Is Hydroxyapatite Toothpaste Safe and Effective?
A recent government report raises the question: Should we rethink our choice of toothpaste? Is hydroxyapatite, a popular alternative to fluoride, both effective and safe?
For the first time, a U.S. government agency has acknowledged that higher fluoride levels are linked to lower IQ in children.1 The report referred to fluoride in drinking water, but this raises an important question: Should we rethink our choice of toothpaste?
A Time-tested tool with modern benefits
Toothpaste has existed for centuries, dating back to ancient Egypt and Rome. Originally, it was used mainly as a gritty substance to scrub away plaque and stains. But in recent times, toothpaste has evolved with active ingredients added to boost its ability to fight cavities - a preventable condition afflicting many in the modern world.
Today, toothpaste serves multiple purposes: reducing sensitivity to hot and cold, whitening teeth, and most importantly, preventing dental decay.
What do dental associations recommend?
Currently, the American Dental Association (ADA) only endorses fluoride toothpaste. However, it recommends that parents with children under the age of 2 consult with their dentist before using fluoride toothpaste.
In contrast, UK government guidelines recommend children under three years should use a toothpaste containing no less than 1,000 parts per million (ppm) fluoride.
But why Fluoride?
Regardless of where you stand on the fluoride debate, the scientific evidence shows that fluoride is effective at preventing tooth decay.
According to a study by Walsh (2019), the effectiveness of 1500ppm fluoride toothpaste was compared to non-fluoridated toothpaste using a measure called the Numbers Needed to Treat (NNT).2 The result? For every 5 people who choose non-fluoride toothpaste, 1 additional person is likely to develop a cavity compared to if they had used fluoride toothpaste.
I’m not here to push a pro-fluoride agenda—I’m here to share the science on both sides so you can choose what’s best for you. So, let's dive deeper into fluoride.
Can Fluoride from toothpaste enter our bloodstream?
Toothpaste is a significant source of fluoride ingestion, especially for young children.
The issue is particularly concerning for children under the age of 2. According to a study by Sudrajat (2024), parents often dispense 6 to 7 times the recommended amount of toothpaste for toddlers, which increases their risk of dental fluorosis (permanent white specks or brown mottling) on the teeth.3
What are the dangers of fluoride ingestion?
It can cause a condition called fluorosis (teeth mottling) which has become more common over recent decades.4
Fluoride ingestion at higher levels has been correlated with lower IQ in children -and just last week, the National Toxicology Program in the U.S. FINALLY acknowledged that higher fluoride intake (at a total intake level equivalent of 1.5mg/L in drinking water) was associated with lower IQ in children.5
An increase of 0.5mg/L of maternal urine fluoride is correlated with a 2.5 reduction in IQ points in the child.6
Kids and teens who ingest high amounts of fluoride have also been found to have higher rates of ADHD and ADHD-like symptoms.78
Fluoride in water may negatively impact the production of 2 thyroid hormones (TSH + T3) and may worsen hypothyroidism.9
Chronic fluoride ingestion can cause damage to our kidneys.10
Is there an alternative to prevent dental decay?
You might have heard about a new player in the dental care world: hydroxyapatite.
What Is Hydroxyapatite (HAP)?
Hydroxyapatite (HAP) is in all of us. It is the natural mineral form of calcium and phosphate, making up the majority of our teeth and bones. When organized into a dense, crystal-like structure, this material becomes one of the hardest naturally occurring substances - second only to diamonds. Despite this, acidic conditions can dissolve hydroxyapatite, which leads to tooth decay.
Interesting fact: Artificial hydroxyapatite, used in toothpaste, was first developed by NASA in the 1970s to help astronauts who experienced bone density loss in zero gravity.
Hydroxyapatite can come in two particle sizes:
Micro-hydroxyapatite: 5,000 to 10,000 nanometers
Nano-hydroxyapatite: 10 to 200 nanometers
Lab studies on extracted teeth suggest that nanoparticles may be more effective at remineralizing damaged tooth structure and reducing sensitivity by sealing exposed dentine tubules.11
P.S. Dentinal tubules are tiny channels within the dentin layer of your teeth. The exposure of dentine tubules often underlies sensitivity. Both micro- and nano-HAP can seal dentinal tubules.
Does HAP prevent cavities?
I did the digging so you don’t have to!
In 2021, a researcher named Limeback conducted a meta-analysis of five studies on hydroxyapatite (HAP) toothpaste. The review suggested that HAP might be more effective than fluoride toothpaste. However, there are a few things to consider12: