Hydroxyapatite toothpaste rivals fluoride in short-term trials

Dental experts say early evidence indicates hydroxyapatite toothpaste performs comparably to fluoride in preventing tooth decay, though the research base remains smaller.

Interest in fluoride-free options has grown as patients ask dentists about calcium phosphate minerals, particularly hydroxyapatite. Dr. Jin-Ho Phark, an associate professor of clinical dentistry at the University of Southern California, notes that patients frequently request these products, often after seeing them promoted on social media.

Fluoride toothpaste became common in the late 1950s when Procter & Gamble released Crest. The Centers for Disease Control and Prevention state that fluoride in water reduces cavities by 25%. Despite this history, skepticism persists. Health Secretary Robert F. Kennedy Jr. has linked water fluoridation to various health issues, including arthritis and thyroid disease, contributing to public hesitation.

Hydroxyapatite works differently than fluoride. While fluoride helps remineralize teeth by forming a protective compound, hydroxyapatite products, often using nano-sized particles, are thought to penetrate tiny crevices in tooth enamel. Bennett Amaechi, a professor of dentistry at the University of Texas at San Antonio, states that for remineralization and preventing caries, hydroxyapatite is as effective as fluoride in current studies.

A 2021 study in Scientific Reports tracked 177 children for nearly a year and found similar decay outcomes between hydroxyapatite and fluoride users. That research received funding from Dr. Wolff Group, a German company that manufactures hydroxyapatite toothpastes. A subsequent 2023 study in Frontiers in Public Health followed 171 healthy young adults for 18 months and reported similar results. However, Dr. Livia Tenuta, an associate professor at the University of Michigan School of Dentistry, notes that most studies recruit participants with low caries risk.

A 2019 study in the Journal of Investigative and Clinical Dentistry examined 133 people at higher risk for caries. After five months, both toothpaste types performed similarly. Despite these findings, the American Dental Association describes the evidence for hydroxyapatite as limited and ambiguous. ADA spokesperson Dr. Ada Cooper wrote that the organization acknowledges the growing use of these products but maintains its recommendation for fluoride.

Hydroxyapatite toothpastes often cost more than one dollar per ounce more than fluoride alternatives. Amaechi advises patients open to both options to use fluoride because of the extensive long-term evidence supporting its efficacy. Tenuta agrees, recommending fluoride as the best option due to the depth of available research.