# Patent

## Title
Fluoride composition and methods for dental mineralization

## Abstract

The present invention relates to compositions and methods for mineralizing a dental surface or subsurface including providing a composition including stabilized ACP and a source of fluoride ions.

## Background
The present invention relates to a composition for mineralizing a dental surface, in particular tooth enamel. Methods of mineralizing hypomineralized lesions (including subsurface lesions) in the tooth enamel caused by dental caries, dental corrosion, erosion and fluorosis are also provided.
BACKGROUND
Dental caries is initiated by the demineralization of hard tissue of the teeth usually by organic acids produced from fermentation of dietary sugar by dental plaque odontopathogenic bacteria. Dental caries is still a major public health problem. Further, restored tooth surfaces can be susceptible to further dental caries around the margins of the restoration. Even though the prevalence of dental caries has decreased through the use of fluoride in most developed countries, the disease remains a major public health problem. Dental erosion or corrosion is the loss of tooth mineral by dietary or regurgitated acids. Dental hypersensitivity is due to exposed dentinal tubules through loss of the protective mineralized layer, cementum. Dental calculus is the unwanted accretion of calcium phosphate minerals on the tooth surface. All these conditions, dental caries, dental corrosion, dental hypersensitivity and dental calculus are therefore imbalances in the level of calcium phosphates.
Fluoride-containing dentifrices and mouthrinses have been demonstrated to significantly reduce caries experience in randomized, controlled clinical trials (Biesbrock et al., 1998; Biesbrock et al., 2001; Curnow et al., 2002; Davies et al., 2002; Biesbrock et al., 2003). The efficacy of these oral care products in reducing caries activity has been attributed to their ability to incorporate fluoride ions into plaque as several investigators have suggested an inverse relationship between plaque fluoride levels and caries incidence (Duckworth et al., 1992, Duckworth and Stewart, 1994, Hartshorne et al., 1994; Skold-Larsson et al., 2000; Lynch et al., 2004).
Fluoride ions in plaque immediately promote the formation of fluorhydroxyapatite in the presence of calcium and phosphate ions produced during demineralization of tooth enamel by plaque bacterial organic acids (ten Cate, 1999). This is now believed to be the major mechanism of fluoride ion's action in preventing enamel demineralization (ten Cate, 1999; Lynch et al., 2004). However, fluoride ions can also promote the remineralization of previously demineralized enamel if enough salivary or plaque calcium and phosphate ions are available when the fluoride is applied. For every two fluoride ions, ten calcium ions and six phosphate ions are required to form one unit cell of fluorapatite. Hence on topical application of fluoride ions, the availability of calcium and phosphate ions can be rate limiting for net enamel remineralization to occur. This is highly exacerbated under xerostomic (dry mouth) conditions. Furthermore, as fluoride treatments can lead to fluorosis, particularly in children, it would be advantageous to produce dental treatment compositions having the highest efficacy for the amount of fluoride present, to reduce the overall quantity of fluoride necessary to achieve the mineralization effect.
WO 98/40406 in the name of The University of Melbourne (the contents of which are herein incorporated fully by reference) describes casein phosphopeptide-amorphous calcium phosphate complexes (CPP-ACP) and CPP-stabilised amorphous calcium fluoride phosphate complexes (CPP-ACFP) which have been produced at alkaline pH. CPP-ACP (available commercially as RecaldentTM) has been shown to remineralize enamel subsurface lesions in vitro and in situ (Reynolds, 1998; Shen et al., 2001; Reynolds et al., 2003).
The CPP which are active in forming the complexes do so whether or not they are part of a full-length casein protein. Examples of active (CPP) that can be isolated after tryptic digestion of full length casein have been specified in U.S. Pat. No. 5,015,628 and include peptides Bos αs1-casein X-5P (f59-79) [1], Bos β-casein X-4P (f1-25) [2], Bos αs2-casein X-4P (f46-70) [3] and Bos αs2-casein X-4P (f1-21) [4] as follows:








[1]



Gln59-Met-Glu-Ala-Glu-Ser(P)-Ile-Ser(P)-Ser(P)-Ser


 


(P)-Glu-Glu-Ile-Val-Pro-Asn-Ser(P)-Val-Glu-Gln-


 


Lys79 αs1(59-79)


 


[2]


Arg1-Glu-Leu-Glu-Glu-Leu-Asn-Val-Pro-Gly-Glu-Ile-


 


Val-Glu-Ser(P)-Leu-Ser(P)-Ser(P)-Ser(P)-Glu-Glu-


 


Ser-Ile-Thr-Arg25 β(1-25)


 


[3]


Asn46-Ala-Asn-Glu-Glu-Glu-Tyr-Ser-Ile-Gly-Ser(P)-


 


Ser(P)-Ser(P)-Glu-Glu-Ser(P)-Ala-Glu-Val-Ala-Thr-


 


Glu-Glu-Val-Lys70 αs2(46-70)


 


[4]


Lys1-Asn-Thr-Met-Glu-His-Val-Ser(P)-Ser(P)-Ser(P)-


 


Glu-Glu-Ser-Ile-Ile-Ser(P)-Gln-Glu-Thr-Tyr-Lys21


 


αs2(1-21)






