Hydroxyapatite Toothpaste Matches Fluoride in Short-Term Studies

Two recent studies found that toothpaste containing hydroxyapatite prevented tooth decay as effectively as traditional fluoride toothpaste. The findings offer data to patients who are increasingly asking their dentists about fluoride-free alternatives.

Hydroxyapatite is a calcium phosphate mineral naturally found in tooth enamel. It has gained popularity on social media, where influencers promote products claiming to whiten teeth and reduce sensitivity without using fluoride. Dr. Jin-Ho Phark, an associate professor of clinical dentistry at the University of Southern California, notes that patient interest has grown steadily.

"There's a lot of interest from the patients," Phark says. "I hear that also regularly from students."

The push for fluoride-free products follows public skepticism regarding the mineral. Health Secretary Robert F. Kennedy Jr. has linked water fluoridation to various health issues, including bone fractures and neurodevelopmental disorders. While health agencies generally consider low levels of fluoride safe and effective for cavity prevention, this debate has opened the market for competing ingredients.

Researchers have begun comparing the two approaches. A 2021 study in Scientific Reports tracked 177 children for nearly one year. Another study published in 2023 in Frontiers in Public Health followed 171 adults for 18 months. Both studies reported similar outcomes for tooth decay between the hydroxyapatite group and the fluoride group.

However, the studies had limitations. The participants in the adult study were mostly healthy young adults with low risk for tooth decay. Both studies received funding from the Dr. Wolff Group, a German company that manufactures hydroxyapatite toothpaste brands. Dr. Livia Tenuta, an associate professor at the University of Michigan School of Dentistry, points out that long-term data for high-risk patients remains scarce.

"There are very few studies and they recruited participants of low caries risk," Tenuta says. She advises that fluoride remains the best option because of the extensive body of evidence supporting its efficacy. Bennett Amaechi, a professor of dentistry at the University of Texas at San Antonio, agrees that fluoride is the standard recommendation due to its proven track record in long-term studies.

The American Dental Association acknowledges that hydroxyapatite products are becoming more common. In an email, ADA Consumer Advisor spokesperson Dr. Ada Cooper stated that evidence for the ingredient is new and remains limited. The organization continues to recommend brushing twice daily for two minutes with fluoride toothpaste and flossing daily.