New toothpaste claims rival fluoride
Hydroxyapatite is gaining traction as a fluoride-free alternative, but experts say the long-term evidence is still thin.
By Thomas Obasi ·
A growing number of patients are asking dentists about fluoride-free toothpaste, driven by social media marketing and political skepticism about the mineral. The primary alternative gaining attention is hydroxyapatite, a calcium phosphate mineral that mimics the composition of tooth enamel.
Dr. Jin-Ho Phark, an associate professor of clinical dentistry at the University of Southern California, notes that inquiries have increased recently. He attributes the trend to influencers promoting these products online. The shift reflects a broader hesitancy among consumers, particularly parents, who are wary of fluoride after Health Secretary Robert F. Kennedy Jr. linked water fluoridation to conditions ranging from arthritis to neurodevelopmental disorders.
The debate centers on efficacy. Traditional fluoride toothpaste has been the standard since Procter & Gamble released Crest in the late 1950s. The Centers for Disease Control and Prevention states that adding fluoride to public water reduces cavities by 25 percent. Fluoride works by remineralizing teeth, creating a protective layer against the acids produced by bacteria that feed on sugar.
Hydroxyapatite is thought to work differently. Products often use nano-hydroxyapatite, which consists of smaller particles designed to penetrate the pores of enamel. Proponents claim it offers similar benefits, including cavity protection and whitening, without the presence of fluoride.
Bennett Amaechi, a professor of dentistry at the University of Texas at San Antonio, says early research is positive. He co-authored a 2021 study in Scientific Reports that tracked 177 children for nearly a year. The study found that hydroxyapatite toothpaste performed similarly to fluoride in preventing tooth decay. A follow-up study in Frontiers in Public Health in 2023 yielded similar results for 171 adults over 18 months. However, both studies received funding from Dr. Wolff Group, a German manufacturer of hydroxyapatite products.
Experts caution that the evidence base is not yet equivalent to that of fluoride. Dr. Livia Tenuta, an associate professor at the University of Michigan School of Dentistry, points out that most participants in these trials were healthy adults with a low risk of cavities. She says there are very few studies involving individuals with high caries risk or long-term data. The American Dental Association acknowledges that some evidence supports hydroxyapatite for remineralization but describes the clinical effectiveness as limited and ambiguous.
Until more data is available, major dental organizations continue to recommend fluoride. The ADA advises brushing twice daily for two minutes with fluoride toothpaste and flossing daily. Hydroxyapatite products are typically more expensive, often costing over a dollar more per ounce than their fluoride counterparts.