International patent application numbers WO 03/059303 and WO 03/059304 in the name of the Procter & Gamble Company identify difficulties in maintaining measurable fluoride ions levels in oral compositions containing CPP-ACP complexes and fluoride and propose including additional components to maintain measurable fluoride levels.
It would be useful augment the remineralization activity of CPP-ACP complexes or fluoride compositions to better treat conditions such as dental caries.
It is accordingly an object of the present invention to overcome, or at least alleviate, one or more of the difficulties and/or deficiencies related to the prior art.
SUMMARY OF THE INVENTION
In one aspect, the present invention provides a composition for dental mineralization including stabilized amorphous calcium phosphate (ACP) and a source of fluoride ions. The ACP may also contain some fluoride ions, and these fluoride ions may be part of a stabilised amorphous calcium fluoride phosphate (ACFP) complex.
The composition may include any suitable oral composition, such as a composition for maintaining oral/dental heath used by the patient and/or a treatment composition for use by the dental practitioner. Such compositions may include toothpastes, tooth gels, tooth powders, dental crèmes, liquid dentifrices, mouthwashes, troches, chewing gums, gingival massage crèmes, gargle tablets and dental restoratives.
In a further aspect of the present invention there is provided a method of mineralizing a dental surface or subsurface including providing a composition including stabilized ACP and a source of fluoride ions. In a preferred embodiment the dental surface is enamel.
In a further aspect of the present invention there is provided a method for treating and/or preventing dental caries including contacting a caries lesion in tooth enamel with a composition including stabilized ACP and a source of fluoride ions.
It has now been found that the dental remineralization efficacy of an oral composition including a source of fluoride ions can be substantially enhanced by the addition of stabilized ACP to the composition. Furthermore, the uptake of fluoride ions into dental enamel from an oral composition containing a source of fluoride ions can be enhanced by the inclusion of stabilized ACP into the composition.
Accordingly, in a further aspect of the present invention there is provided a method of increasing the remineralisation efficacy of an oral composition having a source of fluoride ions, including the incorporation of stabilized ACP into the oral composition.
In a further aspect of the present invention there is provided a method of increasing the uptake of fluoride ions into a dental surface or subsurface after treatment with an oral composition having a source of fluoride ions, including the incorporation of stabilized ACP into the oral composition.
Preferably, the dental surface or subsurface is tooth enamel.
In a further aspect, the present invention provides a method for increasing the uptake of fluoride ions into dental plaque after treatment with an oral composition having a source of fluoride ions, including the incorporation of stabilized ACP into the oral composition.
Typically in these methods of the invention, the fluoride ions are supplied separately but substantially simultaneously with the ACP.
The ACP is preferably a basic, soluble form of ACP.
The fluoride ions are preferably present in the composition in an amount greater than 1 ppm. More preferably, the amount is more than 3 ppm. In another embodiment, it is preferably more than 10 ppm. In typical embodiments described below, the amount may be several hundred or thousand ppm. The fluoride content is typically measured as a ppm in oral compositions in the manner commonly used in the art. Where the fluoride is provided from a source with the stabilized ACP, the ppm refers to the concentration of the fluoride in that source, typically a solution or suspension of bioavailable fluoride.
The fluoride ions may be from any suitable source. A source of fluoride ions may include free fluoride ions or fluoride salts. Examples of sources of fluoride ions include, but are not limited to the following: sodium fluoride, sodium monofluorophosphate, stannous fluoride, sodium silicofluoride and amine fluoride. These may be provided in solution (typically an aqueous solution), or a suspension.
Preferably the ACP is phosphopeptide (PP)-stabilized. Preferably, the phosphopeptide (as defined below) is a casein phosphopeptide. In a preferred embodiment the ACP is in the form of a casein phosphopeptide stabilized ACP complex.
In a further aspect of the present invention there is provided a method for mineralizing a tooth surface or subsurface comprising applying an ACP complex and a source of fluoride ions to a tooth surface or subsurface. Preferably the tooth surface or subsurface is tooth enamel. In a preferred embodiment, the tooth surface is tooth enamel containing a lesion selected from the group consisting of one or more of a caries lesion; a lesion caused by tooth erosion, a white spot lesion, or a fluorotic lesion.
In one embodiment, the dental surface is in need of such treatment. The invention also includes a method of treating a subject suffering dental caries, dentinal hypersensitivity, fluorosis or dental calculus.
It has been surprisingly found that the inclusion of stabilized ACP into an oral composition including a source of fluoride ions, increases extent to which remineralization occurs throughout the body of the enamel lesion, covering the surface and subsurface of the lesion, when compared with the oral composition without the stabilized ACP.
Accordingly, in a further aspect of the present invention there is provided a method for remineralizing a subsurface enamel lesion including contacting a subsurface enamel lesion with a composition including stabilized ACP and a source of fluoride ions.
In a further aspect there is provided the use of stabilized ACP and a source of fluoride ions in the manufacture of a medicament for the mineralization of a tooth surface or subsurface.
In a further aspect of the present invention there is provided the use of stabilized ACP and a source of fluoride ions in the manufacture of a composition for increasing the remineralization efficacy of an oral composition having a source of fluoride ions.
In a further aspect of the present invention there is provided the use of stabilized ACP and a source of fluoride ions in the manufacture of an oral composition for increasing the uptake of fluoride ions into a dental surface or subsurface after treatment with an oral composition having a source of fluoride ions.
In a further aspect of the present invention there is provided the use of stabilized ACP and a source of fluoride ions in the manufacture of an oral composition for increasing the uptake of fluoride ions into a dental plaque after treatment with an oral composition having a source of fluoride ions.
In a further aspect of the present invention there is provided the use of stabilized ACP and a source of fluoride ions in the manufacture of a composition for remineralizing a subsurface enamel lesion.
Without being bound by any theory or mode of action it is believed that the fluoride ions interact with the ACP to form fluorapatite on contact with the tooth surface, which is more resistant to acid challenge than normal tooth enamel. This may result in tooth enamel with superior caries resistant properties. Another part of the mechanism may involve the fluoride ions forming a PP stabilized amorphous calcium fluoride phosphate complex (which may include a mixture of basic amorphous calcium phosphate and fluoride ions, in situ during use). The use of amorphous calcium fluoride phosphate includes the use of a mixture of ACP with amorphous calcium fluoride phosphate.
“Phosphopeptide” or “PP” in the context of the description of this invention means an amino acid sequence in which at least one amino acid is phosphorylated. Preferably, the phosphopeptide includes one or more of the amino acid sequence -A-B-C-, where A is a phosphoamino residue, B is any amino acyl residue including a phosphoamino residue and C is selected from a glutamyl, aspartyl or phosphoamino residue. Any of the phosphoamino residues may independently be a phosphoseryl residue. B is desirably a residue the side-chain of which is neither relatively large nor hydrophobic. It may be Gly, Ala, Val, Met, Leu, Ile, Ser, Thr, Cys, Asp, Glu, Asn, Gln or Lys.
In another embodiment, at least two of the phosphoamino acids in the sequence are preferably contiguous. Preferably the phosphopeptide includes the sequence A-B-C-D-E, where A, B, C, D and E are independently phosphoserine, phosphothreonine, phosphotyrosine, phosphohistidine, glutamic acid or aspartic acid, and at least two, preferably three, of the A, B, C, D and E are a phosphoamino acid. In a preferred embodiment, the phosphoamino acid residues are phosphoserine, most preferably three contiguous phosphoserine residues. It is also preferred that D and E are independently glutamic or aspartic acid.
It will also be understood that the term “comprises” (or its grammatical variants) as used in this specification is equivalent to the term “includes” and may be used interchangeably and should not be taken as excluding the presence of other elements or features.
The ACP may also include ACFP, or ACFP may be included in the compositions and methods of the present invention in the place of ACP.
In one embodiment, the ACP or ACFP is stabilized by a casein phosphopeptide (CPP), which is in the form of intact casein or fragment of the casein, and the complex formed preferably has the formula [CPP(ACP)8]n or [(CPP)(ACFP)8]n where n is equal to or greater than 1, for example 6. The complex formed may be a colloidal complex, where the core particles aggregate to form large (eg 100 nm) colloidal particles suspended in water. Thus, the PP can be a casein protein or a polyphosphopeptide.
The PP may be from any source; it may be present in the context of a larger polypeptide, including a full length casein polypeptide, or it may be isolated by tryptic or other enzymatic or chemical digestion of casein, or other phosphoamino acid rich proteins such as phosphitin, or by chemical or recombinant synthesis, provided that it comprises the sequence -A-B-C- or A-B-C-D-E as described above. The sequence flanking this core sequence may be any sequence. However, those flanking sequences in αs1(59-79) [1], β(1-25) [2], αs2(46-70) [3] and αs2(1-21) [4] are preferred. The flanking sequences may optionally be modified by deletion, addition or conservative substitution of one or more residues. The amino acid composition and sequence of the flanking region are not critical. Examples of conservative substitutions are shown in Table 1 below.









