title: Clinical efficacy of casein derivatives: a systematic review of the literature.
abstract: BACKGROUND
  The objective of this article was to review systematically the clinical trials of casein derivatives (specifically casein phosphopeptide-amorphous calcium phosphate [CPP-ACP] complex) used in dentistry.
  
  
  METHODS
  The authors included clinical studies that examined the efficacy of casein derivatives in dentistry. They excluded in vitro studies, case series, case reports, letters to editors (not containing primary data), editorials, review articles and commentaries, but read them to identify any potential studies.
  
  
  RESULTS
  The authors searched 98 articles for relevance, determined according to title, abstract and full text, resulting in a yield of 12 original studies. Nine were clinical trials that focused on caries prevention, seven of which showed that CPP-ACP (as found in sugar-free pellet or slab chewing gum, lozenges, milk or mouthrinse) was effective in preventing dental caries by remineralizing subsurface carious lesions in situ in a dose-response fashion. One was a clinical trial with conflicting results regarding the effect of CPP-ACP on the regression of white-spot lesions; one was a survey of the relief of dry-mouth symptoms; and one was an uncontrolled clinical study that showed the lack of effectiveness and lack of short-term therapeutic effect in treating dentin hypersensitivity.
  
  
  CONCLUSIONS
  The quantity and quality of clinical trial evidence are insufficient to make conclusions regarding the long-term effectiveness of casein derivatives, specifically CPP-ACP, in preventing caries in vivo and treating dentin hypersensitivity or dry mouth.
authors.affiliation: Community Dental Health Services Research Unit, Faculty of Dentistry, University of Toronto, Toronto, ON, Canada. amir.azarpazhooh@dentistry.utoronto.ca
authors.forename: Amir
authors.initials: A
authors.lastname: Azarpazhooh
authors.forename: Hardy
authors.initials: H
authors.lastname: Limeback
mesh_terms: D002327:Cariostatic Agents / Q000627:therapeutic use*; D002364:Caseins / Q000627:therapeutic use*; D002614:Chelating Agents / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D003731:Dental Caries / Q000517:prevention & control; D006801:Humans; D014089:Tooth Remineralization
chemical_list: D002327:Cariostatic Agents; D002364:Caseins; D002614:Chelating Agents; C447032:casein phosphopeptide-amorphous calcium phosphate nanocomplex