Hydroxyapatite toothpaste matches fluoride in short-term trials

Oral hygiene routines are shifting as consumers seek alternatives to standard fluoride products.

Dentists are reporting a surge in patient inquiries about toothpastes containing hydroxyapatite, a calcium phosphate mineral. Dr. Jin-Ho Phark, an associate professor of clinical dentistry at the University of Southern California, notes that this interest is driven largely by social media influencers. "There's a lot of interest from the patients," Phark says.

Hydroxyapatite mimics the mineral composition of tooth enamel. Proponents claim it offers cavity protection and whitening benefits without fluoride. This appeal comes amid growing public hesitation toward fluoride, a mineral that has been a standard in oral care since Crest launched nationally in the late 1950s.

Public Health Secretary Robert F. Kennedy Jr. has recently linked water fluoridation to various health issues, including bone cancer and thyroid disease. While the Centers for Disease Control and Prevention state that fluoride in water reduces cavities by 25%, some experts note that skepticism is now influencing toothpaste choices.

Bennett Amaechi, a dentistry professor at the University of Texas at San Antonio, states that early research suggests hydroxyapatite is effective for remineralization. "When it comes to remineralization and preventing caries manifestation, it is as effective as fluoride," Amaechi says.

A 2021 study in Scientific Reports followed 177 children for one year and found similar decay outcomes in both groups. A 2023 study in Frontiers in Public Health tracked 171 adults for 18 months with comparable results. Both studies received funding from Dr. Wolff Group, a German company that produces hydroxyapatite toothpastes.

However, Dr. Livia Tenuta, a dental professor at the University of Michigan, cautions that the existing data is limited. "There are very few studies and they recruited participants of low caries risk," Tenuta says. A 2019 study involving 133 high-risk patients also found similar performance, but the duration was only five months.

Hydroxyapatite pastes typically cost more than a dollar per ounce more than fluoride options. The American Dental Association acknowledges that hydroxyapatite may contribute to remineralization but describes the clinical evidence as limited and ambiguous. Dr. Ada Cooper, an ADA consumer advisor, notes that the organization still recommends brushing twice daily with fluoride toothpaste.