TABLE 1






Exemplary Conservative
Preferred Conservative


Original Residue
Substitution
Substitution







Ala
Val, Leu, Ile
Val


Asn
Gln Lys His Phe
Gln


Gln
Asn
Asn


Gly
Pro
Pro


Ile
Leu, Val, Met, Ala, Phe
Leu


Leu
Ile, Val, Met, Ala, Phe
Ile


Lys
Arg, Gln, Asn
Arg


Phe
Leu, Val, Ile, Ala
Leu


Pro
Gly
Gly


Ser
Thr
Thr


Val
Ile, Leu, Met, Phe, Ala
Leu


Asp
Glu
Glu


Thr
Ser
Ser


Trp
Tyr
Tyr


Tyr
Trp Phe Thr Ser
Phe









The flanking sequences may also include non-naturally occurring amino acid residues. Commonly encountered amino acids which are not encoded by the genetic code, include:

    2-amino adipic acid (Aad) for Glu and Asp;
    2-aminopimelic acid (Apm) for Glu and Asp;
    2-aminobutyric (Abu) acid for Met, Leu, and other aliphatic amino acids;
    2-aminoheptanoic acid (Ahe) for Met, Leu and other aliphatic amino acids;
    2-aminoisobutyric acid (Aib) for Gly;
    cyclohexylalanine (Cha) for Val, and Leu and Ile; homoarginine (Har) for Arg and Lys;
    2,3-diaminopropionic acid (Dpr) for Lys, Arg and His;
    N-ethylglycine (EtGly) for Gly, Pro, and Ala;
    N-ethylasparigine (EtAsn) for Asn, and Gln;
    Hydroxyllysine (Hyl) for Lys;
    allohydroxyllysine (AHyl) for Lys;
    3-(and 4) hydroxyproline (3Hyp, 4Hyp) for Pro, Ser, and Thr;
    alloisoleucine (Alle) for Ile, Leu, and Val;
    ρ-amidinophenylalanine for Ala;
    N-methylglycine (MeGly, sarcosine) for Gly, Pro, Ala.
    N-methylisoleucine (Melle) for Ile;
    Norvaline (Nva) for Met and other aliphatic amino acids;
    Norleucine (Nle) for Met and other aliphatic amino acids;
    Ornithine (Orn) for Lys, Arg and His;
    Citrulline (Cit) and methionine sulfoxide (MSO) for Thr, Asn and Gln;
    N-methylphenylalanine (MePhe), trimethylphenylalanine, halo (F, Cl, Br and I) phenylalanine, trifluorylphenylalanine, for Phe.


