Evaluation of Remineralizing Effects of CPP-ACP and Nanohydroxyapatite on Erosive Lesions of Enamel in Deciduous Teeth After Exposure to Acetaminophen Syrup: An in vitro Study

Fateme Hadidi1, Roza Haghgoo1, Somaye Kameli1, Motahare Ahmadvand1, *
1 Department of Pediatric Dentistry, Faculty of Dentistry, Shahed University, Tehran, Iran

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© 2022 Hadidi et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Pediatric Dentistry, Faculty of Dentistry, Shahed University, Tehran, Iran; Tel: 00989125391573; E-mail:



Oral pediatric liquid medications are commonly used in children who suffer from chronic diseases. Due to acid components in their formulations, these medications may possess a high erosive potential to dental tissues. Erosion is one of the major causes of degradation and demineralization of the enamel. If demineralization causes are not inhibited, it progresses and completely degrades the enamel. So, the dentin is exposed, and, finally, the pulp will be engaged in the process.


This study aimed to evaluate the remineralizing properties of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and nanohydroxyapatite on erosive lesions caused by acetaminophen syrup intake in vitro.


The microhardness of 34 healthy human primary molars was determined prior to and following a seven-day, three-times-a-day, one-minute exposure to acetaminophen syrup. The teeth were then randomly divided into four groups and were immersed in artificial saliva, fluoride gel, nano-hydroxyapatite, and CPP-ACP for 10 minutes. Then, their final microhardness was measured, and repeated-measures ANOVA analyzed the data.


Enamel microhardness in two groups decreased after exposure to acetaminophen syrup and increased after applying remineralization agents, CPP-ACP, and nano-hydroxyapatite. The two groups did not show significant differences in terms of microhardness increase (p-value=0.141).


According to the findings of this study, CPP-ACP and nano-hydroxyapatite can improve the microhardness of enamel, which has been reduced as a result of exposure to medicinal syrups.

Keywords: Deciduous teeth, Demineralization, Nanohydroxyapatite, CPP-ACP, Acetaminophen syrup, Microhardness, Dental enamel, Tooth remineralization.