The idea behind fluoride is that it helps remineralize teeth, even though that mineral doesn’t naturally occur in teeth. The good news is it can just as well be done these days with the mineral that your enamel is actually made from: hydroxyapatite, or HAP for short.
HAP is the natural calcium phosphate mineral that makes up about 97% of tooth enamel and 70% of dentin. As such, it’s biocompatible. Fluoride, not so much.
We’ve blogged a bit about HAP before, including studies showing its effectiveness. Now, a new systematic review and meta-analysis in the Journal of Dentistry confirms a role for HAP in protecting teeth against decay.
For this updated review, the authors examined 18 studies of various types, including randomized clinical trials (RCTs), including both in vivo trials (studies on actual patients) and in situ studies (shorter experiments using dental appliances with tooth samples). Thirteen of these studies were included in their meta-analysis.
Among their findings:
- Those who used HAP toothpaste were 2.5 times more likely to prevent decay than those using placebo toothpaste.
- HAP toothpaste performed slightly better than fluoride in cavity prevention – and did significantly better in reducing the depth of early cavity lesions.
- Compared to control rinses, HAP mouthwashes reduced bacterial load by about 65%.
The inclusion of in situ studies is especially important because they provide valuable insights into HAP’s mechanisms, showing it can not only remineralize enamel but also prevent mineral loss and reduce bacterial adhesion.
Notably, the review considered both micro and nano forms of hydroxyapatite, both of which were found to be clinically effective.
And they do so biocompatibly, without the toxicity concerns that fluoride toothpastes present. In fact, no side effects or adverse reactions were reported in any of the included studies.
This updated systematic review and meta-analysis of in vivo and in situ clinical trials, confirmed that hydroxyapatite in oral care products can reduce the risk of dental caries in the absence of fluoride. Additionally, the results of the in situ studies showed evidence supporting that hydroxyapatite inhibits bacterial adhesion and/or viability. As an active ingredient, considered safe if swallowed, HAP is an ideal substitute for fluoride in toothpaste and mouthwash tailored for young children, and new data presented in this review demonstrated that hydroxyapatite-based oral care products can be used by people of all ages.
And while this paper was focused specifically on HAP’s impact on tooth decay, the authors do mention its versatility in addressing other oral health concerns, including reducing sensitivity, improving gum health, and gently whitening teeth.
This review gives all the more reason to consider switching to a HAP toothpaste, whether from a fluoridated or natural, fluoride-free brand. The one we like is Dr. Jen, which contains 10% nanohydroxyapatite. This is currently considered the optimum level of nHAP for best results. Because teeth recognize this compound, they absorb it more deeply, so they become stronger and more resistant to decay.
They even have a new formulation which is derived from eggshells, making it the only naturally-sourced nHAP toothpaste currently available.
Ready to learn more about HAP and its benefits? Check out this interview with Dr. Jen herself.