In one embodiment, the PP is one or more phosphopeptides selected from the group consisting of αs1(59-79) [1], β(1-25) [2], αs2(46-70) [3] and αs2(1-21) [4].
In preferred embodiments, the compositions of the present invention do not include a phosphate buffer and/or a calcium chelator.
In an embodiment of the present invention there is provided a composition for dental mineralization including stabilized amorphous calcium phosphate (ACP) and a source of fluoride ions, wherein the composition does not include a phosphate buffer and/or calcium chelator.
In another embodiment of the invention, the stabilised ACP complex is incorporated into an oral composition containing a source of fluoride ions such as toothpaste, mouth washes or formulations for the mouth to aid in the prevention and/or treatment of dental caries, tooth decay, dental erosion and/or fluorosis. The ACP complex may comprise 0.01-50% by weight of the composition, preferably 1.0-50%. For oral compositions, it is preferred that the amount of the ACP complex administered is 0.01-50% by weight, preferably 1.0%-50% by weight of the composition. In a particularly preferred embodiment, the oral composition of the present invention contains about 2% CPP-ACP. The fluoride ions may be present in the oral composition at a concentration in the range of about 200 ppm to 3000 ppm. In a preferred embodiment, the fluoride ions are at a concentration in the range of about 400 ppm to about 1500 ppm. In a further preferred embodiment, the fluoride ions in the oral composition are at a concentration of about 900 ppm.
An oral composition of this invention which contains the above-mentioned agents may be prepared and used in various forms applicable to the mouth such as dentifrice including toothpastes, toothpowders and liquid dentifrices, mouthwashes, troches, chewing gums, dental pastes, gingival massage creams, gargle tablets, dairy products and other foodstuffs. An oral composition according to this invention may further include additional well known ingredients depending on the type and form of a particular oral composition.
In certain preferred forms of the invention the oral composition may be substantially liquid in character, such as a mouthwash or rinse. In such a preparation the vehicle is typically a water-alcohol mixture desirably including a humectant as described below. Generally, the weight ratio of water to alcohol is in the range of from about 1:1 to about 20:1. The total amount of water-alcohol mixture in this type of preparation is typically in the range of from about 70 to about 99.9% by weight of the preparation. The alcohol is typically ethanol or isopropanol. Ethanol is preferred.
The pH of such liquid and other preparations of the invention is generally in the range of from about 5 to about 9 and typically from about 5.0 to 7.0. The pH can be controlled with acid (e.g. citric acid or benzoic acid) or base (e.g. sodium hydroxide) or buffered (as with sodium citrate, benzoate, carbonate, or bicarbonate, disodium hydrogen phosphate, sodium dihydrogen phosphate, etc).
In other desirable forms of this invention, the stabilised ACP composition may be substantially solid or pasty in character, such as toothpowder, a dental tablet or a toothpaste (dental cream) or gel dentifrice. The vehicle of such solid or pasty oral preparations generally contains dentally acceptable polishing material. Examples of polishing materials are water-insoluble sodium metaphosphate, potassium metaphosphate, tricalcium phosphate, dihydrated calcium phosphate, anhydrous dicalcium phosphate, calcium pyrophosphate, magnesium orthophosphate, trimagnesium phosphate, calcium carbonate, hydrated alumina, calcined alumina, aluminium silicate, zirconium silicate, silica, bentonite, and mixtures thereof. Other suitable polishing material include the particulate thermosetting resins such as melamine-, phenolic, and urea-formaldehydes, and cross-linked polyepoxides and polyesters. Preferred polishing materials include crystalline silica having particle sizes of up to about 5 microns, a mean particle size of up to about 1.1 microns, and a surface area of up to about 50,000 cm2/g., silica gel or colloidal silica, and complex amorphous alkali metal aluminosilicate.
When visually clear gels are employed, a polishing agent of colloidal silica, such as those sold under the trademark SYLOID as Syloid 72 and Syloid 74 or under the trademark SANTOCEL as Santocel 100, alkali metal aluminosilicate complexes are particularly useful since they have refractive indices close to the refractive indices of gelling agent-liquid (including water and/or humectant) systems commonly used in dentifrices.
Many of the so-called “water insoluble” polishing materials are anionic in character and also include small amounts of soluble material. Thus, insoluble sodium metaphosphate may be formed in any suitable manner, for example as illustrated by Thorpe's Dictionary of Applied Chemistry, Volume 9, 4th Edition, pp. 510-511. The forms of insoluble sodium metaphosphate known as Madrell's salt and Kurrol's salt are further examples of suitable materials. These metaphosphate salts exhibit only a minute solubility in water, and therefore are commonly referred to as insoluble metaphosphates (IMP). There is present therein a minor amount of soluble phosphate material as impurities, usually a few percent such as up to 4% by weight. The amount of soluble phosphate material, which is believed to include a soluble sodium trimetaphosphate in the case of insoluble metaphosphate, may be reduced or eliminated by washing with water if desired. The insoluble alkali metal metaphosphate is typically employed in powder form of a particle size such that no more than 1% of the material is larger than 37 microns.
The polishing material is generally present in the solid or pasty compositions in weight concentrations of about 10% to about 99%. Preferably, it is present in amounts from about 10% to about 75% in toothpaste, and from about 70% to about 99% in toothpowder. In toothpastes, when the polishing material is silicious in nature, it is generally present in an amount of about 10-30% by weight. Other polishing materials are typically present in amount of about 30-75% by weight.
In a toothpaste, the liquid vehicle may comprise water and humectant typically in an amount ranging from about 10% to about 80% by weight of the preparation. Glycerine, propylene glycol, sorbitol and polypropylene glycol exemplify suitable humectants/carriers. Also advantageous are liquid mixtures of water, glycerine and sorbitol. In clear gels where the refractive index is an important consideration, about 2.5-30% w/w of water, 0 to about 70% w/w of glycerine and about 20-80% w/w of sorbitol are preferably employed.
Toothpaste, creams and gels typically contain a natural or synthetic thickener or gelling agent in proportions of about 0.1 to about 10, preferably about 0.5 to about 5% w/w. A suitable thickener is synthetic hectorite, a synthetic colloidal magnesium alkali metal silicate complex clay available for example as Laponite (e.g. CP, SP 2002, D) marketed by Laporte Industries Limited. Laponite D is, approximately by weight 58.00% SiO2, 25.40% MgO, 3.05% Na2O, 0.98% Li2O, and some water and trace metals. Its true specific gravity is 2.53 and it has an apparent bulk density of 1.0 g/ml at 8% moisture.
Other suitable thickeners include Irish moss, iota carrageenan, gum tragacanth, starch, polyvinylpyrrolidone, hydroxyethylpropylcellulose, hydroxybutyl methyl cellulose, hydroxypropyl methyl cellulose, hydroxyethyl cellulose (e.g. available as Natrosol), sodium carboxymethyl cellulose, and colloidal silica such as finely ground Syloid (e.g. 244). Solubilizing agents may also be included such as humectant polyols such propylene glycol, dipropylene glycol and hexylene glycol, cellosolves such as methyl cellosolve and ethyl cellosolve, vegetable oils and waxes containing at least about 12 carbons in a straight chain such as olive oil, castor oil and petrolatum and esters such as amyl acetate, ethyl acetate and benzyl benzoate.
It will be understood that, as is conventional, the oral preparations will usually be sold or otherwise distributed in suitable labelled packages. Thus, a bottle of mouth rinse will have a label describing it, in substance, as a mouth rinse or mouthwash and having directions for its use; and a toothpaste, cream or gel will usually be in a collapsible tube, typically aluminium, lined lead or plastic, or other squeeze, pump or pressurized dispenser for metering out the contents, having a label describing it, in substance, as a toothpaste, gel or dental cream.
Organic surface-active agents may be used in the compositions of the present invention to achieve increased prophylactic action, assist in achieving thorough and complete dispersion of the active agent throughout the oral cavity, and render the instant compositions more cosmetically acceptable. The organic surface-active material is preferably anionic, non-ionic or ampholytic in nature and preferably does not interact with the active agent. It is preferred to employ as the surface-active agent a detersive material which imparts to the composition detersive and foaming properties. Suitable examples of anionic surfactants are water-soluble salts of higher fatty acid monoglyceride monosulfates, such as the sodium salt of the monosulfated monoglyceride of hydrogenated coconut oil fatty acids, higher alkyl sulfates such as sodium lauryl sulfate, alkyl aryl sulfonates such as sodium dodecyl benzene sulfonate, higher alkylsulfo-acetates, higher fatty acid esters of 1,2-dihydroxy propane sulfonate, and the substantially saturated higher aliphatic acyl amides of lower aliphatic amino carboxylic acid compounds, such as those having 12 to 16 carbons in the fatty acid, alkyl or acyl radicals, and the like. Examples of the last mentioned amides are N-lauroyl sarcosine, and the sodium, potassium, and ethanolamine salts of N-lauroyl, N-myristoyl, or N-palmitoyl sarcosine which should be substantially free from soap or similar higher fatty acid material. The use of these sarconite compounds in the oral compositions of the present invention is particularly advantageous since these materials exhibit a prolonged marked effect in the inhibition of acid formation in the oral cavity due to carbohydrates breakdown in addition to exerting some reduction in the solubility of tooth enamel in acid solutions. Examples of water-soluble non-ionic surfactants suitable for use are condensation products of ethylene oxide with various reactive hydrogen-containing compounds reactive therewith having long hydrophobic chains (e.g. aliphatic chains of about 12 to 20 carbon atoms), which condensation products (“ethoxamers”) contain hydrophilic polyoxyethylene moieties, such as condensation products of poly (ethylene oxide) with fatty acids, fatty alcohols, fatty amides, polyhydric alcohols (e.g. sorbitan monostearate) and polypropyleneoxide (e.g. Pluronic materials).
The surface active agent is typically present in amount of about 0.1-5% by weight. It is noteworthy, that the surface active agent may assist in the dissolving of the active agent of the invention and thereby diminish the amount of solubilizing humectant needed.
Various other materials may be incorporated in the oral preparations of this invention such as whitening agents, preservatives, silicones, chlorophyll compounds and/or ammoniated material such as urea, diammonium phosphate, and mixtures thereof. These adjuvants, where present, are incorporated in the preparations in amounts which do not substantially adversely affect the properties and characteristics desired.
Any suitable flavouring or sweetening material may also be employed. Examples of suitable flavouring constituents are flavouring oils, e.g. oil of spearmint, peppermint, wintergreen, sassafras, clove, sage, eucalyptus, marjoram, cinnamon, lemon, and orange, and methyl salicylate. Suitable sweetening agents include sucrose, lactose, maltose, sorbitol, xylitol, sodium cyclamate, perillartine, AMP (aspartyl phenyl alanine, methyl ester), saccharine, and the like. Suitably, flavour and sweetening agents may each or together comprise from about 0.1% to 5% more of the preparation.
The compositions of this invention can also be incorporated in lozenges, or in chewing gum or other products, e.g. by stirring into a warm gum base or coating the outer surface of a gum base, illustrative of which are jelutong, rubber latex, vinylite resins, etc., desirably with conventional plasticizers or softeners, sugar or other sweeteners or such as glucose, sorbitol and the like.
In a further aspect, the invention provides compositions including pharmaceutical compositions comprising the ACP complex described above and a source of fluoride ions together with a pharmaceutically-acceptable carrier. Such compositions may be selected from the group consisting of dental, anticariogenic compositions and therapeutic compositions. Dental compositions or therapeutic compositions may be in the form of a gel, liquid, solid, powder, cream or lozenge. Therapeutic compositions may also be in the form of tablets or capsules. For example, a crème formulation may be employed containing: water; glycerol; CPP-ACP; sodium fluoride, D-sorbitol; silicon dioxide; sodium carboxymethylcellulose (CMC-Na); propylene glycol; titanium dioxide; xylitol; phosphoric acid; guar gum; zinc oxide; sodium saccharin; ethyl p-hydroxybenzoate; magnesium oxide; butyl p-hydroxybenzoate and propyl p-hydroxybenzoate.
The invention further includes a formulation described above provided together with instructions for its use to treat or prevent any one or more of dental caries or tooth decay, dental corrosion and fluorosis.
In a further aspect, the present invention provides a kit of parts including (a) a source of fluoride ions and (b) a CPP-ACP complex in a pharmaceutically acceptable carrier. Desirably, the kit further includes instructions for their use for the mineralization of a dental surface in a patent in need of such treatment. In one embodiment, the agent and the complex are present in suitable amounts for treatment of a patient. The invention also provides a system for improved remineralization including (a) a source of fluoride ions and (b) a CPP-ACP complex in a pharmaceutically acceptable carrier for combining with the source of fluoride before application to a dental surface.
In a further aspect, the present invention provides a method for enhancing the remineralization effect of fluoride ions in an oral care composition including addition of stabilised ACP to the oral care composition.
In a further aspect, the present invention provides a method of improving fluoride incorporation into an enamel lesion including contacting a lesion in tooth enamel with a composition including stabilized ACP and a source of fluoride ions.
In a further aspect of the present invention there is provided the use of stabilized ACP and a source of fluoride ions in the manufacture of a medicament for the mineralization of a dental surface or subsurface.
In a further aspect of the present invention there is provided the use of stabilized ACP and a source of fluoride ions in the manufacture of a medicament for the treatment and/or prevention of dental caries.
In a further aspect of the present invention there is provided a method for treating and/or preventing dental erosion comprising contacting a lesion in tooth enamel caused by erosion with a composition including stabilized ACP and a source of fluoride ions.
In a further aspect of the present invention there is provided the use of stabilized ACP and a source of fluoride ions in the manufacture of a medicament for the treatment and/or prevention of dental erosion.
It will be clearly understood that, although this specification refers specifically to applications in humans, the invention is also useful for veterinary purposes. Thus in all aspects the invention is useful for domestic animals such as cattle, sheep, horses and poultry; for companion animals such as cats and dogs; and for zoo animals.



