characterization of Casein Phosphopeptide-Amorphous Calcium Phosphate Nanocomplexes

Milk caseins stabilize calcium and phosphate ions and make them available to the neonate. Tryptic digestion of the caseins yields phosphopeptides from their polar N-terminal regions that contain clusters of phosphorylated seryl residues. These phosphoseryl clusters have been hypothesized to be responsible for the interaction between the caseins and calcium phosphate that lead to the formation of casein micelles. The casein phosphopeptides stabilize calcium and phosphate ions through the formation of complexes. The calcium phosphate in these complexes is biologically available for intestinal absorption and remineralization of subsurface lesions in tooth enamel. We have studied the structure of the complexes formed by the casein phosphopeptides with calcium phosphate using a range of physicochemical techniques including x-ray powder diffraction, scanning electron microscopy, transmission electron microscopy, and equilibrium binding analyses. The amorphous nature of the calcium phosphate phase was confirmed by two independent methods: x-ray powder diffraction and selected area diffraction. In solution, the ion activity product of a basic amorphous calcium phosphate phase was the only ion product that was a function of bound phosphate independent of pH, consistent with basic amorphous calcium phosphate being the phase stabilized by the casein phosphopeptides. Detailed investigations of calcium and calcium phosphate binding using a library of synthetic homologues and analogues of the casein phosphopeptides have revealed that although the fully phosphorylated seryl-cluster motif is pivotal for the interaction with calcium and phosphate, other factors are also important. In particular, calcium binding and calcium phosphate stabilization by the peptides was influenced by peptide net charge, length, and sequence.

The use of in situ models and QLF for the study of coronal caries

OBJECTIVES

The purpose of the paper is to review aspects of the systems available to model the caries process in enamel.

METHODS

The in situ model developed in Liverpool, and the new method of quantifying mineral loss, Quantitative Light-induced Fluorescence (QLF), are described. QLF is a powerful new diagnostic tool which can be used to measure demineralisation and remineralisation in tooth surfaces in vivo; studies to optimise, validate and use QLF in different clinical situations are described.

RESULTS

Examples of the use of in situ models show that they are particularly valuable for monitoring de and remineralisation of artificial lesions in relation to product testing as alternatives to clinical trials, and present significant advances over in vitro methods. Quantification of mineral loss by Transverse Microradiography (TMR) as in the traditional Liverpool model has produced much valuable information, but the destructive nature of the method limits experimental design, and removes the system from the clinical situation. As a possible alternative, QLF has been validated and optimised. Longitudinal measures can be made on the same surface, and examples of its use are for monitoring recurrent caries and demineralisation around orthodontic brackets.

CONCLUSIONS

While current in situ models provide a major advance over earlier caries models, measurement of de and remineralisation by destructive methods such as transverse microradiography limits the design of experimental investigations. QLF offers significant time saving, reduces the cost of clinical studies, and because the measurements can be carried out longitudinally in vivo, can remove the need for intra-oral appliances carrying experimental tissues.

Acid resistance of enamel subsurface lesions remineralized by a sugar-free chewing gum containing casein phosphopeptide-amorphous calcium phosphate

The aim of this clinical study was to investigate the acid resistance of enamel lesions remineralized in situ by a sugar-free chewing gum containing casein phosphopeptide-amorphous calcium phosphate nanocomplexes (CPP-ACP: Recaldent). The study utilized a double-blind, randomized, crossover design with two treatments: (i) sugar-free gum containing 18.8 mg of CPP-ACP, and (ii) sugar-free gum not containing CPP-ACP as control. Subjects wore removable palatal appliances with insets of human enamel containing demineralized subsurface lesions and chewed the gum for 20 min 4 times per day for 14 days. After each treatment the enamel slabs were removed and half of each lesion challenged with acid in vitro for 8 or 16 h. The level of remineralization was determined using microradiography. The gum containing CPP-ACP produced approximately twice the level of remineralization as the control sugar-free gum. The 8- and 16-hour acid challenge of the lesions remineralized with the control gum resulted in 65.4 and 88.0% reductions, respectively, of deposited mineral, while for the CPP-ACP-remineralized lesions the corresponding reductions were 30.5 and 41.8%. The acid challenge after in situ remineralization for both control and CPP-ACP-treated lesions resulted in demineralization underneath the remineralized zone, indicating that the remineralized mineral was more resistant to subsequent acid challenge. The results show that sugar-free gum containing CPP-ACP is superior to an equivalent gum not containing CPP-ACP in remineralization of enamel subsurface lesions in situ with mineral that is more resistant to subsequent acid challenge.

