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Title The Use of Casein Phosphopeptide Amorphous Calcium Phosphate Fluoride (CPP-ACPF) Products Can Improve The Salivary Rate And Buffer Capacity in Patients Undergoing Chemotherapy Treatment
Clinical Question In patients undergoing chemotherapy, what is/are the effect(s) of casein phosphopeptide amorphous calcium phosphate fluoride (CPP-ACPF) products on oral and salivary status?
Clinical Bottom Line For patients undergoing chemotherapy treatment, the application of casein phosphopeptide amorphous calcium phosphate fluoride (CPP-ACPF) paste twice daily can improve the resting & stimulated salivary rate and the buffering capacity. This finding is based on a randomized clinical trial involving 20 patients undergoing chemotherapy treatment. According to this study, CPP-ACPF paste showed positive effects on salivary conditions even though the control group differences proved to be statistically insignificant. In the future, larger sample size studies with longer and more frequent follow up intervals may enhance the study results.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 26767110Banava/201520 Patients undergoing chemotherapy treatmentRandomized Controlled Trial
Key resultsPatients who applied calcium phosphopeptide amorphous calcium phosphate fluoride (CPP-ACPF) paste twice per day showed a decreased incidence of xerostomia and burning sensation. At the outset of this study, 70% of the treatment group reported experiencing xerostomia and only 20% reported experiencing xerostomia after 42 days (p > 0.86). 20% of the treatment group reported experiencing burning sensations and 0% reported experiencing burning sensations after 42 days (p > 0.36). These results, although positive, were not statistically significant when compared to the control group's data. Further research with a larger treatment group must be done to provide more evidence to support the positive effects of CPP-ACPF paste.
Evidence Search (("caseins"[MeSH Terms] OR "caseins"[All Fields] OR "casein"[All Fields]) AND ("phosphopeptides"[MeSH Terms] OR "phosphopeptides"[All Fields] OR "phosphopeptide"[All Fields]) AND ("amorphous calcium phosphate"[Supplementary Concept] OR "amorphous calcium phosphate"[All Fields])) AND ("saliva"[MeSH Terms] OR "saliva"[All Fields])
Comments on
The Evidence
The control and treatment groups were not similar at the start of this trial. The two groups differed in incidence of xerostomia, frequency of dysgeusia and burning sensation, difficulty swallowing, and baseline pH. It is not indicated whether the study accomplished a completion rate of > 80%, however, it is noted that some participants were excluded after failing to return for follow-up appointments. The treatment group received application of CPP-ACPF paste for at least 5 minutes twice daily and the participants were evaluated at 21 and 42 days for data collection. The authors note that the small size of the treatment group (n = 10) and poor patient cooperation were limitations to their study. The authors note that a larger treatment group and less intervention criteria could provide more resounding evidence to support the positive effects of CPP-ACPF paste. It is also noted that this study could be considered as a pilot study that may be expanded upon with further research. The authors were not blinded for the purpose of this study, received no financial support, and declared no conflict of interest.
Applicability The subject participants for this trial are representative of a subset of patients seen in general practice who are affected by cancer and/or experiencing xerostomia. The application of casein phosphopeptide amorphous calcium phosphate fluoride could be performed at any dental office and requires no special training. The beneficial effects of CPP-ACPF and other fluoride containing products on enamel remineralization are well documented and support a positive effect for patients receiving the treatment. Although CPP-ACPF products do not contain any harmful toxins or chemicals, they do contain casein, a protein found in various dairy products. Thus, caution should be exercised with patients that are intolerant or sensitive to dairy products.
Specialty/Discipline (General Dentistry)
Keywords Calcium phosphopeptide amorphous calcium phosphate fluoride (CPP-ACPF) CPP-ACPF paste Salivary status Xerostomia Chemotherapy Cancer
ID# 3013
Date of submission: 03/17/2016spacer
E-mail chapach@uthscsa.edu
Author Carlos Humberto Chapa
Co-author(s) e-mail
Faculty mentor/Co-author Moshtagh Farokhi, DDS, MPH
Faculty mentor/Co-author e-mail Farokhi@uthscsa.edu
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