Hydroxyapatite kept pace with fluoride in three trials - the full review

What we reviewed

Hydroxyapatite is the calcium phosphate mineral that makes up most of tooth enamel. Toothpastes add a synthetic particle form of it, usually at 10%. We searched for human studies of hydroxyapatite oral care products published through July 2026 and kept 14 sources: six randomized controlled trials, one in-situ study, two systematic reviews with meta-analyses, and five papers we use for context on mechanism, methods, and guidelines. Laboratory studies on extracted teeth appear only as context — they show what an ingredient can do to a tooth surface, not what happens in a mouth over a year.

The head-to-head trials

The most useful evidence compares hydroxyapatite directly against fluoride, the best-tested ingredient in oral care. Three randomized trials have done this, in three different groups of people.

In an 18-month double-blind trial, 189 adults brushed with either a 10% hydroxyapatite toothpaste or a 1450 ppm fluoride toothpaste. 89.3% of the hydroxyapatite group developed no new decayed surfaces, against 87.4% with fluoride — the hydroxyapatite paste was statistically no worse1.
Paszynska et al. · Front Public Health · 2023 · n=189 · RCT