NMR studies of a novel calcium, phosphate and fluoride delivery vehicle-αS1-casein(59–79) by stabilized amorphous calcium fluoride phosphate nanocomplexes

The repair of early tooth enamel lesions has been recently demonstrated by tryptic phosphopeptides derived from milk caseins that associate with amorphous calcium phosphate (ACP) forming stable complexes. These casein phosphopeptides (CPP), containing the cluster sequence-Ser(P)-Ser(P)-Ser(P)-Glu-Glu-, form calcium phosphate delivery vehicles that retard enamel demineralization and promote remineralization. Recently, we have shown that these peptides also stabilize calcium fluoride phosphate as soluble complexes. These complexes designated CPP-ACFP, have the potential to provide superior clinical efficacy in preventing dental caries and treating and repairing early stages of disease. In an approach to determine the ultrastructure of the casein phosphopeptide-amorphous calcium fluoride phosphate complexes, we have studied the structure of the predominant peptide alpha(S1)-CN(59-79) bound to ACFP using nuclear magnetic resonance (NMR) spectroscopy and X-ray diffraction. The alpha(S1)-CN(59-79) peptide stabilized calcium fluoride phosphate as amorphous nanocomplexes with a hydrodynamic radius of 2.12+/-0.26 nm. The nanocomplexes exhibited stoichiometry of one peptide to 15 calcium, nine phosphate and three fluoride ions. Sequence-specific resonance assignments were determined for the peptide alpha(S1)-CN(59-79) complexed to the ACFP. The secondary structure of the peptide alpha(S1)-CN(59-79) was characterized by sequential (i, i+1), medium-range (i, i+2) nOes and H alpha chemical shifts. The spectral data were compared with that of the peptide alpha(S1)-CN(59-79) bound to calcium ions, revealing that the structurally significant secondary NH and alpha-chemical shifts were similar.

The relationship between healthful eating practices and dental caries in children aged 2-5 years in the United States, 1988-1994

BACKGROUND

As a result of the introduction of multiple fluoride vehicles and other preventive agents, caries prevalence rates in young children have been declining over the past two decades in the United States. However, changing dietary patterns in young children may offset some of the oral health benefits of fluoridation. The objective of this study was to examine the relationship between caries in primary teeth and healthful eating practices in young children.

METHODS

The authors used data from the third National Health and Nutrition Examination Survey to investigate the relationship between healthful eating practices (such as breast-feeding, eating breakfast and consuming five servings of fruits and vegetables a day) and dental caries (untreated tooth decay and overall caries experience) in the primary dentition among children aged 2 through 5 years.

RESULTS

The odds of experiencing caries in primary teeth were significantly greater in nonpoor children who did not eat breakfast daily or ate fewer than five servings of fruit and vegetables per day (odds ratio, or OR = 3.77; 95 percent confidence interval, or CI, 1.80 to 7.89 and OR = 3.21; 95 percent CI, 1.74 to 5.95, respectively). No association was found between breast-feeding and caries in primary teeth.

CONCLUSION

Young children with poor eating habits are more likely to experience caries. Overall, the findings support the notion that dental health education should encourage parents, primary caregivers and policy-makers to promote healthful eating practices, such as eating breakfast daily, for young children.

