Let’s talk a little bit about tooth enamel.
Made from hard minerals, enamel is super strong – the hardest tissue in your body. But it’s not invulnerable. Some of those minerals are constantly being lost, mostly due to acids interacting with the tooth surface.
Those acids can come from the food and drink you consume, with sugary sodas and fruit juices being the worst offenders. But they’re also generated by the harmful bacteria that feast on sugars and other fermentable carbohydrates.
No matter the source, acids immediately attack a tooth’s mineral structure, creating tiny pores and weakening the enamel.
Fortunately, your body is continually delivering new minerals to the enamel through your saliva to help repair the damage. This is another reason why we stress healthy eating so much: to make sure your body has the raw materials it needs for this biological process – in this case, mainly calcium and phosphorus, but also a handful of trace minerals.
Mostly, though, it’s the calcium and phosphorus that come together in a unique and intricate way to form the mineral compound that makes up the bulk of your tooth enamel (and about 70% of the dentin layer below it): hydroxyapatite, or HAP for short.
Imagine tiny crystal structures packed together so tightly and precisely that they form an incredibly robust material. Picture them as microscopic building blocks that interlock and overlap, creating a surface that can withstand a lot of pressure.
At the same time, HAP is rather flexible at the molecular level, which is what allows it to be remineralized. The calcium and phosphate ions in the crystalline structure can move around, allowing your teeth to heal themselves in small ways.
Now, you may have noticed that there’s a mineral we haven’t mentioned being key to this process. If you haven’t, we’ll give you a hint: It starts with the letter F and is routinely added to drinking water and toothpaste. It’s also come under even greater scrutiny lately due to its negative effects on children’s developing brains, not to mention other documented health risks.
Sure, fluoride can be taken up by tooth enamel, too, to create a compound called fluorapatite, but wouldn’t it make more sense to support remineralization by giving the teeth what they’re actually made of?
We think so, as do increasing numbers of dentists who have taken note of the scientific evidence showing that hydroxyapatite toothpastes can be at least as, if not more, effective than fluoride.
And that brings us to a new systematic review in the Journal of Dentistry to see if oral care products with hydroxyapatite could protect teeth from cavities, especially as an alternative to fluoride.
To conduct their review, the researchers carefully searched three major medical and scientific databases for relevant studies – those that included participants of all ages and types of dentition (primary teeth, permanent teeth, or a mix of the two) who used hydroxyapatite toothpastes, mouthwashes, or gels. They specifically sought studies that compared HAP products to placebos or fluoridated products.
Out of 18 studies that made the cut, the team focused on the 13 most rigorous ones, which included 5 clinical trials and 8 lab-based studies. They used a standardized grading system to evaluate the quality of these studies and analyzed the results using advanced statistical methods.
Their analysis led them to the conclusion that yes, HAP can effectively prevent tooth decay, no fluoride needed. And it has the added benefit of being safe to swallow, making it especially suited for children’s oral care products.
As Dr. Bicuspid noted in their coverage of the study,
Clinical studies have consistently shown that HAP toothpaste can be as effective as fluoride in preventing dental caries. Early trials demonstrated a 35% to 56% reduction in caries among children using 5% HAP toothpaste compared to placebo. Later studies showed 10% HAP to be as effective as fluoride in slowing enamel caries in orthodontic patients, and HAP was more effective than fluoride for remineralizing white-spot lesions postorthodontics, according to the results.
“The evidence,” note the authors of the study, “…has expanded.”
Indeed, this growing body of evidence confirms what we’ve long understood about the remarkable capabilities of our bodies and the value of working in harmony with our body’s own healing mechanisms. The science behind hydroxyapatite not only validates this approach but opens up new possibilities for maintaining optimal oral health through safe, effective, and biocompatible means.
