Dentists say fluoride remains the better choice as hydroxyapatite gains popularity
While early studies show promise for the alternative ingredient, experts note that fluoride has decades more data supporting its effectiveness.
By Javier Sanders ·
Hydroxyapatite toothpastes are gaining market share, but most dental experts still recommend fluoride.
The shift toward these fluoride-free products began in the late 1950s when Procter & Gamble released Crest nationally. Over the following decades, fluoride became the standard active ingredient in oral care products worldwide. These products protect the outer layer of teeth from cavity-causing bacteria.
Interest in alternatives has grown recently. Dr. Jin-Ho Phark, an associate professor at the University of Southern California, reports that patients and students frequently ask about hydroxyapatite. He attributes much of the interest to social media influencers promoting these products.
Health Secretary Robert F. Kennedy Jr. has fueled public skepticism by linking fluoridated water to various health issues, including arthritis and neurodevelopmental disorders. While the Centers for Disease Control and Prevention note that fluoride in water reduces cavities by 25%, some consumers remain hesitant. This hesitation has created space for hydroxyapatite-based products.
Hydroxyapatite is a mineral similar to the composition of tooth enamel. Researchers believe nano-hydroxyapatite particles can penetrate tiny crevices in enamel to help with remineralization. A 2021 study in Scientific Reports followed 177 children for nearly a year and found that hydroxyapatite toothpaste performed similarly to fluoride in preventing tooth decay. A 2023 study in Frontiers in Public Health tracked 171 adults over 18 months and reached a similar conclusion.
Dr. Bennett Amaechi, a professor at the University of Texas at San Antonio, authored the 2021 study. He notes that while early research is positive, fluoride remains the more extensively researched option. He states that hydroxyapatite is as effective as fluoride for remineralization and preventing caries manifestation.
Dr. Livia Tenuta, an associate professor at the University of Michigan, cautions that most studies have focused on participants with low caries risk. She wants to see more long-term data on individuals with higher decay risks. A 2019 study in the Journal of Investigative and Clinical Dentistry did test 133 higher-risk patients and found both types of toothpaste performed similarly after five months.
Hydroxyapatite toothpastes often cost more than fluoride options, with some brands charging over a dollar more per ounce. The American Dental Association advises brushing twice daily for two minutes with fluoride toothpaste. Spokesperson Dr. Ada Cooper noted that while evidence for hydroxyapatite is emerging, it remains limited and ambiguous.
