Dentists Say Fluoride Still Leads as Hydroxyapatite Toothpaste Gains Traction

Dentists report a rising number of patients asking for toothpaste without fluoride.

Dr. Jin-Ho Phark, an associate professor of clinical dentistry at the University of Southern California, says the shift is visible in his clinic and among students. "There's a lot of interest from the patients," he said. He notes that many inquisitive buyers have encountered these alternatives through social media influencers who promote the products aggressively.

Fluoride toothpaste became the standard in the late 1950s when Procter & Gamble released Crest nationally. The Centers for Disease Control and Prevention state that adding fluoride to public water reduces cavities by 25%. However, skepticism has grown in recent years. Health Secretary Robert F. Kennedy Jr. has linked water fluoridation to health issues such as arthritis, bone fractures, and neurodevelopmental disorders, fueling consumer doubt.

The primary competitor to fluoride is hydroxyapatite, a mineral similar to tooth enamel. Proponents claim it strengthens teeth and whitens enamel without using fluoride. Dr. Livia Tenuta, an associate professor at the University of Michigan School of Dentistry, explains that fluoride works by remineralizing teeth with calcium and phosphate to create a protective shield. Hydroxyapatite products, often in nano-form, are designed to penetrate tiny crevices in enamel to achieve a similar effect.

Research on hydroxyapatite is emerging but limited. A 2021 study in Scientific Reports followed 177 children for nearly a year and found similar decay outcomes in groups using hydroxyapatite versus fluoride. That research was funded by Dr. Wolff Group, a German manufacturer of hydroxyapatite toothpaste. A follow-up study in 2023 in Frontiers in Public Health tracked 171 healthy adults for 18 months and also found comparable results. A 2019 study in the Journal of Investigative and Clinical Dentistry involved 133 high-risk patients and showed both types of toothpaste performed similarly over five months.

Despite these findings, experts caution that the evidence base for fluoride is far more extensive. Bennett Amaechi, a professor of dentistry at the University of Texas at San Antonio, authored the 2021 study and advises patients to stick with fluoride due to its longer track record. Tenuta agrees, noting that current hydroxyapatite studies mostly involve participants with low caries risk. The American Dental Association acknowledged in an email that some evidence supports hydroxyapatite's role in remineralization, but Dr. Ada Cooper, a spokesperson, described the clinical effectiveness data as limited and ambiguous.

Consumers choosing hydroxyapatite toothpaste pay a premium, with some products costing over a dollar more per ounce than fluoride counterparts. The ADA continues to recommend brushing twice daily for two minutes with fluoride toothpaste, flossing daily, and seeing a dentist regularly.