The invention will now be further described with reference to the following non-limiting examples and FIGURES.
In the FIGURES, Figure 1 shows representative microradiographs of enamel subsurface lesions after remineralization in situ and acid challenge (AC) in vitro.



EXAMPLE 1
A plaque fluoride study was conducted as a randomized, double-blind three-way crossover design involving three coded mouthrinses. The three mouthrinses were (i) 2% w/v CPP-ACP (RecaldenTM) as supplied by Recaldent Pty Ltd (Melbourne, Australia) and 450 ppm F as NaF in deionized water, (ii) 450 ppm F as NaF in deionized water, (iii) a placebo control rinse as deionized water. The CPP-ACP mouthrinse was adjusted to pH 7.0 with 1M HCl. Subjects were supplied with the coded rinses in opaque plastic tubes and used 15 ml of each rinse for 60 s three times a day, after breakfast, after lunch and at night before retiring, for four days and kept a diary of mouthrinse use. On the fifth day the rinse was used after breakfast and supragingival plaque was collected 2-3 hr later. Subjects refrained from all oral hygiene procedures while using the rinses. Each subject crossed over to use each mouthrinse with a four week washout period between treatments. Supragingival plaque was collected using a Gracey 7/8 curefte from the buccal and lingual surfaces of all teeth. Plaque was collected into a preweighed microcentrifuge tube, re-weighed and then stored at −70° C. After thawing of the plaque samples they were centrifuged for 5 min at 20,000 g, dried in a Jouan RC10.10 rotary evaporator and then re-weighed to determine dry weights. The dry samples were then extracted with 200 μl of 1M HCl by mixing in a vortex mixer for 1 min and then treated in ice water in a Bransonic 12 ultrasonic bath (Consolidated Ultrasonic, Melbourne, Australia) for 8 h. After centrifugation (20,000 g, 5 min) fluoride ion concentrations in the supernatant were determined as described previously (Silva and Reynolds, 1996). The plaque fluoride levels were statistically analyzed using a non-parametric Friedmans test with Wilcoxon Signed-Ranks tests (Norusis, 1993).
Both fluoride rinses produced an increase in plaque fluoride levels with the 450 ppm fluoride rinse nearly doubling the fluoride level obtained with the placebo control rinse (Table 2). The addition of 2% CPP-ACP to the 450 ppm fluoride rinse significantly increased the incorporation of fluoride ions into plaque where the plaque fluoride level was over double that obtained with the fluoride rinse. No significant difference was observed in the dry weights of plaque for the three rinses, however the dry weight of the plaque obtained with the 2% CPP-ACP plus 450 ppm fluoride rinse exhibited a tendency to be greater than that obtained with the other two rinses.







TABLE 2







Fluoride levels in supragingival plaque after treatment with various


mouthrinses










Plaque Fluoride Level
Dry Weight of Plaque


Mouthrinse
(nmol/mg dry wt)
(mg)





Placebo Control
 7.4 ± 4.7a, b
4.3 ± 2.5a


Fluoride (450 ppm)
14.4 ± 6.7a,b
3.9 ± 1.9a


2% CPP-ACP plus 450
33.0 ± 17.6a,b
5.0 ± 2.1a


ppm F





aMean ± SD (n = 14).


bSignificantly different from all values in same column (P < 0.001).