PRACTICE IMPLICATIONS

Dental professionals are well-positioned to inform parents and caregivers regarding age-appropriate healthful eating practices for young children entrusted in their care.

Nascent helix in the multiphosphorylated peptide alphaS2-casein(2-20)

Sequence-specific nuclear magnetic resonance (NMR) assignments have been determined for the peptide alphaS2-CN(2-20) containing the multiphosphorylated motif-8Ser(P)-Ser(P)-Ser(P)-Glu-Glu12- in the presence of molar excess Ca2+. The secondary structure of the peptide was characterized by sequential (i,i + 1), medium-range (i,i + 2/3/4) nOes and H alpha chemical shifts. Molecular modelling of the peptide based on these constraints suggests a nascent helix for residues Ser(P)9 to Glu12. The spectral data for alphaS2-CN(2-20) were compared with those of other casein phosphopeptides beta-CN(1-25) and alphaS1-CN(59-79) that also contain the multiphosphorylated motif. This comparison revealed a similar pattern of secondary amide chemical shifts in the multiphosphorylated motif. However, the patterns of medium-range nOe connectivities in the three peptides suggests they have distinctly different conformations in the presence of Ca2+ despite having a high degree of sequential similarity.

Retention in plaque and remineralization of enamel lesions by various forms of calcium in a mouthrinse or sugar-free chewing gum

Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) nanocomplexes incorporated into sugar-free chewing gum have been shown to remineralize enamel subsurface lesions in situ. The aim of this study was to compare the ability of CPP-ACP, with that of other forms of calcium, to be retained in supragingival plaque and remineralize enamel subsurface lesions in situ when delivered in a mouthrinse or sugar-free gum in randomized, double-blind trials. In the mouthrinse study, only the CPP-ACP-containing mouthrinse significantly increased plaque calcium and inorganic phosphate levels, and the CPP were immunolocalized to the surfaces of bacterial cells as well as the intercellular matrix. In the chewing gum studies, the gum containing the CPP-ACP, although not containing the most calcium per piece of gum, produced the highest level of enamel remineralization independent of gum-chewing frequency and duration. The CPP could be detected in plaque extracts 3 hrs after subjects chewed the CPP-ACP-containing gum. The results showed that CPP-ACP were superior to other forms of calcium in remineralizing enamel subsurface lesions.

Short-term consumption of probiotic-containing cheese and its effect on dental caries risk factors

Cheese is known to contain compounds that reduce the risk of dental caries. The long-term consumption of milk containing Lactobacillus rhamnosus GG, ATCC 53103 (LGG), has been shown to reduce caries risk in children. The aim of the present study was to examine whether short-term consumption of cheese containing LGG and Lactobacillus rhamnosus LC 705 would diminish caries-associated salivary microbial counts in young adults. Altogether, 74 18-35 year-old subjects completed this double-blinded, randomised, placebo-controlled study. During the 3 week intervention, the subjects ate 5 x 15 g cheese per day. Oral examinations were made before and after the study. Stimulated salivary secretion rates, buffer capacity and counts of salivary Streptococcus mutans, yeast and lactobacilli were evaluated before and after the intervention and after a 3 week post-treatment period. The results showed no statistically significant difference between the groups in Streptococcus mutans counts after the intervention, but during the post-treatment period there was a significantly greater reduction in these counts in the intervention group compared to the control group (P=0.05). However, Streptococcus mutans counts decreased in 20% (P=0.01) and yeast counts in 27% (P=0.005) of all the subjects, regardless of the intervention group. Results from logistic regression showed a trend indicating that probiotic intervention might reduce the risk of the highest level of Streptococcus mutans (OR=0.37, 95% CI 0.08-1.75, P=0.21) and salivary yeasts (OR=0.40, 0.09-1.71, P=0.22).

A clinical trial of the anticaries efficacy of casein derivatives complexed with calcium phosphate in patients with salivary gland dysfunction

OBJECTIVE

The purpose of this study was to compare the caries preventive efficacy of a mouthrinse solution containing casein derivatives coupled with calcium phosphate (CD-CP) with that of a 0.05% sodium fluoride mouthrinse among individuals with dry mouth.

