While tooth enamel is the strongest tissue in the human body, it’s not invulnerable. Sugars and acids in what you eat and drink can erode it. So can habitual clenching and grinding, not to mention acid reflux, bulimia, and even some medications.
Still, your body is constantly working to replace minerals lost from your teeth, via your saliva. It’s yet another reason why eating a healthy, nutrient-dense diet and staying hydrated are just as important to your oral health as brushing, flossing, and regular dental visits. A steady flow of saliva delivers essential minerals to your teeth, helping them remineralize naturally.
One mineral that’s not essential is fluoride, a toxin. Although conventional wisdom holds that fluoride “makes the enamel more resistant to the action of acids…and accelerate[s] the buildup of healthy minerals in the enamel,” fluoride itself isn’t present in natural tooth enamel at all.
Tooth enamel is made of the same stuff your bones are made of: hydroxyapatite. This combination of calcium, phosphate, and hydroxide ions forms tightly packed microscopic crystal rods and plates, which is what makes enamel so tough. Hydroxyapatite makes up roughly 95% of tooth enamel. The rest is water (4%) and proteins (1%).
Increasingly, we see toothpastes that forego the fluoride and deliver hydroxyapatite directly to your teeth instead. Hydroxyapatite toothpastes like Risewell, Boka, and Dr. Jen are a welcome innovation. Because teeth recognize the compound, they absorb it more deeply, becoming stronger and more resistant to decay.
This is borne out by research published just last month in Frontiers in Public Health.
Nearly 200 younger adults took part in this double-blind, randomized trial. Each participant had at least 10 decay-free teeth, no untreated dental problems, and willingness to use an electric toothbrush.
Each participant was randomly given either fluoride or hydroxyapatite toothpaste without knowing which kind they got. They were told to brush twice a day after meals and to not use any other oral hygiene products or change what they ate. They were also instructed to come in for a followup exam every 6 months for a year and a half.
Analyzing all the data collected by the end of the study, the research team found that most people didn’t show signs of worsening decay. Among those who used the fluoride paste, 87.4% had the same (or possibly better) oral health as they did at the start of the study.
The rate was 89.3% for the hydroxyapatite group.
Although the researchers couldn’t claim that the hydroxyapatite paste performed better than fluoride – the difference wasn’t found to be statistically significant – they could conclude that hydroxyapatite “was proven to be a safe and efficient anticaries agent.” (“Caries” is the clinical term for tooth decay.)
This result is in agreement with two previously published clinical trials; thus, this is the third clinical trial showing that fluoride-free hydroxyapatite toothpastes are non-inferior to fluoride toothpastes in caries prevention. Although not statistically significant in all three clinical trials, there was a tendency that the hydroxyapatite toothpastes were slightly more efficient than the corresponding fluoride control toothpastes.
Additionally, the authors note, hydroxyapatite toothpastes have been shown to decrease tooth sensitivity, improve gum health, and help whiten teeth.
And toothpaste isn’t the only option. Risewell, for instance, also makes a teflon-free floss that’s coated with the mineral, so you can apply it to the sides of your teeth and along the gumline. Simply Silver makes a rinse that contains both hydroxyapatite, as well as colloidal silver. (Silver has antibacterial properties.) We’ve even seen oil blends intended for oil pulling that contain the mineral, as well.
So you’ve got lots of options. And as a 2021 review of hydroxyapatite in oral care products noted,
Research has shown comparable effectiveness for HA [hydroxyapatite] when compared to fluoride in remineralisation and CHX [chlorhexidine] in biofilm management. HA’s effectiveness in reducing dentine hypersensitivity and whitening teeth appears to be promising too. Although the evidence for HA is comparable to other substances, its non-toxic and biomimetic property provides an advantage over conventional products.
In our opinion, nontoxic and biomimetic win every time.