Hydroxyapatite toothpaste costs up to $1 more per ounce than fluoride options

Consumers buying hydroxyapatite toothpaste are paying a premium for a product with a shorter track record than traditional fluoride formulas. Some brands cost more than a dollar more per ounce than their fluoride counterparts. Dentists report a surge in patient questions about these fluoride-free alternatives, often driven by social media influencers promoting the mineral.

Dr. Jin-Ho Phark, an associate professor of clinical dentistry at the University of Southern California, says he hears this interest regularly from both patients and students. The products feature hydroxyapatite, a calcium phosphate mineral that mimics the structure of tooth enamel. Proponents claim it can protect against cavities, whiten teeth, and strengthen enamel without the use of fluoride, a mineral that has been a standard in oral care since Procter & Gamble released Crest nationally in the late 1950s.

The shift toward hydroxyapatite coincides with growing public hesitancy about fluoride. Health Secretary Robert F. Kennedy Jr. has linked water fluoridation to various health issues, including bone fractures and neurodevelopmental disorders, despite the Centers for Disease Control and Prevention naming fluoride addition to public water as a top 20th-century public health achievement. The CDC states that fluoride in water reduces cavities by 25%.

Bennett Amaechi, a professor of dentistry at the University of Texas at San Antonio, notes that while fluoride is extensively researched, early data on hydroxyapatite is positive. He co-authored a 2021 study in Scientific Reports that tracked 177 children for nearly a year. The researchers found similar tooth decay outcomes in groups using hydroxyapatite versus fluoride toothpaste. That study received funding from Dr. Wolff Group, a German company that owns two hydroxyapatite brands. A subsequent 2023 study in Frontiers in Public Health tracked 171 adults for 18 months with similar results.

However, experts note limitations in the current evidence. Dr. Livia Tenuta, an associate professor at the University of Michigan School of Dentistry, points out that many studies recruited participants with low risk of tooth decay. She calls for more long-term research, particularly among high-risk patients. A 2019 study in the Journal of Investigative and Clinical Dentistry did include 133 people at higher risk of caries and found both types of toothpaste performed similarly over five months.

The American Dental Association acknowledges that some evidence suggests hydroxyapatite products can contribute to remineralization. However, Dr. Ada Cooper, a Consumer Advisor for the ADA, wrote that the research is new and evidence regarding clinical effectiveness remains limited and ambiguous. The ADA continues to recommend brushing twice daily for two minutes with fluoride toothpaste, flossing daily, and visiting a dentist regularly.