Dentists weigh in on the rise of fluoride-free toothpaste

A growing number of patients are asking their dentists about fluoride-free toothpaste, shifting away from the standard oral care routine that has dominated the market for decades. This change is driven largely by social media trends and a specific interest in an ingredient called hydroxyapatite.

Dr. Jin-Ho Phark, an associate professor of clinical dentistry at the University of Southern California, reports seeing this interest in his practice and among his students. He notes that patients frequently ask about calcium phosphate minerals, particularly after seeing hydroxyapatite products promoted by influencers online.

The traditional use of fluoride in toothpaste dates back to the late 1950s when Procter & Gamble released Crest nationally. Since then, fluoride has been the standard active ingredient in oral care products worldwide. Health officials credit these products with protecting the outer layer of teeth from bacteria that cause cavities.

Skepticism toward fluoride has grown in recent years, partly due to public criticism from Health Secretary Robert F. Kennedy Jr. He has linked water fluoridation to various health issues, including arthritis, bone fractures, and neurodevelopmental disorders. This scrutiny has made some consumers hesitant to use fluoride, especially for their children.

Bennett Amaechi, a professor of dentistry at the University of Texas at San Antonio, says there is no concrete evidence that fluoride harms children's IQ at recommended levels. He points out that studies linking fluoride to lower IQ scores generally involved exposure to levels more than double the amount found in U.S. water supplies.

Hydroxyapatite is a mineral that resembles the structure of tooth enamel, which is composed mostly of calcium and phosphate. Proponents of hydroxyapatite toothpaste argue it can help with sensitivity and remineralization. Many of these products use nano-hydroxyapatite, a form with smaller particles designed to penetrate the pores of enamel more easily.

Research comparing the two ingredients is still developing. A 2021 study in the journal Scientific Reports tracked 177 children for nearly a year and found similar outcomes for tooth decay between those using hydroxyapatite and those using fluoride. That study was funded by the Dr. Wolff Group, a German company that owns brands producing hydroxyapatite toothpaste.

A subsequent study in 2023 in the journal Frontiers in Public Health tracked 171 adults for 18 months and also found similar results in preventing decay. However, Dr. Livia Tenuta, an associate professor at the University of Michigan School of Dentistry, notes that these studies often recruit participants with low risk of tooth decay, leaving a gap in long-term data for high-risk patients.

For those open to both options, Amaechi advises using fluoride because it has a longer history of extensive research supporting its efficacy. Tenuta agrees, recommending fluoride as the best option based on the current volume of evidence. The American Dental Association acknowledges that hydroxyapatite may contribute to remineralization but states that clinical effectiveness remains limited and ambiguous.

The ADA continues to recommend brushing twice daily for two minutes with fluoride toothpaste, flossing daily, and visiting a dentist regularly. While hydroxyapatite products can cost more than a dollar per ounce more than fluoride alternatives, they are not yet considered a standard replacement in professional dental guidance.