Hydroxyapatite toothpaste uses hydroxyapatite (HAp), a form of calcium phosphate that makes up most of your tooth enamel, in place of fluoride. It's been used in Japan since the 1990s and has become one of the most popular fluoride-free toothpaste ingredients in the US. Here's what it is, what the research says, how nano and micro hydroxyapatite differ, and every hydroxyapatite toothpaste we stock, compared.
Key takeaways
- Hydroxyapatite is the same mineral your enamel is made of; toothpaste versions use synthetic, food-grade HAp.
- An 18-month clinical trial in adults found a 10% hydroxyapatite toothpaste was not inferior to a fluoride toothpaste for preventing new cavities.
- The ADA still recommends fluoride toothpaste and doesn't give its Seal to hydroxyapatite products. Talk to your dentist if you're at high risk for cavities.
- The EU's scientific safety committee concluded nano-hydroxyapatite is safe in toothpaste up to 10%.
What is hydroxyapatite toothpaste?
Hydroxyapatite toothpaste is toothpaste that contains hydroxyapatite particles, usually listed on the label as "hydroxyapatite," "nano-hydroxyapatite" or "nHAp." The idea is that the particles fill tiny surface defects in enamel and help the mineral balance of the tooth surface. Most hydroxyapatite toothpastes are also fluoride-free, which is why many people looking for a fluoride-free toothpaste end up here.
Does hydroxyapatite toothpaste work?
The best evidence so far is a randomized, double-blinded trial published in 2023 (Paszynska and colleagues) that followed adults for 18 months. Toothpaste with 10% hydroxyapatite was found to be non-inferior to a fluoride toothpaste (1,450 ppm) at preventing new cavities. Other studies suggest hydroxyapatite may help reduce tooth sensitivity. That's encouraging, but the body of research is still much smaller than for fluoride, which is why dental associations continue to recommend fluoride as the standard.
Nano vs. micro hydroxyapatite
| Nano-hydroxyapatite (nHAp) | Micro-hydroxyapatite | |
|---|---|---|
| Particle size | Under 100 nanometers | Larger, micron-sized particles |
| Research | Most clinical studies, including the 18-month trial, used nano or a 10% HAp formula | Fewer studies |
| Why brands choose it | Smaller particles fill smaller enamel defects | Avoids "nano" ingredients for people who prefer not to use them |
On safety, the European Commission's Scientific Committee on Consumer Safety (SCCS) concluded in 2023 that specific forms of nano-hydroxyapatite are safe in toothpaste at up to 10% and in mouthwash at up to 0.465%.
How to choose a hydroxyapatite toothpaste
- Check the percentage. The strongest clinical results used 10% HAp. Some products list their percentage; many don't.
- Pick a format. Tubes, toothpaste tablets, mouthwash and even mints now contain HAp.
- Look at the rest of the label. If you want SLS-free, check for sodium lauryl sulfate; if you have a dog, keep xylitol products away from it.
- Kids: ask your child's dentist before switching; see fluoride-free toothpaste for kids.
Hydroxyapatite toothpaste we stock, compared
All 22 hydroxyapatite products we carry. "Form" comes from each brand's label.
Shop everything in hydroxyapatite toothpaste and fluoride-free toothpaste.
Weighing it up against fluoride? Read hydroxyapatite vs. fluoride toothpaste.
FAQ
Is hydroxyapatite better than fluoride?
Not proven to be better. One 18-month trial found 10% hydroxyapatite toothpaste was not inferior to fluoride toothpaste in adults, but fluoride has far more research behind it and remains the ADA's recommendation.
Is nano-hydroxyapatite safe?
The EU's SCCS concluded in 2023 that specified nano-hydroxyapatite is safe in toothpaste up to 10% and mouthwash up to 0.465%. Hydroxyapatite itself is the mineral teeth and bones are made of.
Can I use hydroxyapatite toothpaste with fluoride toothpaste?
Yes, some people alternate or use HAp at one brushing and fluoride at the other. Ask your dentist what fits your cavity risk.
Does hydroxyapatite toothpaste whiten teeth?
Some brands market a brighter look because HAp can smooth the enamel surface, but it doesn't bleach teeth.
Is hydroxyapatite toothpaste safe for kids?
Hydroxyapatite isn't toxic if swallowed in toothpaste amounts, which is one reason parents consider it. Pediatric dental groups still recommend fluoride for children, so ask your child's dentist.
Sources: Paszynska et al., Frontiers in Public Health (2023); European Commission SCCS, Hydroxyapatite (nano); ADA, Toothpastes.
This guide is general information, not medical advice. Patch-test new products and ask a dermatologist or doctor about skin or health concerns.
Hydroxyapatite vs. Fluoride Toothpaste: Which Is Better?
Fluoride-Free Toothpaste for Kids: What Parents Should Know
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