New toothpaste ingredient promises same protection as fluoride
Dentists say hydroxyapatite products are gaining popularity, but clinical data remains limited compared to decades of research on traditional formulations.
By Kevin Iyer ·
Hydroxyapatite toothpaste is becoming a popular alternative for consumers who want to avoid fluoride while still protecting their enamel from cavities. Dr. Jin-Ho Phark, an associate professor of clinical dentistry at the University of Southern California, says he regularly hears patients asking about these fluoride-free options. Many of these inquiries stem from social media marketing where influencers heavily promote the products.
The shift away from fluoride is partly driven by public skepticism regarding the mineral. Health Secretary Robert F. Kennedy Jr. has linked water fluoridation to various health issues, including arthritis, bone fractures, and neurodevelopmental disorders. This criticism has created a market for toothpastes that use calcium phosphate minerals instead. Traditional fluoride toothpaste became common in the late 1950s after Procter & Gamble released Crest nationally.
Hydroxyapatite is a mineral naturally found in tooth enamel. Enamel is composed primarily of calcium and phosphate, which protect the inner layers of the tooth from damage caused by acids produced by bacteria. These bacteria feed on sugars in the mouth. When fluoride is present in saliva after brushing, it helps bring minerals back to the tooth surface to strengthen it. Hydroxyapatite works differently by filling tiny crevices in the enamel with its own particles.
Bennett Amaechi, a professor of dentistry at the University of Texas at San Antonio, notes that while fluoride has extensive long-term research behind it, early studies on hydroxyapatite show positive results. He states that for remineralization and preventing decay, hydroxyapatite is as effective as fluoride. However, he acknowledges that the body of evidence for the newer ingredient is still growing.
A 2021 study published in Scientific Reports followed 177 children for nearly a year. The researchers compared tooth decay in groups using hydroxyapatite toothpaste versus fluoride toothpaste. Both groups showed similar outcomes in terms of decay rates. This study was funded by Dr. Wolff Group, a German company that owns two brands making hydroxyapatite products.
In 2023, another study appeared in Frontiers in Public Health. It tracked 171 adults for 18 months and compared the two types of toothpaste. The results again showed similar outcomes between the groups. The participants in this study were mostly healthy young adults with no severe oral health issues. The Dr. Wolff Group also provided funding for this research.
Dr. Livia Tenuta, an associate professor at the University of Michigan School of Dentistry, points out that most existing studies focus on people with a low risk of tooth decay. She says there is a need for more long-term studies, particularly with patients who are at high risk for cavities. A 2019 study in the Journal of Investigative and Clinical Dentistry did look at 133 people with higher caries risk. After five months, the researchers found that both toothpaste types performed similarly.
Cost is a practical consideration for consumers. Hydroxyapatite toothpastes are generally more expensive than fluoride versions, often costing more than a dollar per ounce more. Despite the promising early data, many dental professionals still recommend fluoride as the primary choice due to the depth of existing evidence.
The American Dental Association states that while some evidence suggests hydroxyapatite can contribute to remineralization, the clinical effectiveness remains limited and ambiguous. Dr. Ada Cooper, the ADA Consumer Advisor, wrote that the research is new. The organization continues to recommend brushing twice daily for two minutes with fluoride toothpaste, flossing daily, and visiting a dentist regularly.
