Interest in fluoride-free toothpaste is growing, particularly in products that use hydroxyapatite, a calcium phosphate mineral similar to the main components of tooth enamel. Dentist Jin-Ho Phark says patients and dental students increasingly ask about these products, which have also gained visibility through social media influencers.
Fluoride toothpaste has been widely used since the late 1950s and is supported by extensive research showing that it helps protect teeth against decay. Fluoride works with calcium and phosphate in saliva and dental plaque to remineralize enamel, creating a more resistant surface. Dentists generally recommend brushing twice a day to maintain this protection.
Hydroxyapatite is believed to work differently. Products containing the mineral, particularly nano-hydroxyapatite, are designed to enter tiny pores in enamel. Some research also suggests that hydroxyapatite may help with tooth sensitivity. However, data on the smaller particles and their long-term effects remain limited.
Early studies have produced encouraging results. A 2021 study involving 177 children found similar outcomes for hydroxyapatite and fluoride toothpaste over almost a year. Another study, published in 2023, followed 171 mostly healthy young adults for 18 months and also found comparable results. A shorter 2019 study of 133 people at higher risk of cavities reported similar performance from both types of toothpaste after just over five months.
Researchers caution that the available studies do not settle the question. Livia Tenuta, a specialist in preventing tooth decay, says more long-term research is needed, particularly among people at high risk of cavities. Several of the studies involved participants with relatively low levels of dental risk, and one of the longer studies received funding from a company that owns hydroxyapatite toothpaste brands.
Bennett Amaechi, who studies hydroxyapatite, says the early evidence is positive but recommends fluoride for people willing to use either option because fluoride has been researched more extensively. Tenuta gives the same advice.
The American Dental Association recognizes that some evidence links hydroxyapatite products with remineralization, but says research into their clinical effectiveness remains limited and ambiguous. The organization recommends brushing twice a day for two minutes with fluoride toothpaste, flossing daily and visiting a dentist regularly.
Hydroxyapatite toothpastes also tend to cost more than fluoride products, with some priced more than a dollar higher per ounce. For now, dentists say fluoride remains the better-supported choice, while hydroxyapatite continues to be studied as an alternative.
Sources: NPR News.