STUDY DESIGN

A randomized control trial design was used. Participants included individuals who had had radiotherapy for head and neck cancer (n = 82) and others with Sjögren's syndrome (n = 56). Baseline data collection was followed by reexamination 12 months later. Posterior bite-wing radiographs were taken on both occasions.

RESULTS

A total of 124 participants, 61 (49.2%) in the sodium fluoride group and 63 (50.8%) in the CD-CP group, completed the 12-month examination. The baseline characteristics of the 2 groups did not differ. Coronal caries incidence was higher in the sodium fluoride group than in the CD-CP group (34.4% and 27%, respectively), but the difference was not statistically significant. Similarly, the small difference in coronal caries increment between the 2 groups was not statistically significant (0.4 and 0.3 surfaces, respectively). There was insufficient root surface caries experience between the 2 groups observed for differences to be examined. Proportionately more of the CD-CP group lost 1 or more teeth, and the mean number of tooth loss was higher. The participants with the highest incidence and increment were those with Sjögren's syndrome in the CD-CP group. Some of that difference was accounted for by differences in baseline caries status.

CONCLUSION

It appears that CD-CP preparations hold promise as caries preventive agents for individuals with dry mouth, although confirmation of this study's findings in other settings is warranted before a definitive conclusion can be reached.

Remineralization of enamel subsurface lesions by sugar-free chewing gum containing casein phosphopeptide-amorphous calcium phosphate

Casein phosphopeptide-amorphous calcium phosphate nanocomplexes (CPP-ACP) exhibit anticariogenic potential in laboratory, animal, and human in situ experiments. The aim of this study was to determine the ability of CPP-ACP in sugar-free chewing gum to remineralize enamel subsurface lesions in a human in situ model. Thirty subjects in randomized, cross-over, double-blind studies wore removable palatal appliances with six human-enamel half-slabs inset containing sub-surface demineralized lesions. The appliances were inserted immediately before gum-chewing for 20 min and then retained for another 20 min. This was performed four times per day for 14 days. At the completion of each treatment, the enamel half-slabs were paired with their respective demineralized control half-slabs, embedded, sectioned, and subjected to microradiography and densitometric image analysis, for measurement of the level of remineralization. The addition of CPP-ACP to either sorbitol- or xylitol-based gum resulted in a dose-related increase in enamel remineralization, with 0.19, 10.0, 18.8, and 56.4 mg of CPP-ACP producing an increase in enamel remineralization of 9, 63, 102, and 152%, respectively, relative to the control gum, independent of gum weight or type.

Cation-dependent structural features of beta-casein-(1-25)

Complete sequence-specific, proton-resonance assignments have been determined for the calcium phosphate-stabilizing tryptic peptide beta-casein-(1-25) containing the phosphorylated sequence motif Ser(P)(17)-Ser(P)-Ser(P)-Glu-Glu(21). Spectra of the peptide have been recorded, in separate experiments, in the presence of excess ammonium ions, sodium ions and calcium ions, and of the dephosphorylated peptide in the presence of excess sodium ions. We observed significant changes to chemical shifts for backbone and side-chain resonances that were dependent upon the nature of the cation present. Medium-range nuclear Overhauser effect (nOe) enhancements, characteristic of small structured regions in the peptide, were observed and also found to be cation dependent. The secondary structure of the peptide was characterized by sequential and medium-range (i, i+2/3/4, which denotes an interaction between residue i and residue i+2, i+3 or i+4 in the peptide) nOe connectivities, and Halpha chemical shifts. Four structured regions were identified in the calcium-bound peptide: residues Arg(1) to Glu(4) were involved in a loop-type structure, and residues Val(8) to Glu(11), Ser(P)(17) to Glu(20) and Glu(21) to Thr(24) were implicated in beta-turn conformations. Comparison of the patterns of medium-range nOe connectivities in beta-casein-(1-25) with those in alpha(S1)-casein-(59-79) suggest that the two peptides have distinctly different conformations in the presence of calcium ions, despite having a high degree of sequential and functional similarity.

