Is Hydroxyapatite Toothpaste Better Than Fluoride? A Dentist Weighs in on the Debate

You may have heard about hydroxyapatite toothpaste — it’s been touted as a “natural” alternative to fluoride toothpaste. That’s because it contains the same minerals that make up your teeth. 

People claim that hydroxyapatite prevents cavities, reduces tooth sensitivity, and whitens teeth. It’s typically found in less recognized toothpaste brands. 

But is hydroxyapatite as effective as time-tested fluoride? And are there any benefits to switching toothpaste? Read on to learn more.

How to prevent cavities

To understand how toothpaste prevents cavities, it helps to know about your tooth enamel and how cavities are formed. 

Tooth enamel, the hard outer layer of your tooth, is made up of hydroxyapatite crystals. These crystals are made of calcium and phosphate. Tooth enamel is the hardest tissue in your body. 

But the enamel is constantly exposed to acids produced by bacteria in your mouth. As tough as enamel is, these acids can eat away at it. That’s called demineralization. When that happens, your teeth become vulnerable to cavities.

The goal of cavity prevention is both to prevent demineralization and to replace minerals when it happens — that’s called remineralization. Your saliva contains high levels of calcium and phosphate, which naturally helps both of these processes. 

What is hydroxyapatite toothpaste?

Hydroxyapatite is made of calcium and phosphate, which are the same minerals that make up your tooth enamel. Because hydroxyapatite is made of the same minerals, it can penetrate your teeth to protect enamel and replace lost minerals. 

Hydroxyapatite is found in less well-known brands of toothpaste and is sometimes marketed as natural or fluoride-free. Hydroxyapatite may also be listed on the label as nano-hydroxyapatite.

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What is fluoride?

Fluoride is a naturally occurring mineral that can be found in soil, water, and foods. It’s the active ingredient in most toothpastes and is often added to drinking water to help fight cavities.

Fluoride works by bonding with calcium and phosphate on the surface of your enamel to create a stronger surface called fluorapatite. This form of enamel is better at resisting acids. It also helps rebuild enamel.  

Comparing hydroxyapatite toothpaste vs. fluoride

It’s a bit hard to compare a newcomer to a well-studied toothpaste ingredient. There’s a lot more science supporting fluoride because it’s been researched and used in oral health for decades. Fluoride toothpaste is also approved by the American Dental Association, while hydroxyapatite is not. 

But here’s what the science shows about each ingredient’s effect on cavity prevention, tooth whitening, and tooth sensitivity.

Cavity prevention

While there’s a ton of research showing fluoride protects against cavities, recent research shows that hydroxyapatite toothpaste can also prevent cavities. 

There are only a few high-quality studies that compare hydroxyapatite to fluoride toothpastes. But these small studies show that hydroxyapatite is equally effective as fluoride in preventing cavities. Larger studies are needed to confirm these findings.

Teeth whitening

There isn’t a lot of good quality research on whether hydroxyapatite toothpaste whitens teeth. But studies suggest it may help. Hydroxyapatite has a naturally white color, so when they combine with tooth enamel, it may create a whiter appearance.

On the other hand, fluoride doesn’t whiten teeth. Whitening toothpastes with fluoride often contain other ingredients that scrub away the staining pigments.  

Tooth sensitivity

Tooth sensitivity happens when enamel wears away and dentin is exposed. Dentin is the deeper layer of your tooth. Dentin contains dentinal tubules, which are tiny channels that lead to nerves in the inner tooth pulp. Hot, cold, or acidic foods can directly reach the nerves of your tooth through these channels, causing pain. 

Traditional toothpastes help reduce this sensitivity by using a specific form of fluoride called stannous fluoride. This fluoride covers the dentinal tubules, protecting them from painful stimuli. 

Hydroxyapatite toothpaste may be equally if not more effective as fluoride toothpaste in reducing sensitivity. Hydroxyapatite is thought to penetrate deeper into the tooth than fluoride. It can reach and repair the dentin, helping to reduce tooth sensitivity.

Hydroxyapatite toothpaste benefits

Hydroxyapatite mimics the natural makeup of enamel, which may appeal to some people. Here are some other benefits:

• Fluoride-free: Hydroxyapatite is an effective alternative for people who want to avoid fluoride.

• Mimics tooth enamel: Hydroxyapatite remineralizes teeth by directly replacing lost calcium and phosphate in the enamel. 

• Goes deeper: Hydroxyapatite integrates deeper into the enamel’s microscopic cracks and defects. This may be better than fluoride at reducing tooth sensitivity. But, there’s no evidence that it’s better than fluoride at preventing cavities. 

• Antibacterial properties: When hydroxyapatite attaches to the enamel, it helps keep damaging bacteria from attaching to the surface. 

Benefits of fluoride toothpaste

Fluoride toothpaste is a long-established approach to preventing cavities. Here are some other benefits:

• Recommended by dentists: Only toothpastes with fluoride can earn the American Dental Association seal of acceptance.

• Antibacterial properties: Fluoride reduces the ability of bacteria to produce acids in the mouth. It also creates an environment that’s less hospitable for bacteria to thrive.

• Strengthens developing teeth: For children, using toothpaste that contains a small amount of fluoride can strengthen developing teeth. The fluoride integrates into the enamel during the stages when it’s forming. This makes the teeth more resistant to decay over a lifetime.

• Widely available: Fluoride toothpaste is easily available in drugstores and online, and tends to be less expensive than hydroxyapatite toothpaste.

Which toothpaste is right for me?

Which toothpaste you choose may come down to personal preference. Consider the following when choosing a toothpaste:

• Stick with fluoride toothpaste if you’re looking for a proven option to prevent cavities and strengthen your enamel. 

• Fluoride toothpaste is a good option if cost is a factor. 

• Consider hydroxyapatite toothpaste if you prefer a fluoride-free alternative. Some brands include Davids and Boka.

• If you’re treating tooth sensitivity, both options will help, but hydroxyapatite toothpaste may have a better result.

• If you prefer a natural ingredient, hydroxyapatite mimics the natural structure of your teeth more compared to fluoride. 

If you are on the fence about which one is better for you, talk with your dentist. 

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Written by:

Zack Youngblood, DMD

Zack Youngblood, DMD, is a dentist who strives to change the general look of dentistry. Before stepping foot in the clinical field, he authored multiple works that helped dental students and dentists find their unique path in dentistry.

Edited by:

Laurie Tarkan

Laurie Tarkan is a senior health editor for general health and well-being at GoodRx. She has an extensive background in health journalism, and wrote regularly for The New York Times for a decade.

Reviewed by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

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