Hydroxyapatite Toothpaste For A Naturally White Smile

Looking for fluoride-free, SLS-free toothpaste? Make the switch to hydroxyapatite toothpaste for a brighter smile and glossy teeth. This enamel strengthening toothpaste is a great fluoride alternative with no harsh additives and it naturally whitens your teeth. We tested and reviewed 6 brands of hydroxyapatite toothpaste and found some that we love!

Bamboo toothbrushes in glass cup

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As a dentist’s daughter, good oral hygiene was par for the course growing up. My dad’s dental office was attached to our house, and I could never skip out on fluoride treatments, biannual checkups and lectures on flossing and brushing. As an adult, I still keep up with my flossing and brushing, and I’m always on the lookout for new dental products that are safe for my whole family.

In my quest for new toothpaste options, I came across the ingredient hydroxyapatite. I was so impressed by the scientific literature on hydroxyapatite and dental care (see scientific study section below) that I took a deep dive into researching, testing and reviewing hydroxyapatite toothpaste. You can read more about the brands I tested below, but first, let’s have a closer look at hydroxyapatite.

WHAT IS HYDROXYAPATITE?

Hydroxyapatite is the main substance in your teeth, making up 97% of enamel and 70% of dentin. Also known as calcium phosphate, this compound is non-toxic and biocompatible (not harmful to living tissue) (1). This safe fluoride alternative has been used in Japan for over 40 years. It works just as well as fluoride at preventing cavities (see scientific study section below).

The main draw of hydroxyapatite in toothpaste is that it helps to remineralize (rebuild) tooth structure without any known side effects. Hydroxyapatite can also aid in reducing tooth sensitivity and plaque buildup.

THE HISTORY OF HYDROXYAPATITE

In the 1970’s, astronauts returning from space missions experienced weakened tooth enamel and bone loss due to the effects of weightlessness. In order to restore and strengthen softened, weak tooth enamel and bone, NASA created a synthetic version of hydroxyapatite.

The Sangi Company of Japan acquired the hydroxyapatite patent from NASA in 1978 and developed an enamel-restorative toothpaste that is still the gold standard for fighting cavities in Japan today.

Diagram of tooth and hydroxyapatite structure

HOW DOES HYDROXYAPATITE WORK?

Tooth enamel is constantly exposed to corrosive acids in your mouth. The acid creates small fissures in your tooth enamel, and this process is called demineralization. Hydroxyapatite works to fill in the microfissures (remineralization) and restore tooth enamel. It also works to rebuild areas where cavities are starting to form. A compilation of hydroxyapatite research studies from a 2021 review and meta-analysis concludes that hydroxyapatite is effective at reducing dental cavities (2).

IS HYDROXYAPATITE SAFE?

Yes! Hydroxyapatite, a calcium phosphate substance, is almost identical to the natural hydroxyapatite of our teeth and bones. It’s biocompatible, non-toxic and can be safely ingested. Numerous studies have demonstrated the safety of hydroxyapatite in toothpaste (3, 4).

  • Nano hydroxyapatite particles are small enough to settle into all of the microfissures in your enamel and start the remineralization process. Nano hydroxyapatite is known for being the gold standard to treat sensitive teeth in Japan.  There is no evidence that nano-hydroxyapatite is dangerous to human health.
  • Micro hydroxyapatite particles are bigger than nano particles. Micro hydroxyapatite is sourced from nature, not made in the lab.

SCIENTIFIC STUDIES ON HYDROXYAPATITE IN DENTAL CARE

  • Participants in a 2012 study had their teeth bleached with a 7% hydrogen peroxide gel for 14 days. Half the group used nano-hydroxyapatite paste after bleaching, leaving it on for 5 minutes, and the placebo had a paste applied with no hydroxyapatite added. The group treated with nano-hydroxyapatite paste had significantly lower sensitivity levels than the placebo group (4).
  • Orthodontic patients in a 2016 study were treated with either a fluoride toothpaste, two brands of nano-hydroxyapatite toothpaste or a control toothpaste. The two brands of nano-hydroxyapatite toothpaste were found to be the most efficient at preventing tooth demineralization compared with the fluoride toothpaste and the control (5).
  • In a 2017 study measuring tooth hardness, demineralized tooth surface coated with hydroxyapatite toothpaste was found to be harder after 2 weeks of application than tooth surface coated with fluoride toothpaste alone (6).
  • A 2019 study found that toothpaste containing a 10% hydroxyapatite solution and toothpaste containing amine fluoride were equally effective for preventing and reversing tooth decay in children (7).

