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Calcium phosphate mineral (nano/micro)

Hydroxyapatite (in toothpaste)

Hydroxyapatite toothpaste looks about as good as fluoride toothpaste for preventing early decay in trials of 6 to 18 months, and it reduced tooth sensitivity within 2 to 4 weeks, but fluoride has far more evidence, many hydroxyapatite trials come from one manufacturer, and the non-inferiority margins used were wide. Treat it as a reasonable fluoride-free option, not proven to be better than fluoride.

The EU's scientific committee (SCCS) considers nano-hydroxyapatite safe in toothpaste up to 29.5% and in mouthwash up to 10%, but not when it contains needle-shaped particles.

Updated
10 October 2026
A toothbrush with white toothpaste beside a glass
At a glance
Last reviewed 10 October 2026
Evidence
Moderate
Best for
Fluoride-free caries prevention
Typical form & use
Fluoride-free toothpaste; 15% in a trial
Onset
2 weeks
Safety
Less evidence than fluoride; avoid needle-shaped nano form. No interactions in our data.
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What it's used for

Evidence is rated per use. The same ingredient can be strong for one thing and traditional for another.

UseEvidenceWhat the research shows
Caries prevention versus fluoride toothpasteModerate

In an 18-month double-blind trial of 189 adults, 89.3% of people using a fluoride-free hydroxyapatite toothpaste had no increase in decayed, missing or filled surfaces against 87.4% with 1450 ppm fluoride, and the authors declared it non-inferior within a 20% margin; three authors worked for the maker.

In 207 children, a hydroxyapatite toothpaste used three times daily was non-inferior to fluoride on new enamel lesions over about 11 months. In 150 orthodontic patients, new lesions occurred in 56.8% with hydroxyapatite and 60.9% with 1400 ppm fluoride over 6 months, with no significant difference.

The benchmark is stronger: a Cochrane review of 96 fluoride trials rated 1000 to 1450 ppm fluoride toothpaste as reducing caries versus non-fluoride toothpaste with high- to moderate-certainty evidence, so fluoride is rated 4 and hydroxyapatite 3.2,3,4,1

Tooth sensitivity (dentine hypersensitivity)Moderate

In a double-blind trial of 105 people, a fluoride-free 15% nano-hydroxyapatite toothpaste reduced cold-air and touch sensitivity and VAS pain at 2 and 4 weeks more than fluoride toothpaste or a placebo (all differences P < .001).

A systematic review of 74 randomised trials of desensitising treatments found that hydroxyapatite was among the agents with a significant reduction at medium term (up to 1 month) and long term, but this compared against starting levels. Trials are short, often on single products, and come from a small number of groups.7,8

Remineralising early enamel lesionsLimited

A 2025 systematic review found four in situ randomised trials in people under 25 comparing fluoride-free hydroxyapatite with fluoride toothpastes. New and progressing lesions did not differ significantly (risk ratio 0.98, 95% CI 0.85 to 1.12), and differences in lesion size (P < 0.0001) and fluorescence (P = 0.01) were recorded after 6 months. The authors conclude it could be an effective alternative to fluoride, from only four studies.5,6

How much

Ranges below are what studies used and what supplements commonly contain. They are not a recommendation for you. Start at the low end.

Caries trials
Brushing with fluoride-free paste, vs 1400–1450 ppm fluoride2,3,4
Adults used it for 18 months, children three times daily for about 11 months, orthodontic patients for 6 months. The abstracts do not state the hydroxyapatite percentage.
Sensitivity trial
15% nano-hydroxyapatite, twice daily for 4 weeks7
The strength in the 105-person trial.
EU safety limit (SCCS 2025)
Up to 29.5% in toothpaste, 10% in mouthwash9
For nano-hydroxyapatite meeting the opinion's particle specifications; it does not apply to any material that contains needle-shaped particles. The committee says ingested nanoparticles dissolve rapidly in stomach fluid and raise no nano-specific safety concern.
Timing · The adult and orthodontic caries trials used it as the regular toothpaste; the child trial used it three times a day. The sensitivity trial brushed twice a day.With food? · Not applicable. The SCCS opinion says swallowed nanoparticles dissolve rapidly in gastric fluid.How long to trial · Give it 2 to 4 weeks for sensitivity, which is when the trials measured a response. Caries prevention cannot be judged by feel; it shows up over months on a dentist's examination.

How people take it

Fluoride-free hydroxyapatite toothpasteUsed as the daily toothpasteWhat the caries trials tested, mostly a microcrystalline form; the 2023 trial's authors included employees of one manufacturer. Not all products on the market are the ones tested.
Nano-hydroxyapatite toothpasteUp to 15% in a trial; EU limit 29.5%Assessed by the SCCS as a nanomaterial. The SCCS excludes needle-shaped particles.
MouthwashUp to 10% (EU limit)Covered by the SCCS opinion. We did not review mouthwash trials.

