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  • Writer's pictureDr. Charlotte Morgan, D.Ac.

Hydroxyapatite vs Fluoride: What the Research Says

Updated: Sep 29, 2022

We have always been taught that toothpaste must contain fluoride in order to prevent cavities, but research has shown again and again that another ingredient, hydroxyapatite, works equally as well (and often better) in comparison to fluoride as a remineralizing agent. Unlike fluoride, it is non-toxic, biocompatible (not harmful to our bodies), and has no known side effects.

What is Hydroxyapatite?

Tooth enamel is made up of 97% hydroxyapatite, a form of calcium created in the body, and the rest consisting of collagen, water, and various proteins. Hydroxyapatite, or HAp, is also a major component of our bones (60%), and is being researched to help strengthen bone material. Lets dive in…

How does HAp work?

  • HAp remineralizes (rebuilds) tooth structure and counteracts decay, which heals cavities and prevents new ones from forming.

  • Because HAp is naturally found in the body, teeth recognize the compound and absorb it down to the root of the tooth, which rebuilds enamel at the deepest area of decay.

  • HAp fills the tiny scratches in your teeth caused by demineralization, which would otherwise be home to bacteria. This filling also alters the appearance of teeth, making them look whiter.


  • HAp increases the micro-hardness of human enamel and prevents and reverses enamel erosion more effectively than over-the-counter fluoridated toothpaste.

  • A concentration of 10% hydroxyapatite was just as effective as an amine fluoride toothpaste in a December 2019 study for preventing and reversing tooth decay in children.

  • HAp was successfully able to shrink lesions of decay (called “caries lesions” or “carious lesions”) on teeth and improve enamel remineralization in a study conducted in Japan. According to the authors, the more hydroxyapatite in the toothpaste, the better it restored the enamel surface.

  • In 2019, a study found that the use of hydroxyapatite toothpaste actually created a coating on the teeth more sturdy than that formed by fluoride toothpaste. This helped to strengthen enamel for future resistance to breakdown.

The Problem with Fluoride

  • Fluoride is a neurotoxin (a toxin that impacts the brain). When consumed in large doses, it is associated with increased risk of at least 11 medical conditions, can impact cognitive development in children, and has been shown to result in decreased IQ scores.

  • Typically, fluoride in our toothpaste is not swallowed or ingested, which is why it is considered safe. However, the CDC found that most kids use far more toothpaste than they should. This is a big problem when you’re talking about toothpastes with hundreds of times the amount of fluoride than is found in water. On that note, the biggest problem with fluoride is that it is found in our drinking water, which results in constant exposure.

  • Fluoride doesn’t actually replace minerals in your teeth. Instead, it creates a new structure called fluorapatite which forms its own unique material above the surface of the tooth, protecting it from dental plaque acids. Unlike fluoride, HAp reaches down through your entire tooth to build it from the inside out, to the lesions where fluoride cant touch.

  • Fluoride is a bactericidal, meaning it kills off all bacteria in the mouth. The oral microbiome, much like our gut, needs a good balance of bacteria to function properly. Wiping out all of this bacteria may alleviate overgrowth in the short term, but creates far more issues over time. HAp does not wreck your oral microbiome, but instead protects your teeth from bacterial attacks.

My favorite HAp toothpaste is Boka Ella Mint!

*as an amazon associate, I receive a small commission from your purchase. The price of the item is the same as retail.

With Love,

Dr. Charlotte Morgan, D.Ac.


Amaechi, B. T., AbdulAzees, P. A., Alshareif, D. O., Shehata, M. A., Lima, P., Abdollahi, A., Kalkhorani, P. S., & Evans, V. (2019). Comparative efficacy of a hydroxyapatite and a fluoride toothpaste for prevention and remineralization of dental caries in children. BDJ open, 5, 18.

Use of Toothpaste and Toothbrushing Patterns Among Children and Adolescents — United States, 2013–2016:

Bossù, M., Saccucci, M., Salucci, A., Di Giorgio, G., Bruni, E., Uccelletti, D., Sarto, M. S., Familiari, G., Relucenti, M., & Polimeni, A. (2019). Enamel remineralization and repair results of Biomimetic Hydroxyapatite toothpaste on deciduous teeth: an effective option to fluoride toothpaste. Journal of nanobiotechnology, 17(1), 17.

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