EXAMPLE 2
A remineralization study was conducted as a randomized, double-blind, 5-way crossover remineralization study with five toothpaste slurries using an in situ model previously described (Shen et al., 2001; Reynolds et al., 2003). Palatal appliances containing six human enamel half-slabs with subsurface demineralized lesions were prepared as described by Shen et al. (2001). Toothpastes were prepared as coded products and the base of the product consisted of sorbitol, silica, sodium lauryl sulphate, flavour, sodium carboxymethyl cellulose, titanium dioxide, xanthan gum, sodium saccharin and water. The pH of the formulation was adjusted to 7.0 with phosphoric acid. Five toothpaste formulations were prepared: (i) placebo, (ii) 1100 ppm fluoride as sodium fluoride, (iii) 2800 ppm fluoride as sodium fluoride, (iv) 2% CPP-ACP and (v) 2% CPP-ACP plus 1100 ppm fluoride as sodium fluoride. Toothpaste slurries were prepared by adding 1 g of paste to 4 ml deionized water and vortex mixing for 60 s. Subjects rinsed with the slurries for 60 s four times per day for 14 days at the following times: 10.00 am, 11.30 am, 2.00 pm and 3.30 pm. Subjects kept diaries of toothpaste slurry use and were instructed not to eat, drink or perform oral hygiene procedures while wearing the appliances. When the appliances were not in the mouth they were stored in a sealed moist plastic bag at room temperature. Subjects were instructed to rinse their appliances using deionized water. After the completion of each treatment the enamel half-slabs were removed from the appliances and prepared for acid challenge.
For the acid challenge of the remineralized lesions, the test enamel blocks were covered with acid-resistant nail varnish to leave only half of each remineralized window (1×3 mm2) exposed. The slabs were mounted onto the end of 3-4 cm sticks of dental wax and immersed in 40 ml of unagitated lactic/Carbopol demineralization buffer (Reynolds, 1997) for 8 hours at 37° C. After completion of this acid challenge the enamel slabs were rinsed with deionized water and sectioned through the midline of both windows to produce two blocks. These two enamel blocks containing remineralized lesions and acid challenged remineralized lesions were paired with their control block containing the original demineralized lesions and embedded, sectioned and microradiographed as described previously (Shen et al., 2001). Images of the lesions and the neighbouring sound enamel were scanned and the percent mineral profile of each lesion determined as described by Iijima et al. (2004). The difference between the areas under the densitometric profile of the original demineralized lesion and sound enamel, calculated by trapezoidal integration, is represented by Δzd. The difference between the areas under the densitometric profile of the remineralized lesion and sound enamel, calculated by trapezoidal integration, is represented by Δzr. Percentage remineralization (% R) represents the percentage change in ΔZ values eg




  
    %
    ⁢
    
      
    
    ⁢
    R
  
  -
  
    
      
        
          Δ
          ⁢
          
            
          
          ⁢
          Zd
        
        -
        
          Δ
          ⁢
          
            
          
          ⁢
          Xr
        
      
      
        Δ
        ⁢
        
          
        
        ⁢
        Zd
      
    
    ×
    100
  




(Ijima et al., 2004). Data were statistically analyzed using a repeated measures ANOVA with post hoc Scheffe test (Norusis, 1993).

All toothpaste formulations replaced mineral in the enamel subsurface lesions in the in situ study (Table 3). Fluoride produced a dose-response remineralization with the 2800 ppm replacing significantly more mineral than the 1100 ppm formulation which replaced significantly more than the placebo control. The toothpaste with 2% CPP-ACP produced a level of remineralization similar to the 2800 ppm fluoride formulation and the paste with 2% CPP-ACP plus 1100 ppm fluoride was superior to all other formulations including the 2800 ppm fluoride paste. Microradiography of the lesions after remineralization revealed that fluoride ion alone tended to promote remineralization of the surface layer whereas CPP-ACP promoted remineralization, even in the presence of fluoride, throughout the body of the lesion (Figure 1).
Acid challenge in vitro of the in situ remineralized enamel slabs resulted in substantial loss of mineral from the placebo-treated enamel slabs. A smaller amount of mineral was lost from the lesions remineralized with 2% CPP-ACP upon acid challenge. Although there was a tendency to lose a small amount of mineral from the enamel treated with the fluoride formulations the loss was not statistically significant. The residual remineralization after acid challenge was significantly greater for the paste containing 2% CPP-ACP plus 1100 ppm fluoride when compared with the residual remineralization obtained with all other pastes including the paste containing 2800 ppm fluoride. Microradiography of the remineralized lesions after acid challenge revealed that the acid removed mineral predominantly from underneath the remineralized zone.
This in situ study showed a clear dose response in enamel subsurface lesion remineralization by fluoride, with 8.2±0.2% remineralization by the toothpaste containing 1100 ppm F− and 15.5±2.4% by that containing 2800 ppm F−. It also revealed that the paste containing 2% CPP-ACP was superior in remineralizing enamel subsurface lesions when compared with the paste containing 1100 ppm F− and was not significantly different to the paste containing 2800 pm F. The paste containing 2% CPP-ACP plus 1100 ppm F− produced greater remineralization than the paste containing 2800 ppm F−. Addition of 2% CPP-ACP to 1100 ppm F− increased enamel subsurface remineralization by 156% relative to the 1100 ppm F− paste.
The casein phosphopeptides (CPP) have been shown to not only stabilize amorphous calcium phosphate (ACP), but also to deliver and localize ACP at the tooth surface (Reynolds, 1998; Reynolds et al., 1999; Reynolds et al., 2003). CPP-ACP in a mouthwash significantly increased the level of calcium and inorganic phosphate ions in supragingival plaque with the CPP bound to salivary pellicle and to the surface of bacteria in the supragingival plaque biofilm (Reynolds et al., 2003). This clinical trial demonstrated that CPP-ACP can also promote the uptake of fluoride ions into plaque. Therefore CPP-ACP should promote the uptake of calcium, phosphate and fluoride ions into supragingival plaque when added to a fluoride-containing toothpaste formulation. The present in situ study demonstrated that CPP-ACP delivered in a toothpaste formulation was very effective in enamel subsurface remineralization, and that the mineral formed was more resistant to acid than natural enamel apatite. Enamel remineralized by CPP-ACP in the presence of fluoride showed greater resistance to acid challenge relative to natural enamel or enamel remineralized by CPP-ACP. This suggests that CPP-ACP in the presence of F− ions promotes remineralization with acid-resistant fluorapatite. These results demonstrate that addition of CPP-ACP, to a toothpaste formulation significantly enhances the ability of fluoride to remineralize enamel subsurface lesions with acid resistant fluorapatite.







TABLE 3







Percentage remineralization of enamel subsurface lesions by various toothpaste formulations


followed by acid challenge

















2% CPP-ACP plus



Placebo control
1100 ppm fluoride
2800 ppm fluoride
2% CPP-ACP
1100 ppm fluoride
















Initial lesion depth (μm)
  105 ± 7a
106 ± 9  
102 ± 7 
  107 ± 8
104 ± 8  


ΔZd (vol % min. μm)
4,489 ± 2,465
3,544 ± 1,432 
3,704 ± 1,278
4,287 ± 2,282
4,382 ± 1,714 


ΔZd-ΔZr
  138 ± 122d
290 ± 136d
576 ± 222
  580 ± 311
919 ± 462d


% Rb
 3.1 ± 1.6e
8.2 ± 2.0e
15.5 ± 2.4 
 13.5 ± 1.5
21.0 ± 5.9e 


% RcAC
 −4.1 ± 1.6f,g
7.1 ± 1.3f
13.2 ± 1.1f
 8.7 ± 1.5f,g
17.4 ± 1.2f 





aMean ± SD (n = 14).


b% R = ΔZd-ΔZr/ΔZd × 100 (Shen et al., 2001).


cRAC = % R after acid challenge.


dsignificantly different from all other values in row (P < 0.01).


esignificantly different from all other values in row (P < 0.01).


fsignificantly different from all other values in row (P < 0.01).


gsignificantly different from % R value in same column (P < 0.01).