The cariostatic potential of cheese: cooked cheese-containing meals increase plaque calcium concentration

OBJECTIVE

Eating cheese by itself increases plaque calcium concentration - which is probably one mechanism of the well-established action of cheese in reducing experimental caries. The objective of the present study was to determine whether consumption of cheese as part of a cooked, mixed meal (ie as it is habitually consumed) is able to increase plaque calcium concentration.

DESIGN

Plaque samples were obtained from 16 adult volunteers before and 5 minutes after consumption of either a 15 g cube of cheese, one of two cheese-containing test meals, or one of two control meals. Each subject tested each of the four meals on a separate occasion. Plaque calcium concentration was measured using atomic absorption spectrophotometry.

RESULTS

The test meals increased plaque calcium concentrations to a significantly greater magnitude than the control meals (P < 0.05). A non-significant trend was observed towards a larger magnitude of change in plaque calcium concentration in the 8 subjects with the lowest, compared with the 8 subjects with the highest baseline concentration.

CONCLUSION

The findings suggest that cheese-containing meals increase plaque calcium concentration and thus probably protect against dental caries.

Biological mechanisms of early childhood caries

The present paper reviews biological issues in early childhood caries (ECC) in light of the current understanding of the field. Despite the general global decline in dental caries in the past decades, ECC has become a significant problem in many developing countries and some minority communities in western industrialized nations. Like other types of caries, ECC is caused by mutans streptococci that ferment dietary carbohydrates to produce acid attacks on susceptible teeth over a period of time. However, while the general etiology of ECC appears similar to that of other types of caries, the predisposing factors are still unclear. The biology of ECC may be modified by several factors unique to young children, related to the implantation of cariogenic bacteria, immaturity of the host defense systems, as well as behavioral patterns associated with feeding and oral hygiene in early childhood.

An ELISA for a multiphosphorylated peptide, alpha(s1)-casein(59-79)

Multiphosphorylated segments of proteins are predicted to be in or near epitopes. However, due to the very hydrophilic nature of multiphosphorylated peptides, epitope mapping by ELISA using conventional microtitre plates can produce false negatives due to poor antigen adsorption. We have developed a sensitive ELISA for a multiphosphorylated peptide alpha(s1)-casein(59-79) containing five phosphoseryl residues using Nunc-Immuno Maxisorp modules for antigen adsorption. The peptide alpha(s1)-casein(59-79) was detected in the ELISA at antigen coating concentrations of 1.0 microg/ml and above, using rabbit anti-casein antibodies at a dilution of 1/10,000 in Tris-buffered saline containing 0.05% (w/v) Tween 20 and 1.0% (v/v) normal goat serum. At an antigen coating concentration of 10 microg/ml, anti-casein antibodies bound to alpha(s1)-casein(59-79) and produced an absorbance of more than 100 times background. Using conventional polyvinyl chloride and polystyrene plates the peptide alpha(s1)-casein(59-79) could only be detected at very high antigen coating concentrations of 1-10 mg/ml. The addition of 0.05% (w/v) Tween 20 to the blocking, antibody diluting and wash buffers of the ELISA was shown to significantly reduce nonspecific binding of the primary antibody. Further, the inclusion of normal goat serum in the blocking and antibody diluting buffers resulted in a small but significant increase in absorbance. The ELISA developed in this study has been used successfully with a range of enzymatically derived and synthetic peptides containing one to five phosphorylated residues such that it should have general applicability to the study of antigenicity of multiphosphorylated peptides.

