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Some dentists say, anyway. We don’t. As a biological practice, we put a premium on biocompatibility and recognize that fluoride’s risks outweigh any benefits.
In our practice, prevention starts with nutrition. A healthy, nutrient-dense diet of real food (not hyper-processed junk) that’s low in sugars and other highly refined carbs is the foundation. As one paper neatly summed up, “Without sugars, the chain of causation is broken, so the disease does not occur.”
Of course, oral hygiene matters, too. It’s just that fluoride really doesn’t need to be a part of it. Strictly speaking, neither does toothpaste. Most of brushing’s power comes from the mechanical action, not anything in toothpaste.
Brushing with plain water or a bit of baking soda or even a good DIY toothpaste can be enough. These options are the kindest to tooth enamel – a tissue that, for all its hardness, can actually be damaged by the abrasiveness of many popular, big brand toothpastes.
What toothpastes CAN do – and do very well – is deliver things like natural antimicrobial compounds, probiotics, and even hydroxyapatite to help remineralize your tooth enamel.
Hydroxyapatite – HAP, for short – is a combination of calcium, phosphate, and hydroxide ions formed into tightly packed microscopic crystal rods and plates. It’s what natural tooth enamel is made of and what gives it its strength. While your teeth are able to remineralize naturally with proper nutrition, using HAP toothpaste can offer some extra support.
As a 2022 review of the science noted,
HAP is a biomimetic oral care agent, and its caries prevention has been tested in vivo, in situ, and in vitro with a high safety profile and no risk of fluorosis. While more research is needed to confirm the clinical effectiveness of HAP at preventing and arresting dental caries, the research suggesting its equivalency to fluoride toothpaste is promising. HAP-containing oral products can be considered as an alternative in young children where fluorosis is a concern. In addition to perhaps reducing the need for traditional dental restorations, HAP also offers relief from dentin hypersensitivity and reduces biofilm formation making it a multifunctional agent for preventive oral health care.
Subsequent research has backed this up.
For instance, a double-blind, randomized trial in Frontiers in Public Health compared the impact of fluoridated toothpaste vs. HAP in almost 200 younger adults with healthy mouths. Each was given an electric toothbrush and randomly assigned one of the two types of toothpastes. They were told to brush twice daily after meals and not use any other oral hygiene products or change their diet in any way. Each underwent a dental exam every 6 months for one and a half years.
By the end of the study, the researchers found that most people showed no signs of worsening decay. Most people’s oral health stayed the same or improved, leading the authors to conclude that hydroxyapatite was found to be “a safe and efficient anticaries agent.” (“Caries” is the clinical term for tooth decay.) “This result,” they wrote,
is in agreement with two previously published clinical trials; thus, this is the third clinical trial showing that fluoride-free hydroxyapatite toothpastes are non-inferior to fluoride toothpastes in caries prevention. Although not statistically significant in all three clinical trials, there was a tendency that the hydroxyapatite toothpastes were slightly more efficient than the corresponding fluoride control toothpastes.
There are a number of HAP toothpastes available today, such as Davids, Boka, and RiseWell. The one we prefer is Dr. Jen, which contains a clinically proven level of 10% nano-hydroxyapatite for best results. Because teeth recognize this compound, they absorb it more deeply, becoming stronger and more resistant to decay.
Ask us about it next time you’re here in our St. Louis office.
Updated from the original 