EXAMPLE 3
Electron microprobe wavelength dispersive spectrometry was used to measure fluoride levels in remineralized lesions as follows.
Enamel sections were embedded in epoxy resin on a one inch specimen holder. The resin was flat polished to expose the enamel sections using 2400 grit abrasive paper. To achieve optical smoothness 3 μm and 1 μm diamond polishing pastes were used on a cloth pad with final finishing accomplished with a 0.25 μm aluminium oxide paste. All samples and standards were coated with 20 nm of carbon using a Dynavac 300. The electron probe (8900R SuperProbe JEOL, Japan) was operated at a 15 kV accelerating voltage, 12 nA specimen current, 400 take-off angle. Dwell times of 10 seconds for the peak and 10 seconds for the background per point were used. The detection limit for F was 800 ppm. The beam diameter employed during collection of standards was a 10 μm spot whereas the diameter for analysis of lesions was 2 μm. Calcium, phosphorous, fluoride, and chloride X-ray intensities were measured simultaneously using four spectrometers with filter crystals of Pentaerythritol, Pentaerythritol, W/Si layered synthetic, Pentaerythritol, respectively. The standard was analysed using a 10 μm (defocused) and 2 μm (focused) diameter beam to calibrate the X ray count intensity. The standard was synthetic fluorapatite with a calcium to phosphorous ratio of 1.667 and a fluoride content of 3.70 wt %. Elemental maps and quantitative line scans for calcium, phosphorous, fluoride, oxygen and chlorine were collected across the lesions starting from the base of the lesion to the surface layer. Data was corrected using a Phi(RhoZ)-Parabolic method correction procedure implemented in STRATA (Thin Film Analysis Package).
Microradiography of the remineralized lesions after acid challenge revealed that the acid removed mineral predominantly from underneath the remineralized zone. The fluoride level of the remineralized lesions for the placebo, 1100 ppmF and 2% CPP-ACP plus 1100 ppmF pastes was determined using electron microprobe wavelength dispersive spectrometry (Table 4). The fluoride incorporated into the lesion was significantly higher for the 2% CPP-ACP plus 1100 ppmF paste when compared with the 1100 ppmF paste (Table 4). Further, the measured fluoride levels for the 2% CPP-ACP plus 1100 ppmF paste was close to that predicted assuming the remineralized mineral was fluorapatite (Table 4).







TABLE 4







Predicted and measured fluoride levels in the remineralized lesions











Remineralization level
Predicteda
Measuredb


Toothpaste
(vol % min)
F (wt %)
F (wt %)





Placebo
1.31
0.05
0.05 ± 0.05c


1100 ppmF
2.74
0.10
0.23 ± 0.09c


CPP-ACP 2% plus
8.84
0.33
0.30 ± 0.13c


1100 ppm F





aPredicted F level based on remineralized mineral being fluorapatite (3.768 wt % F)


bMeasured using electron microprobe wavelength dispersive spectrometry with a JEOL 8900 SuperProbe microprobe. Mean level of fluoride measured by line scans from the base of the lesion to the surface layer.


cSignificantly different from other values in same column (p < 0.01).






EXAMPLE 4
A topical crème may be produced in accordance with the present invention having the following ingredients:

    
    
        Water
        glycerol
        CPP-ACP complexes
        D-sorbitol
        sodium carboxymethylcellulose (CMC-Na)
        propylene glycol
        silicon dioxide
        titanium dioxide
        xylitol
        phosphoric acid
        sodium fluoride
        flavouring
        sodium saccharin
        ethyl p-hydroxybenzoate
        propyl p-hydroxybenzoate
        butyl p-hydroxybenzoate
    
    


EXAMPLE 5
A mouthrinse formulation be produced in accordance with the present invention having the following composition:

    
    
        Water
        Alcohol
        Poloxamer 407
        Sodium Lauryl Sulphate
        CPP-ACP complexes
        Sodium Fluoride
        Flavours
        Sodium Saccharin
        Ethyl p-Hydroxybenzoate
        Propyl p-hydroxybenzoate
        Butyl p-hydroxybenzoate
    
    


EXAMPLE 6
A sugar-free chewing gum formulation be produced in accordance with the present invention having the following composition:

    
    
        Crystalline sorbitol/mannitol/xylitol
        Gum base
        Calcium carbonate
        Glycerine
        CPP-ACP complexes
        Sodium Fluoride
        Flavour oil
        Water
    
    


It will be understood that the invention disclosed and defined in this specification extends to all alternative combinations of two or more of the individual features mentioned or evident from the text or drawings. All of these different combinations constitute various alternative aspects of the invention.
REFERENCES


    Biesbrock A R, Faller R V, Bartizek R D, Court L K, McClanahan S F (1998). Reversal of incipient and radiographic caries through the use of sodium and stannous fluoride dentifrices in a clinical trial. J Clin Dent 9:5-10.
    Biesbrock A R, Gerlach R W, Bollmer B W, Faller R V, Jacobs S A, Bartizek R D (2001). Relative anti-caries efficacy of 1100, 1700, 2200, and 2800 ppm fluoride ion in a sodium fluoride dentifrice over 1 year. Community Dent Oral Epidemiol 29:382-389.
    Biesbrock A R, Bartizek R D, Gerlach R W, Jacobs S A, Archila L (2003). Dose response efficacy of sodium fluoride dentifrice at 9 and 21 months with supervised brushing. Am J Dent 16:305-312.
    Cross K J, Huq N L, Palamara J E, Perich, J W, Reynolds E C (2005). Physicochemical characterization of casein phosphopeptide-amorphous calcium phosphate nanocomplexes. J Biol Chem 280:15362-15369.
    Curnow M M, Pine C M, Burnside G, Nicholson J A, Chesters R K, Huntington E (2002). A randomised controlled trial of the efficacy of supervised toothbrushing in high-caries-risk children. Caries Res 36:294-300.
    Davies G M, Worthington H V, Ellwood R P, Bentley E M, Blinkhorn A S, Taylor G O, et al. (2002). A randomised controlled trial of the effectiveness of providing free fluoride toothpaste from the age of 12 months on reducing caries in 5-6 year old children. Community Dent Health 19:131-136.
    Duckworth R M, Morgan S N, Gilbert R J (1992). Oral fluoride measurements for estimation of the anti-caries efficacy of fluoride treatments. J Dent Res 71 Spec No: 836-840.
    Duckworth R M, Stewart D (1994). Effect of mouthwashes of variable NaF concentration but constant NaF content on oral fluoride retention. Caries Res 28:43-47.
    Hartshorne J E, Grobler S R, Louw A J, Carstens I L, Laubscher J A (1994). The relationship between plaque index scores, fluoride content of plaque, plaque pH, dental caries experience and fluoride concentration in drinking water in a group of primary school children. J Dent Assoc S Afr 49:5-10.
    Iijima Y, Cai F, Shen P, Walker G, Reynolds C, Reynolds E C (2004). Acid resistance of enamel subsurface lesions remineralized by a sugar-free chewing gum containing casein phosphopeptide-amorphous calcium phosphate. Caries Res 38:551-6.
    Lynch R J, Navada R, Walia R (2004). Low-levels of fluoride in plaque and saliva and their effects on the demineralisation and remineralisation of enamel; role of fluoride toothpastes. Int Dent J:304-309.
    Norusis M (1993). SPSS for Windows: Base System User's Guide, Release 6.0 Illinois, USA: SPSS INC.
    Reynolds E C, Cain C J, Webber F L, Black C L, Riley P F, Johnson I H, et al. (1995). Anticariogenicity of calcium phosphate complexes of tryptic casein phosphopeptides in the rat. J Dent Res 74:1272-1279.
    Reynolds E C (1997). Remineralization of enamel subsurface lesions by casein phosphopeptide-stabilized calcium phosphate solutions. J Dent Res 76:1587-1595.
    Reynolds E C (1998). Anticariogenic complexes of amorphous calcium phosphate stabilised by casein phosphopeptides. Invited review. Spec Care Dentist 18:8-16.
    Reynolds E C, Black C L, Cai F, Cross K J, Eakins D, Huq N L, et al. (1999). Advances in enamel remineralization: casein phosphopeptide-amorphous calcium phosphate. J Clin Dent X:86-88.
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## Claims

