In Situ Evaluation of a New Toothpaste Formulation Containing Fluoride, Casein Phosphopeptide-Amorphous Calcium Phosphate, and Sodium Trimetaphosphate on Dental Enamel Demineralization and Biofilm Variables

Abstract Objectives This in situ study aimed to evaluate a new toothpaste formulation containing fluoride (F), casein phosphopeptide amorphous calcium phosphate (CPP-ACP) and sodium trimetaphosphate (TMP) on the process of dental demineralization and biofilm composition. Materials and Methods This crossover double-blind study consisted of five phases, in which 10 volunteers wore intraoral appliances containing four bovine enamel specimens. The cariogenic challenge was performed using 30% sucrose solution. Blocks were treated 3x/day with the following toothpastes: 1) Placebo (No F-TMP-CPP-ACP), 2) 1100 ppm F (1100F), 3) 1100F + 3%TMP (1100F-TMP), 4) 1100F + 10%CPP-ACP (1100F-CPP-ACP) and 5) 1100F-CPP-ACP-TMP. After 7 days, the percentage loss of surface hardness (%SH), integrated loss of subsurface hardness (ΔKHN), F, calcium (Ca) and phosphorus (P) concentration in the enamel was determined. The concentration of F, Ca, P and insoluble extracellular polysaccharide (EPS) in the biofilm were analyzed. Results The addition of CPP-ACP-TMP to 1100F reduced %SH by 42% and 39% when compared to the 1100F and 1100F-CPP-ACP (p < 0.001); in addition, to a reduction in lesion body (ΔKHN) by 36% for the same treatments. The treatment with 1100F-CPP-ACP-TMP led to a significant increase in the concentration of F, P and Ca in the enamel and biofilm, and reduced the concentration of EPS (p < 0.001). Conclusions Toothpaste formulation containing 1100F-CPP-ACP-TMP provided a greater protective effect against tooth enamel demineralization and significantly influenced the composition of the in situ biofilm. Clinical Relevance: These results are promising and provide valuable insights for the design of further clinical trials.