Anticariogenic complexes of amorphous calcium phosphate stabilized by casein phosphopeptides: a review

Using laboratory, animal, and human in situ caries models, investigators have shown that casein phosphopeptide amorphous calcium phosphate complexes (CPP-ACP) exhibit an anticariogenic activity. The casein phosphopeptides (CPP) are produced from a tryptic digest of the milk protein casein by aggregation with calcium phosphate and purification by ultrafiltration. The CPP have a remarkable ability to stabilize calcium phosphate in solution and substantially increase the level of calcium phosphate in dental plaque. Through their multiple phosphoseryl residues, the CPP bind to forming clusters of amorphous calcium phosphate (ACP) in metastable solution, preventing their growth to the critical size required for nucleation and precipitation. The proposed mechanism of anticariogenicity for the CPP-ACP is that they localize ACP in dental plaque, which buffers the free calcium and phosphate lon activities, thereby helping to maintain a state of supersaturation with respect to tooth enamel depressing demineralization and enhancing remineralization. The CPP-ACP, unlike fluoride, can be added to sugar-containing foods and therefore have commercial potential as an additive to foods as well as to toothpastes and mouthwashes for the control of dental caries.

Remineralization of enamel subsurface lesions by casein phosphopeptide-stabilized calcium phosphate solutions

Casein phosphopeptides (CPP) stabilize amorphous calcium phosphate (ACP), localize ACP in dental plaque, and are anticariogenic in animal and in situ human caries model. In this vitro study, CPP-stabilized calcium phosphate solutions were shown to remineralize subsurface lesions in human third-molar enamel. Solutions were used to examine the effect of CPP-calcium phosphate concentration on remineralization. Other solutions were used to examine the effect of increasing pH, which decreased the concentrations of free calcium and phosphate ions and increased the level of CPP-bound ACP. Although most of the remineralizing solutions were supersaturated with respect to the amorphous and crystalline calcium phosphate phases, the solutions were stabilized by the CPP such that spontaneous precipitation of calcium phosphate did not occur. After a ten-day remineralization period, enamel lesions were sectioned, subjected to microradiography, and the mineral content determined by microdensitometry. All solutions deposited mineral into the bodies of the lesions, with the 1.0% CPP-calcium phosphate (pH 7.0) solution replacing 63.9 +/- 20.1% of mineral lost at an averaged rate of 3.9 +/- 0.8 x 10(-8) mol hydroxyapatite/m2/s. The remineralizing capacity was greater for the solutions with the higher levels of CPP-stabilized free calcium and phosphate ions. Remineralization was not significantly correlated with either the CPP-bound ACP of the degrees of saturation for hydroxyapatite, octacalcium phosphate, or ACP. However, remineralization was significantly correlated with the degree of saturation for dicalcium phosphate dihydrate (CaHPO4.2H2O), but his was attributed to the significant correlation of remineralization with the activity gradients from the solution into the lesion of some calcium phosphate ions and ion pairs, in particular the neutral ion pair CaHPO4(0). The CPP, by stabilizing calcium phosphate in solution, maintain high-concentration gradients of calcium and phosphate ions and ion pairs into the subsurface lesion and thus effect high rates of enamel remineralization.

Caries prevention: current strategies, new directions

Despite major advances in caries prevention, a large subset of the U.S. population still needs additional control measures. In numerous other countries, needs are escalating as caries rates continue to rise. Building on current strategies and new insights into the specific mechanisms of caries initiation, researchers are creatively using a variety of new technologies, especially in molecular biology, to fashion a new generation of preventive measures.

Incorporation of caseinoglycomacropeptide and caseinophosphopeptide into the salivary pellicle inhibits adherence of mutans streptococci

