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Hydroxyapatite toothpaste – an alternative to fluoride toothpaste?

By Dental Tribune International
July 30, 2019

WÜRZBURG, Germany: The use of hydroxyapatite has been investigated and discussed for years as an artificial tooth enamel to prevent loss of tooth structure by erosion and also to contribute to the regeneration of natural tooth enamel. However, we need more scientific evidence to prove its benefits. A recent German study has now shown that hydroxyapatite can be as effective as fluoride for prophylaxis.

Recent in vitro studies have suggested that microcrystalline hydroxyapatite (HAP) particles might contribute to the prevention of demineralisation and the stimulation of remineralisation on enamel and dentine surfaces. The present clinical study assessed the caries‐inhibiting effect of a fluoride‐free HAP dentifrice with regular use by a group of patients with high caries risk.

Researchers selected a group of individuals with a relatively high caries risk –  133 patients aged 11–25 years scheduled to undergo fixed appliance orthodontic treatment. They assigned them to two randomised groups - a test group comprising individuals using a 10% hydroxyapatite toothpaste was compared with a control group that brushed with a 350 ppm and 1050 ppm fluoride toothpaste.

The researchers performed an oral examination before the start of fixed appliance orthodontic therapy and repeated it every four weeks after that for half a year.  They used the International Caries Detection and Assessment System to assess the vestibular enamel surfaces, along with two indices - the plaque index and the gingival index.

Results showed a significant increase in enamel caries during the observation period. However, fluoride and hydroxyapatite did not differ significantly from each other. The test group with hydroxyapatite use showed 54.7% of patients having a carious lesion after six months, whereas the control group with fluoride use showed 60.9% of patients with a lesion. The plaque and gingival indices also increased slightly, without any significant difference.

The results of this study show that hydroxyapatite toothpaste can serve as an alternative to fluoride toothpaste.

The study, titled “Impact of a non‐fluoridated microcrystalline hydroxyapatite dentifrice on enamel caries progression in highly caries‐susceptible orthodontic patients: A randomized, controlled 6‐month trial”, was published in the May 2019 issue of the Journal of Investigative and Clinical Dentistry.


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