Hydroxyapatite Toothpaste Matches Fluoride in Limited Studies, But Dentists Prefer the Traditional Option
New products using calcium phosphate minerals are gaining popularity, yet experts say fluoride remains the gold standard for cavity prevention due to decades of data.
By Jonathan Hoffmann ·
Fluoride-free toothpastes featuring hydroxyapatite are challenging the dominance of traditional oral care products, creating a divide between consumer trends and clinical recommendations. While early data suggests the new ingredient can protect teeth just as well as fluoride, dental professionals generally advise sticking to the conventional choice due to the depth of existing research.
Interest in hydroxyapatite, a calcium phosphate mineral, has surged as patients and dental students ask about it more frequently. Dr. Jin-Ho Phark, an associate professor of clinical dentistry at the University of Southern California, notes that many patients encounter these products through social media influencers. The shift comes as some consumers grow hesitant about fluoride, a mineral that has been a standard in toothpaste since the late 1950s.
The skepticism toward fluoride has been fueled by public health debates. Health Secretary Robert F. Kennedy Jr. has linked water fluoridation to various health issues, including bone problems and neurodevelopmental disorders. While experts like Dr. Bennett Amaechi of the University of Texas at San Antonio state there is no concrete evidence of harm to children's IQ at standard levels, the controversy has opened the door for alternatives. The Centers for Disease Control and Prevention previously identified water fluoridation as a top public health achievement, noting it reduces cavities by 25%.
Hydroxyapatite mimics the composition of tooth enamel, which is primarily made of calcium and phosphate. Dr. Livia Tenuta, a dental professor at the University of Michigan, explains that fluoride works by remineralizing teeth left after brushing. Hydroxyapatite products, often in nano-sized particles, are designed to penetrate tiny crevices in enamel to provide similar protection. Both ingredients help shield teeth from the acids produced by bacteria that feed on sugar.
Clinical trials offer mixed but encouraging results for the new ingredient. A 2021 study in Scientific Reports followed 177 children for nearly a year and found similar decay rates between groups using hydroxyapatite and fluoride. A 2023 study in Frontiers in Public Health tracked 171 adults over 18 months with comparable outcomes. However, researchers noted that the participants in the adult study were mostly healthy young adults with low caries risk.
Dr. Tenuta emphasizes the need for more long-term data, particularly for individuals at high risk of tooth decay. A 2019 study involving 133 people at higher risk found both types of toothpaste performed similarly after five months. Despite these findings, the American Dental Association states that evidence for hydroxyapatite remains limited. Dr. Ada Cooper, a spokesperson for the association, said in an email that while the ingredient shows promise for remineralization, its clinical effectiveness is not yet fully established.
For now, most dentists recommend fluoride. Dr. Amaechi advises patients to use fluoride because it has more evidence supporting its efficacy. He and Dr. Tenuta agree that while hydroxyapatite is a viable option, fluoride remains the best choice for the majority of people. Hydroxyapatite toothpastes often cost more than their fluoride counterparts, with some products priced over a dollar more per ounce. The standard recommendation remains brushing twice daily for two minutes, flossing, and regular dental visits.
