In pre-school children addition of casein phosphopeptide-amorphous calcium phosphate paste to regular brushing with fluoridated toothpaste did not have added decay prevention effect


Early childhood caries (ECC) remains a significant public health problem and evidence (Yengopal 2009) and  has suggested that casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) may improve the effectiveness of fluoridated toothpaste. The aim of this study was to see if adding the daily application of a CPP-ACP-containing paste for 1 yr is superior to regular fluoride toothbrushing alone in preventing caries in high-caries-risk pre-school children.

Participants were healthy Thai children aged between 2.5 and 3.5 yrs with normal dentition and diagnosed as high-caries-risk. Children having chronic use of medications or antibiotics, lack of cooperation in the oral examination, allergies to milk protein or benzoate preservatives, presence of oral soft-tissue lesions or enamel hypoplasia examination, or having received a fluoride supplement or professional topical fluoride prior to the study period were excluded. Children were randomised to receive either CPP-ACP (n = 150) or a placebo control paste (n = 146) in addition to fluoridated toothpaste (1000ppm). The main outcome measure was dental caries assessed using The International Caries Detection and Assessment System (ICDAS) recorded at baseline, 6 months, and 1 yr

After a year

  • The drop-out rates of the CPP-ACP and the control groups were 22.0% and 23.3% mainly due to school transfers and relocations.
  • Both groups showed, a significant increase in mean numbers of enamel and dentin caries lesions, as well as decayed missing and filled surfaces (dmfs)
  • No significant difference were observed between the groups on any measure

The authors concluded

This trial found that daily application of 10% w/v CPP-ACP paste on school days for 1 yr, when added to regular toothbrushing with a fluoride toothpaste, had no significant added effect in preventing caries in the primary dentition of these pre-school children


Original trial protocol

Sitthisettapong T, Phantumvanit P, Huebner C, Derouen T. Effect of CPP-ACP  Paste on Dental Caries in Primary Teeth: A Randomized Trial. J Dent Res. 2012 Jul 17. [Epub ahead of print] PubMed PMID: 22805294.

Yengopal V, Mickenautsch S. Caries preventive effect of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP): a meta-analysis. Acta Odontol Scand. 2009;67(6):321-32. PubMed PMID: 19701818.


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