Oral Health. Hydroxyapatite vs Fluoride

Hydroxyapatite vs Fluoride?

Is it time to switch to using hydroxyapatite toothpaste? I think there is a good argument for it.

Side by side studies comparing fluoride and hydroxyapatite indicate that the latter has the same or even superior efficacy for the core purposes of preventing dental caries & remineralising tooth enamel. In several other ways, hydroxyapatite appears to be simply better.

I personally switched over to hydroxyapatite toothpaste tablets some years ago, based on:

🦷 Evidence for same or superior tooth remineralisation 

🪥 At least equal effectiveness at preventing dental caries

📉 Lower toxicity

💰 Modest price differential

The notable caveats appear to be:

🔬 Whilst the evidence is promising, fluoride has been studied far more extensively

⌛ Very long term studies for hydroxyapatite are lacking given its relative newness within commercially toothpastes

My read on the developing evidence base for hydroxyapatite has these key points & I link to two narrative reviews published in 2025 within the first comments.

🦷 Enamel Bonding🪥

Fluoride enables remineralisation through formation of fluorapatite. Hydroxyapatite enables remineralisation through bonds identical to tooth enamel

🦷Toxicity🪥

Whilst safe & tolerable in very small doses, fluoride nevertheless has significant toxicity, with demonstrated negative effect (in higher doses) on systemic toxicity, and thyroid function. Hydroxyapatite has negligible toxicity

🦷Oral & Gut Microbiome🪥

Fluoride in higher concentrations is antimicrobial, and may disrupt the oral and gut microbiome. Hydroxyapatite appears to have no effect or a modest a positive effect through reducing bacterial adhesion to tooth surfaces

🦷Aesthetics🪥

Fluoride may reduce staining by helping protect enamel, whilst hydroxyapatite directly helps whiten teeth by facilitating natural mineralisation & tooth surface reflectivity

🦷Cost & Availability🪥

This may be the clear advantage fluoride currently has.

I personally use Nowa hydroxyapatite toothpaste tablets. At 15.95 GBP for 240 tablets, that means 0.067 GBP per brushing.

A Colgate Total Active 125ml tube costs around 7 GPB when not on special offer. Using around 0.25 grams per brushing, a pea sized amount, translates to around 0.014 GBP per brushing, so nearly 4x cheaper.

As take-up of hydroxyapatite increases however, the cost is also reducing.

Hydroxyapatite vs fluoride

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