The protective effects of milk and milk products against dental caries have been demonstrated in many animal studies. We have shown that this effect was mediated by micellar casein or caseinopeptide derivatives. A reduction in the Streptococcus sobrinus population in the oral microbiota of animals fed diets supplemented with these milk components was consistently observed. A possible explanation for these findings is that milk components are incorporated into the salivary pellicle, thereby reducing the adherence of S. sobrinus. This hypothesis was tested in vitro by the incubation of bovine enamel discs with unstimulated saliva. The resulting pellicle was washed and incubated with caseinoglycomacropeptide (CGMP) and/or caseinophosphopeptide (CPP) labeled with 17- and 12-nm gold particles. All samples were prepared for electron microscopy by high-pressure freezing followed by freeze-substitution. It was demonstrated by high-resolution scanning electron microscopy with back-scattered electron imaging, as well as by transmission electron microscopy, that both peptides were incorporated into the pellicle in exchange for albumin, confirming previous findings. This protein was identified with a mouse anti-human serum albumin followed by goat anti-mouse IgG labeled with 25-nm gold particles. Incorporation of CGMP and/or CPP into salivary pellicles reduced the adherence of both S. sobrinus and S. mutans significantly. It is suggested that the calcium and phosphate-rich micellar casein or caseinopeptides are incorporated into the pellicle. The resulting ecological shifts, together with the increased remineralization potential of this biofilm, may explain its modified cariogenic potential.

Characterization of casein phosphopeptides prepared using alcalase: determination of enzyme specificity

Tryptic casein phosphopeptides containing the cluster sequence-Ser(P)-Ser(P)-Ser(P)-Glu-Glu- have been shown to stablize amorphous calcium phosphate at neutral and alkaline pH and be anticariogenic in various in vitro, animal and human experiments. Furthermore, metal ion complexes of the casein phosphopeptides (CPPs) have potential as dietetic supplements to increase the bioavailability of calcium, iron, and other essential metal ions. In this study, we have used a Ca2+/ethanol selective precipitation procedure to produce a range of phosphopeptides from an alcalase digest of whole casein. The CPPs released by alcalase were truncated relative to those which are released by trypsin. The peptides could be grouped into those containing the cluster sequence as well as the group of tri-, di-, and monophosphorylated peptides. The two groups contained a number of homologous peptides of varying lengths resulting from the broad specificity of alcalase. Alcalase was observed to cleave peptide bonds on the carboxyl side of Glu, Met, Leu, Tyr, Lys, and Gln; however, of the twenty-six different cleavage sites, seventeen contained a Glu in the P1 position and of these, fifteen contained a hydrophobic residue in either the P2' or P3' positions. Furthermore, of the twenty-six cleavage sites identified, twenty-two contained a hydrophobic residue in either the P2' or P3' positions. Of the four other sites cleaved by alcalase, two contained a hydrophobic residue in the P1' position and one a hydrophobic residue in the P1 position.

Characterization of multiply phosphorylated peptides selectively precipitated from a pancreatic casein digest

Anticariogenic phosphopeptides, released during the hydrolysis of casein with trypsin, contain the cluster sequence Ser(P)-Ser(P)-Ser(P)-Glu-Glu and have commercial potential as toothpaste, mouthwash, and food additives for the prevention of dental caries. To develop a commercial-scale process for the production of these peptides, we have comprehensively characterized casein phosphopeptides that were selectively precipitated using Ca2+ and ethanol from an acid-clarified (pH 4.6) pancreatic casein hydrolysate. Casein was hydrolyzed using pancreatin at 50 degrees C for 2 h. The precipitate contained a series of casein phosphopeptides that were slightly truncated relative to tryptic casein phosphopeptides. The major casein phosphopeptides released by pancreatin were beta-CN-4P(f7-24), alpha s1-CN-5P(f61-78), and alpha s1-CN-5P(f59-78), all containing the cluster sequence. The truncation of the tryptic peptides beta-CN-4P(1-25) and alpha s1-CN-5P(f59-79) resulted from the chy-motryptic and carboxypeptidase activities of the pancreatin. The peptides containing the cluster sequence constituted 77.8 +/- 6.7 mol/100 mol of the total peptides that were selectively precipitated. This composition was not significantly different from that of casein phosphopeptides produced under identical conditions using trypsin. In conclusion, pancreatin should be a suitable enzyme preparation for the production of anticariogenic casein phosphopeptides on a commercial scale.