Hydroxyapatite Toothpaste Rises in Popularity as Fluoride Debate Heats Up

Patients are increasingly asking their dentists about fluoride-free toothpaste, driven by a growing skepticism toward the mineral and a push from social media influencers. Dr. Jin-Ho Phark, an associate professor of clinical dentistry at the University of Southern California, notes that the interest is constant. He hears the same questions from his students as well as his clinical patients.

The product fueling this curiosity is hydroxyapatite, a calcium phosphate mineral. It mimics the composition of tooth enamel, which is primarily made of calcium and phosphate. Proponents claim the ingredient offers cavity protection, whitening, and enamel strengthening without the use of fluoride.

Fluoride has been a standard in oral care since Procter & Gamble released Crest nationally in the late 1950s. The Centers for Disease Control and Prevention identifies fluoride as a key factor in preventing cavities. The agency states that adding fluoride to public drinking water reduces cavities by 25% and lists the practice as one of the top ten public health achievements of the 20th century.

However, public opinion is shifting. Health Secretary Robert F. Kennedy Jr. has blamed water fluoridation for various health issues, including arthritis, bone fractures, and neurodevelopmental disorders. Bennett Amaechi, a professor of dentistry at the University of Texas at San Antonio, observes that this skepticism has made many parents hesitant to use fluoride for their children.

Amaechi points out that research linking fluoride to lower IQ has generally involved very high exposure levels, more than double the recommended amount in U.S. water supplies. He states there is no concrete evidence of harm to children's IQ from standard fluoride use.

Clinical trials suggest hydroxyapatite may perform similarly to fluoride. A 2021 study in Scientific Reports followed 177 children for nearly a year. It found similar tooth decay outcomes in groups using either hydroxyapatite or fluoride toothpaste. Dr. Wolff Group, a German company that produces two hydroxyapatite brands, funded that research.

A 2023 study in Frontiers in Public Health tracked 171 adults for 18 months. It also found similar decay rates between the two groups. However, the participants were mostly healthy young adults with low risk for tooth decay. Dr. Livia Tenuta, an associate professor at the University of Michigan School of Dentistry, says more long-term studies are needed, particularly in populations with high caries risk.

A 2019 study in the Journal of Investigative and Clinical Dentistry focused on 133 individuals at higher risk for caries. After five months, researchers found both toothpastes performed similarly. Despite these findings, the American Dental Association says evidence for hydroxyapatite remains limited.

Dr. Ada Cooper, a spokesperson for the ADA, wrote that the research on the ingredient is new. She noted that clinical effectiveness data is ambiguous regarding specific clinical indications. The ADA continues to recommend brushing twice daily for two minutes with fluoride toothpaste, flossing daily, and visiting a dentist regularly.

Hydroxyapatite toothpastes are typically more expensive than fluoride options, with some costing more than a dollar per ounce. Amaechi advises patients to choose fluoride because it has a stronger body of evidence supporting its efficacy. Tenuta agrees, stating that fluoride is the best option due to the extensive research behind it.