WHAT ARE THE BENEFITS OF USING HYDROXYAPATITE TOOTHPASTE

  • It makes teeth whiter and glossier
  • It reduces tooth sensitivity
  • It helps fight and prevent cavities
  • It remineralizes and repairs enamel
  • It’s biocompatible and non-toxic

WHAT TO EXPECT FROM HYDROXYAPATITE TOOTHPASTE

You won’t get the same foaming action that you may be used to from a conventional toothpaste with SLS (that goes for any natural toothpaste that doesn’t contain SLS). Most of the brands I tested felt more lotion-like in my mouth (you get used to this very quickly). Hydroxyapaptite doesn’t have a flavor – you’ll taste the other added ingredients in the toothpaste such as essential oils.

HOW I TESTED HYDROXYAPATITE TOOTHPASTE

I tested 6 brands of hydroxyapatite toothpaste and bits. I brushed with each brand at least 4 times and took notes on consistency, flavor and breath freshness after using. Jeremy tried each brand too and gave me his opinion (we had similar thoughts on all of the brands).

*Cost was calculated at the time this article was published, and is subject to change. All toothpaste ingredients are listed at the end of this post.

Hydroxyapatite Toothpaste

Davids Sensitive + Whitening Nano-Hydroxyapatite Toothpaste

  • Cost: $9.95 for 5.25 oz. ($1.90 per ounce)
  • Flavor: Natural Peppermint
  • My Take: I had very fresh minty breath after testing this toothpaste. It has a nice thick consistency to coat your teeth. I love that this brand is committed to sustainability, and the toothpaste comes in a recyclable metal tube. This toothpaste is the newest hydroxyapatite toothpaste that I’ve tested and it’s a new favorite!
  • From the David’s website: nano-hydroxyapatite (n-HA) to repair sensitive teeth + remineralize enamel, natural whitening / antiplaque / fresh breath, high performance safe + clean ingredients, fluoride free, sls free, recyclable metal tube, 98% usa origin ingredients, premium natural peppermint oil flavoring, proudly made in usa, metal tube key included (see faq for ordering w/o key).
  • Shop: Davids Sensitive + Whitening nano-Hydroxyapatite Toothpaste

Wellnesse Toothpaste

  • Cost: $12 for 4 oz. (plus $5 shipping)
  • Flavor: Fresh Mint
  • My Take: I really liked the minty taste of this toothpaste. The consistency was also a little thicker than most of the other brands tested. I liked that all of the  individual ingredients have an EWG score of 1 (products are rated on a scale of 1-10, with 10 being harmful to human health). Bonus points that the toothpaste tube is made from sugarcane bioplastic. A great toothpaste all-around!
  • From the Wellnesse website: Glycerin-free, Fluoride-Free and Going Strong. Instead of fluoride, our formula contains green tea leaf extract, which is loaded with antioxidants. Plus, a phytochemical in green tea is shown to fight bacteria that leads to tooth decay. We combined this phytochemical with hydroxyapatite (a naturally-occurring mineral and main component of tooth enamel) to strengthen teeth and prevent cavities. Did we mention our toothpaste is Glycerin-Free?
  • Shop: Wellnesse Toothpaste

Boka Ela Mint Toothpaste

  • Cost: $12 for 4 oz. ($2 shipping)
  • Flavors: Mint, Coco Ginger, Lemon Lavender
  • My Take:  This Ela Mint Toothpaste has a really pleasant mint taste – it’s not too sweet or too zingy. It really makes my gums feel soothed after brushing, like they’ve just been hugged. I really like this toothpaste. The ingredients do state that the toothpaste product is made on the same manufacturing line as peanuts, tree nuts, dairy, eggs, and sunflower. My daughter is severely allergic to tree nuts, so this is something to consider if someone in your house has allergies.
  • From the Boka website: Boka was the first company to introduce hydroxyapatite toothpaste into the US market. Ela Mint is unlike any other toothpaste, by design. It trades fluoride for nano-hydroxyapatite (n-Ha), an evolution in dentistry that’s been a gold standard in Japan for over 40-years. n-Ha makes up the primary foundation of teeth and bones, meaning it’s naturally restorative and helpful in reducing sensitivity. Plus, it’s 100% biocompatible and non-toxic. We complement this powerful ingredient with soothing aloe vera, bacteria-fighting xylitol, antioxidant-rich green tea and refreshing mint. It’s our way to address the “silent epidemic” in healthcare. Features: Fluoride-free, SLS-free, Paraben-free, Sensitivity-fighting, Antiplaque, Free from artificial flavors, Free from endocrine disruptors, Powered by n-Ha, a 100% non-toxic ingredient that remineralizes and desensitizes teeth, Contains aloe vera, xylitol, green tea and mint.
  • Shop: Boka Ela Mint Toothpaste