1. A method of mineralizing a dental surface or subsurface comprising providing a composition to contact the dental surface or subsurface, wherein the composition, prior to contacting the dental surface or subsurface, comprises (i) about 2% by weight casein phosphopeptide-stabilized amorphous calcium phosphate or casein phosphopeptide-stabilized amorphous calcium fluoride phosphate, and, separately, (ii) free fluoride ions in an amount of from at least 400 ppm to about 3,000 ppm.

2. A method according to claim 1, wherein the composition is selected from the group consisting of toothpaste; tooth gel; tooth powder; dental creme; liquid dentifrice; mouthwash; troche; chewing gum; gingival massage creme; gargle tablet and dental restorative.

3. A method according to claim 1, wherein the composition comprises sodium fluoride.

4. A method for remineralizing a subsurface enamel lesion comprising providing a composition to contact the subsurface enamel lesion, wherein the composition, prior to contacting the subsurface enamel lesion, comprises (i) about 2% by weight casein phosphopeptide-stabilized amorphous calcium phosphate or casein phosphopeptide-stabilized amorphous calcium fluoride phosphate, and, separately, (ii) free fluoride ions in an amount of from at least 400 ppm to about 3,000 ppm.

5. A method according to claim 4, wherein the composition is selected from the groups consisting of toothpaste; tooth gel; tooth powder; dental creme; liquid dentifrice; mouthwash; troche; chewing gum; gingival massage creme; gargle tablet and dental restorative.

6. A method of treating and/or preventing dental caries in tooth enamel comprising providing a composition to contact the tooth enamel, wherein the composition, prior to contacting the tooth enamel, comprises (i) about 2% by weight casein phosphopeptide-stabilized amorphous calcium phosphate or casein phosphopeptide-stabilized amorphous calcium fluoride phosphate, and, separately, (ii) free fluoride ions in an amount of from at least 400 ppm to about 3,000 ppm.

7. A method of increasing fluoride uptake into a dental surface or subsurface from an oral composition, the method comprising incorporating about 2% by weight casein phosphopeptide-stabilized amorphous calcium phosphate or casein phosphopeptide-stabilized amorphous calcium fluoride phosphate into the oral composition prior to treatment of the dental surface or subsurface, wherein the oral composition separately comprises free fluoride ions in an amount of from at least 400 ppm to about 3,000 ppm.

8. A method of increasing the dental remineralization efficacy of an oral composition, the method comprising incorporating about 2% by weight casein phosphopeptide-stabilized amorphous calcium phosphate or casein phosphopeptide-stabilized amorphous calcium fluoride phosphate into the oral composition prior to treatment of the dental surface or subsurface, wherein the oral composition separately comprises free fluoride ions in an amount of from at least 400 ppm to about 3,000 ppm.

9. A method of increasing fluoride uptake into a dental surface or subsurface from an oral composition, the method comprising incorporating about 2% by weight casein phosphopeptide-stabilized amorphous calcium phosphate or casein phosphopeptide-stabilized amorphous calcium fluoride phosphate into the oral composition prior to treatment of the plaque, wherein the oral composition separately comprises free fluoride ions in an amount of from at least 400 ppm to about 3,000 ppm.

10. A method according to claim 1, wherein the dental surface or subsurface is tooth enamel.

11. A method according to claim 1, wherein the dental subsurface is a subsurface enamel lesion.

12. A method according to claim 4, wherein the composition comprises sodium fluoride.

13. A method of mineralizing a dental surface or subsurface according to claim 3, wherein the composition further comprises a dentally acceptable polishing material and a surfactant prior to contacting the dental surface or subsurface, wherein the composition does not contain a calcium chelator or a phosphate buffer.

14. A method of increasing the dental remineralization efficacy of an oral composition containing about 2% by weight casein phosphopeptide-stabilized amorphous calcium phosphate or casein phosphopeptide-stabilized amorphous calcium fluoride phosphate, the method comprising separately incorporating free fluoride ions in an amount of from at least 400 ppm to about 3,000 ppm free fluoride ions into the oral composition prior to treatment of a dental surface or subsurface.

15. A method for manufacturing a composition for mineralizing a dental surface or subsurface comprising preparing a composition comprising (i) about 2% by weight casein phosphopeptide-stabilized amorphous calcium phosphate or casein phosphopeptide-stabilized amorphous calcium fluoride phosphate, and, separately, (ii) free fluoride ions in an amount of from at least 400 ppm to about 3,000 ppm.

16. The method according to claim 15, wherein the composition comprises sodium fluoride.

17. The method according to claim 6, wherein the composition comprises sodium fluoride.

18. The method according to claim 14, wherein the composition comprises sodium fluoride.

19. A method according to claim 1, wherein the free fluoride ions are provided by sodium fluoride, stannous fluoride, amine fluoride and combinations thereof.

20. A method according to claim 1, wherein the composition comprises free fluoride ions in a range of about 400 ppm to 1500 ppm.

21. A method according to claim 1, wherein the composition comprises about 900 ppm free fluoride.

22. A method according to claim 4, wherein the composition comprises free fluoride ions in a range of about 400 ppm to 1500 ppm.

23. A method according to claim 4, wherein the composition comprises about 900 ppm free fluoride.

24. A method according to claim 6, wherein the composition comprises free fluoride ions in a range of about 400 ppm to 1500 ppm.

25. A method according to claim 6, wherein the composition comprises about 900 ppm free fluoride.