Safety

Who should avoid
  • Products with needle-shaped nano-hydroxyapatite — SCCS opinions exclude it and flagged toxic concern in 2018
  • Relying on it alone if your dentist has advised fluoride for high decay risk
  • Mouthwash and spray products — we did not review trials of them
Known interactions
No interactions in our data. Absence of a flag is not clearance.

Questions people ask

Does hydroxyapatite toothpaste work as well as fluoride?

In randomised trials lasting 6 to 18 months it was not statistically worse than fluoride toothpaste at preventing early decay, but the margins allowed were wide (20%) and several trials came from the maker's scientists. Fluoride's benefit is supported by a Cochrane review of 96 trials, so the evidence for hydroxyapatite is weaker and shorter.

What are the side effects of hydroxyapatite toothpaste?

The adult trial describes it as safe, but the abstracts we read give no adverse-event data.

The SCCS considered nano-hydroxyapatite safe in toothpaste at up to 29.5% and in mouthwash up to 10%. The exception is needle-shaped particles, which the committee flagged as a concern in 2018 and excludes from its later opinion. We found no long-term safety studies in children.

Does hydroxyapatite help sensitive teeth?

Probably. A 105-person trial found a 15% nano-hydroxyapatite toothpaste lowered sensitivity at 2 and 4 weeks versus fluoride and placebo toothpastes, and a systematic review of 74 trials found hydroxyapatite among the agents that reduced sensitivity. The trials are short and small, so it is a reasonable thing to try for a month.

Is nano-hydroxyapatite safe?

The EU SCCS concluded in 2025 that it is safe at up to 29.5% in toothpaste and 10% in mouthwash, provided the particles are not needle-shaped and meet its specification. It noted that swallowed nanoparticles dissolve rapidly in gastric fluid. The same committee had raised concerns about needle-shaped particles in 2018.

Sources (10)

  1. Systematic review Walsh T, Worthington HV, Glenny AM, Marinho VC, Jeroncic A. Fluoride toothpastes of different concentrations for preventing dental caries. Cochrane Database Syst Rev. 2019.
  2. Randomised controlled trial Paszynska E, Pawinska M, Enax J, et al. Caries-preventing effect of a hydroxyapatite-toothpaste in adults: a 18-month double-blinded randomized clinical trial. Front Public Health. 2023.
  3. Randomised controlled trial Paszynska E, Pawinska M, Gawriolek M, et al. Impact of a toothpaste with microcrystalline hydroxyapatite on the occurrence of early childhood caries: a 1-year randomized clinical trial. Sci Rep. 2021.
  4. Randomised controlled trial Schlagenhauf U, Kunzelmann KH, Hannig C, et al. Impact of a non-fluoridated microcrystalline hydroxyapatite dentifrice on enamel caries progression in highly caries-susceptible orthodontic patients: a randomized, controlled 6-month trial. J Investig Clin Dent. 2019.
  5. Systematic review Chatzidimitriou K, Theodorou K, Seremidi K, Kloukos D, Gizani S, Papaioannou W. The role of hydroxyapatite-based, fluoride-free toothpastes on the prevention and the remineralization of initial caries lesions: a systematic review and meta-analysis. J Dent. 2025.
  6. Systematic review Pawinska M, Paszynska E, Amaechi BT, Meyer F, Enax J, Limeback H. Clinical evidence of caries prevention by hydroxyapatite: an updated systematic review and meta-analysis. J Dent. 2024.
  7. Randomised controlled trial Vano M, Derchi G, Barone A, Covani U. Effectiveness of nano-hydroxyapatite toothpaste in reducing dentin hypersensitivity: a double-blind randomized controlled trial. Quintessence Int. 2014.
  8. Systematic review Marto CM, Baptista Paula A, Nunes T, et al. Evaluation of the efficacy of dentin hypersensitivity treatments: a systematic review and follow-up analysis. J Oral Rehabil. 2019.
  9. Regulator opinion Scientific Committee on Consumer Safety (SCCS). Scientific opinion on hydroxyapatite (nano) - Submission IV, SCCS/1677/25, adopted 26 June 2025. European Commission.
  10. Regulator opinion Scientific Committee on Consumer Safety (SCCS). Opinion of the SCCS: revision of the opinion on hydroxyapatite (nano) in cosmetic products. Regul Toxicol Pharmacol. 2018.

Reader notes

Experiences and questions from readers, read by an editor before they appear. They are personal accounts, not evidence, and are not medical advice.

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Last reviewed 10 October 2026 · Next review April 2027 · How we rate evidence