Bite Toothpaste Bits

  • Cost: $30 for 4 month supply or $12 for 62 bits
  • Flavor: Fresh Mint, Berry Twist, Mint Charcoal
  • My Take: This was my first time trying toothpaste that came in a tablet form. It turns out I’m super impressed with Bite Toothpaste Bits! Jeremy loved them too. You have to bite down on the bit to crush the tablet, then wet your toothbrush and start brushing. It actually produces a nice foam-like texture once you get brushing. These bits leave your mouth feeling very minty fresh. Bonus points for being eco-friendly! One thing to mention- I have very sensitive, receding gums, and I found that some of the little bits did not disintegrate, acting like a scouring agent on my gums. If you have receding gums, this may not be your best bet.
  • From the Bite Toothpaste Bits website: Made with clean, vegan-friendly ingredients, our naturally whitening Fresh Mint toothpaste bits will keep your teeth healthy and our oceans clean. All subscriptions include a refillable glass jar. Remineralizes tooth enamel. Helps fight sensitivity.

Risewell Natural Hydroxyapatite Toothpaste

  • Cost: $12 for 4 oz. ($12 shipping)
  • Flavors: Wild Mint, Kids Cake Batter
  • My Take: This was the sweetest hydroxyapatite toothpaste that I tried. It has a mild mint and orange flavor and felt like a soothing lotion.
  • From the Risewell website: Wild mint flavored, Fluoride-free, paraben-free, vegan & cruelty-free, No harsh foaming agents; SLS & sulfate-free, RiseWell strengthens and restores your tooth enamel, Antiplaque & naturally whitening, Naturally flavored with beneficial essential oils, Safe enough to eat! When used twice daily, one 4 oz. tube lasts about 3 months.
  • Shop: Risewell Natural Hydroxyapatite Toothpaste

Dr. Brite Sensitivity Toothpaste

  • Cost: $8.99 for 5 oz. ($5.95 shipping)
  • My Take: This toothpaste is heavy on the coconut taste. It’s very soothing on the teeth and gums. Hydroxyapatite is the last ingredient on the list, so I’m not sure what percentage of hydroxyapatite this toothpaste contains.
  • From the Dr. Brite website: A tropical blend of Coconut & Mint work in harmony to protect your teeth & gums! Using Ayurvedic principles of coconut oil pulling as our inspiration we added a hint of soothing mint to keep it cool. In essence, we crafted paradise in a paste, just for you. Now with NEW Sulfate-Free Foaming action! Cruelty Free, Gluten Free, Paraben Free, Non-GMO, Phthalate Free, Sulfate Free.
  • Shop: Dr. Brite Sensitivity Toothpaste

Dr. Brite Extreme Whitening Mint Toothpaste

  • Cost: $9.59 for 5 oz.
  • Flavor: Fresh Mint
  • My Take: I’m including this toothpaste even though charcoal can be very abrasive on enamel. I’ve included a section below on charcoal and tooth enamel.
  • From the Dr. Brite website: Finally, selfies with no food or coffee-stained smiles. All-natural and non-gritty, that’s the secret behind our extreme whitening toothpaste. Brite white, picture perfect selfie smiles every time! Hydroxyapatite is a naturally occurring mineral that makes up 97% of our tooth enamel and has been scientifically-proven to whiten, strengthen and protect your teeth without fluoride. Naturally Removes Stains, Vegan & Gluten-Free, Fresh Mint Flavor.
  • Shop: Dr. Brite Extreme Whitening Mint Toothpaste

SHOP HYDROXYAPATITE TOOTHPASTE

SUGGESTIONS FOR HOW TO USE HYDROXYAPATITE TOOTHPASTE

Floss before you brush your teeth. Apply a pea-sized amount of hydroxyapatite toothpaste on your toothbrush and brush for 2 minutes. Spit out any excess toothpaste, but don’t rinse – allow the hydroxyapatite to sit on the tooth surface and coat the microfissures in your tooth enamel. Of course, if you want to rinse, go for it!

How a cavity forms infographic

GOOD DENTAL HABITS

No matter what toothpaste you’re using, you should also be practicing proper oral care habits. This includes avoiding certain food and beverages known for causing cavities (food and drinks high in sugar, starches and acid), brushing twice daily, flossing and getting regular dental checkups.

