Studies on Hydroxyapatite Toothpaste Efficacy & Safety

1. Meyer F, Schulze Zur Wiesche E, Amaechi BT, Limeback H, Enax J. Caries etiology and preventive measures.

This review of the latest knowledge on the causes and treatments for dental caries acknowledges that hydroxyapatite is the most versatile non-fluoride active ingredient that is equivalent to or better than fluoride in combating decay. Hydroxyapatite has been clinically proven to reduce the initial plaque formation to enamel surfaces and acts as acid buffer and reservoir for calcium and phosphate ions in plaque. Due to its lack of direct antimicrobial effects, It is also a much safer alternative to fluoridated toothpastes in children who may be prone to ingesting them.

2. Limeback H, Enax J, Meyer F. Improving oral health with fluoride-free calcium-phosphate-based biomimetic toothpastes: an update of the clinical evidence.

This review focused on fluoride-free toothpastes containing biomimetic calcium phosphate-based molecules as the primary active ingredients. Only clinical trials in human subjects were included, of which there were 62 on hydroxyapatite (HAP). HAP formulations underwent the most testing out of all to demonstrate benefits in preventing caries, dentin hypersensitivity, improving periodontal health, and tooth whitening. Fluoride-free HAP toothpaste formulations are currently the most versatile and efficacious of the calcium phosphate-based active ingredients in toothpastes for improving oral health.

3. Clinical evidence of biomimetic hydroxyapatite in oral care products for reducing dentin hypersensitivity: an updated systematic review and meta-analysis.

Hydroxyapatite (HAP) has been shown in vitro to block dentinal tubules and in vivo to be a safe and effective additive in oral care products that reduce dentinal hypersensitivity clinically. From 44 published clinical trials conducted in humans, it was found that HAP was superior to fluoride in significantly reducing dentinal hypersensitivity compared to placebo.

4. Tooth whitening with hydroxyapatite: a systematic review.

Hydroxyapatite (HAP) is a new ingredient to whiten teeth. This systematic review assessed 17 studies and found that the regular use of hydroxyapatite-containing oral care products effectively whitens teeth.

5. The use of hydroxyapatite toothpaste to prevent dental caries.

Studies demonstrate promising results of hydroxyapatite (HAP) toothpastes on the remineralisation of enamel lesions and preventing/reducing demineralisation and its superiority or equivalency to fluoride toothpaste as anti-caries agents. There are a growing number of randomised clinical trials that provide encouraging support to the results of in vivo studies. As HAP toothpastes have a demonstrated high safety profile and pose no risk of fluorosis, they may be considered as a viable alternative for young children where fluorosis is a concern. HAP also offers relief from dentin hypersensitivity and reduces biofilm formation, making it a multifunctional agent for preventive oral health care.

6. Do we have enough evidence to recommend hydroxyapatite toothpaste for preventing dental caries?

This systematic review and meta-analysis assessed the effectiveness of hydroxyapatite as an intervention agent for caries prevention, in comparison with either active control like fluoride-products, placebo, or no interventions.It included 18 articles, including clinical trials and in-situ studies. It concluded that HAP toothpastes are found to be effective in preventing caries and can be considered as good alternative for fluoride.

7. Biomimetic hydroxyapatite and caries prevention: A systematic review and meta-analysis.

This systematic review and meta-analysis of over 291 studies, concluded that there is good evidence that hydroxyapatite-containing, fluoride-free oral care products are effective in reducing dental decay, especially in children.

8. Caries-preventing effect of a hydroxyapatite-toothpaste in adults: a 18-month double-blinded randomized clinical trial. Frontiers in public health, 11, 1199728.

This 18-month double-blinded, randomized, clinical trial in adults compared the effect of hydroxyapatite toothpaste and a toothpaste with sodium fluoride (1450 ppm fluoride; positive control) on caries prevention. It proved hydroxyapatite to be a safe and efficient anticaries agent in oral care.

9. Effects of low and standard fluoride toothpastes on caries and fluorosis: Systematic review and meta-analysis.

The study assessed the effects of low (< 600 ppm) and standard (1,000-1,500 ppm) F toothpastes on the prevention of caries in the primary dentition and aesthetically objectionable (moderate to severe) fluorosis in the permanent dentition. A systematic review of clinical trials and meta-analyses were carried out.It was found that Low F toothpastes significantly increased the risk of caries in primary teeth and did not significantly decrease the risk of aesthetically objectionable fluorosis in the upper anterior permanent teeth. It concluded that there is no evidence to support the use of low F toothpastes by preschoolers regarding caries and fluorosis prevention.