INGREDIENTS TO AVOID IN TOOTHPASTE

  • Triclosan– Triclosan is an antibacterial agent that’s linked to bacterial resistance and endocrine disruption. A popular brand of toothpaste that I used for years had Triclosan in it.
  • Sodium lauryl sulfate (SLS)– this is associated with canker sores and perioral dermatitis (my daughter is susceptible to this hard-to-eradicate rash around the mouth).
  • Artificial colors– Who needs blue toothpaste if it’s linked to hyperactivity in kids?
  • Parabens– These preservatives prevent the growth of bacteria, but they disrupt hormone function and were able to stimulate breast cancer cell growth in a lab study.
  • Propylene glycol– Propylene glycol is used to make personal care products thicker and better able to transport moisture to the skin. The manufacturing process introduces impurities and by-products, such as ethylene oxides and 1,4-dioxane, which are known carcinogenic materials (8).

As for whether fluoride should be in toothpaste, my dad the dentist was very pro-fluoride. It protects teeth from cavities and strengthens tooth enamel. However, ingestion of fluoride in high doses can cause fluorosis in young children (who may swallow large amounts) and high levels of fluoride in pregnant women can cause nervous system damage to the fetus (9). If you’re at all worried that your child may ingest a large amount of fluoride toothpaste, if you’re pregnant, or if you just want a fluoride-free toothpaste option, add hydroxyapatite toothpaste to your oral care routine. It also works really well for those with sensitive teeth. Whatever toothpaste you decide to use, make sure it contains either hydroxyapatite or fluoride in order to prevent cavities and strengthen tooth enamel.

HOW TO BRUSH YOUR TEETH

REFERENCES

  1. Meyer F, Amaechi BT, Fabritius HO, Enax J. Overview of Calcium Phosphates used in Biomimetic Oral Care. Open Dent J. 2018;12:406-423. Published 2018 May 31. doi:10.2174/1874210601812010406
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5997847/?_ga=2.27426748.1073827304.1599421251-2018910469.1599421251
  2. Limeback H, Enax J, Meyer F. Biomimetic hydroxyapatite and caries prevention: a systematic review and meta-analysis. Can J Dent Hyg. 2021 Oct 1;55(3):148-159. PMID: 34925515; PMCID: PMC8641555.
  3. Ramis, J., Coelho, C., Cordoba, A., Quadros, P., and M. Monjo. Safety Assessment of Nano-Hydroxyapatite as an Oral Care Ingredient according to the EU Cosmetics Regulation. Cosmetics 2018, 5, 53; doi:10.3390/cosmetics5030053.
    https://pdfs.semanticscholar.org/20a0/6a41dfadbf8097bf9878a6ed76e7b7592815.pdf
  4. Komiyama S, Miyasaka R, Kikukawa K, Hayman R (2019) Can nano-hydroxyapatite permeate the oral mucosa? A histological study using three-dimensional tissue models. PLoS ONE 14(4): e0215681. https://doi.org/10.1371/journal. pone.0215681
    https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0215681&type=printable
  5. Browning, WD, Cho, SD and EJ Deschepper. Effect of a nano-hydroxyapatite paste on bleaching-related tooth sensitivity. J Esthet Restor Dent. 2012 Aug;24(4):268-76. doi: 10.1111/j.1708-8240.2011.00437.x.
    https://pubmed.ncbi.nlm.nih.gov/22863133/
  6. Singh, A., Shetty, B., Mahesh, C.M., Reddy, V., Chandrashekar, B.S., and S. Mahendra. Evaluation of Efficiency of Two Nanohydroxyapatite Remineralizing Agents with a Hydroxyapatite and a Conventional Dentifrice: A Comparative In vitro Study. Journal of Indian Orthodontic Society. Volume 51, Issue 2, April-June 2017.
    https://journals.sagepub.com/doi/pdf/10.4103/jios.jios_13_16
  7. Ebadifar A, Nomani M, Fatemi SA. Effect of nano-hydroxyapatite toothpaste on microhardness ofartificial carious lesions created on extracted teeth. J Dent Res Dent Clin Dent Prospects. 2017;11(1):14-17. doi:10.15171/joddd.2017.003
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5390120/
  8. Amaechi BT, AbdulAzees PA, Alshareif DO, et al. Comparative efficacy of a hydroxyapatite and a fluoride toothpaste for prevention and remineralization of dental caries in children. BDJ Open. 2019;5:18. Published 2019 Dec 9. doi:10.1038/s41405-019-0026-8
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6901576/
  9. Lim, T.Y. et al. Propylene Glycol Toxicity in Children. J Pediatr Pharmacol Ther. 2014 Oct-Dec; 19(4): 277–282.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4341412/
  10. Green R, Lanphear B, Hornung R, et al. Association Between Maternal Fluoride Exposure During Pregnancy and IQ Scores in Offspring in Canada [published online ahead of print, 2019 Aug 19]. JAMA Pediatr. 2019;173(10):940-948. doi:10.1001/jamapediatrics.2019.1729.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6704756/

first image via depositphotos