Want to ditch fluoride? Dentists explain who might benefit from hydroxyapatite toothpaste

For decades, fluoride has ruled the toothpaste aisle, but the tubes, they are a-changin’. Now, a mineral called hydroxyapatite is gaining traction as fluoride faces new scrutiny. With Utah and Florida banning added fluoride in public water and federal regulators restricting kids’ fluoride supplements, you might be wondering if it’s time to make the switch.

Before you toss your old tube, it helps to know what you’re trading it for. Early research suggests hydroxyapatite toothpaste can help restore weak spots and calm sensitivity. Even so, fluoride has a much deeper body of research behind it, and dentists still recommend it for most people. Here’s what you need to know about this oral care ingredient and whether it’s right for you.

What is hydroxyapatite toothpaste, and how does it work?

Hydroxyapatite is a calcium phosphate mineral that gives your teeth and bones their hardness. The version in toothpaste is lab-made, and Japan recognized it as an anticavity ingredient back in 1993.

Like fluoride, it protects your teeth, but it goes about it in a different way. Shannon Skiba, dentist and owner of Highmark Dental in Jonesboro, Georgia, explains that hydroxyapatite lays down a mineral that closely resembles enamel, “essentially patching tiny rough spots on the tooth surface.” Conversely, fluoride works by “chemically strengthening enamel so it resists acid and can even help reverse very early decay,” she says.

Hydroxyapatite may also help remineralize areas where enamel has lost minerals and plug microscopic tubules in dentin, the softer layer beneath enamel that’s exposed when enamel wears thin or gums pull back. Those tubules lead to the nerve, which is why cold food and drinks can make you wince.

Nano versus micro hydroxyapatite

Shop around and you’ll notice many hydroxyapatite toothpastes are labeled either nano or micro. These terms describe the size of the mineral’s particles. “Nano is smaller, so theoretically it can get into smaller areas of the enamel,” says Nayson Niaraki, orthodontist and co-founder of Smilebar in Boston. “Is it better? Possibly, but I don’t think we have enough evidence to say for sure.”

That gap shows up in the research. One children’s trial found a micro-hydroxyapatite toothpaste performed about as well as a lower-strength fluoride toothpaste against early decay. But the study only ran about a year, a toothpaste company helped fund it, and it didn’t test nano, so it can’t say whether particle size makes a difference.

Hydroxyapatite vs. fluoride: What dentists want you to know

Here’s how hydroxyapatite and fluoride stack up.

Cavity prevention

In head-to-head trials, hydroxyapatite has kept pace with fluoride. In an 18-month trial of 189 adults, about 89% of people brushing with a 10% hydroxyapatite toothpaste had no new decay, compared with about 87% of those using a standard fluoride paste. But the participants were healthy 18- to 45-year-olds at low risk for cavities who used electric toothbrushes and saw a dentist every six months. It’s unclear whether the results apply to different demographics, particularly those more prone to decay. A toothpaste company also helped fund the study, which is a potential conflict of interest.

It’s impossible to ignore, though, that fluoride has the bigger body of evidence. A large 2019 review found that fluoride toothpaste prevents cavities in kids, teens and adults compared with fluoride-free paste.

If you’d like to move away from fluoride, Niaraki suggests going by your dental history. “If someone rarely gets cavities, I don’t see a big issue with trying hydroxyapatite. If someone is constantly getting cavities, I’d stick with fluoride,” he says.

Sensitivity and white spots

Sensitivity is hydroxyapatite’s strong suit. A 2023 analysis of 44 trials found hydroxyapatite products eased sensitivity by nearly 40% compared with a placebo and 23% compared with fluoride, though two of the three authors work for a company that makes hydroxyapatite toothpaste.

In March 2026, the Food and Drug Administration (FDA) also cleared a fluoride-free hydroxyapatite toothpaste for over-the-counter sensitivity relief in adults and kids. The clearance covers sensitivity only, not cavities, and was based on lab tests rather than studies in people.

Niaraki sees another potential perk. “It may also help with early white spots from mineral loss, which we sometimes see after braces.”

Swallowing and safety

Little kids swallow toothpaste. “Most children are still learning how to properly spit after brushing until they’re around 6 years old, so the amount of toothpaste they’re using on their brush and supervision by an adult is still important no matter which ingredient is in your toothpaste,” says Linda Jubiril-Taylor, pediatric dentist at Kids Smiles in Philadelphia.

That’s a concern with fluoride toothpaste, since swallowing too much while teeth are still forming can cause fluorosis, faint white marks on the enamel. Neusha Najafi, dentist and founder of DoctorSaliva, says the solution comes down to portion control. “Under age three, a smear the size of a grain of rice. From three to six, a pea-sized amount. That’s it. Fluoride toothpaste has an excellent safety record when used as directed.” Many families overdo it, though. A 2019 federal survey found nearly 40% of kids ages 3 to 6 used more toothpaste than recommended, though the survey didn’t ask which kind of toothpaste. If you’re on brushing duty, it’s important to pay attention.

That’s one reason hydroxyapatite appeals to parents. Najafi points out that it can replenish minerals in enamel and, “unlike fluoride, it doesn’t carry the same concern for dental fluorosis, but that doesn’t mean we should encourage kids to swallow it.” 

Regulation and labels

Under the FDA’s rules for anticavity toothpaste, only fluoride products can claim to prevent cavities. Hydroxyapatite toothpastes haven’t had to prove themselves the same way, so it’s up to you to read the label with a critical eye.

Najafi has a quick checklist. “First, make sure hydroxyapatite is actually listed as an ingredient,” she says. “I’d also like to know the concentration, whether it’s nano or micro hydroxyapatite, and whether the manufacturer provides any meaningful research or safety information.” For nano formulas, a 2023 European safety review found nano-hydroxyapatite with a specific rod-shaped particle profile safe at concentrations up to 10% in toothpaste, so that’s a handy number to look for. 

And watch out for big promises. “I’d be skeptical of anything claiming to regrow enamel or reverse cavities,” Niaraki says. “Once you have an actual cavity, toothpaste isn’t going to fix it.”

The fluoride debate

Fluoride is often added to toothpaste and tap water. A 2025 analysis linked higher fluoride exposure to lower IQ scores in kids, making some people wonder whether it’s doing more harm than good. There’s more to the story, though. In the drinking-water analysis, researchers found no clear link below 1.5 milligrams per liter, about twice the amount recommended for U.S. tap water, though the authors said uncertainty remains. The study also can’t prove fluoride caused the lower IQ scores, and some experts have questioned its methods. 

“Some of the recent fluoride research has raised legitimate questions about higher levels of exposure and neurological development,” Najafi says. “But exposure through drinking water at elevated concentrations isn’t the same as using a tiny amount of fluoride toothpaste and spitting it out.”

That’s why the official advice hasn’t changed. “Fluoride is still recommended by the ADA [American Dental Association],” Jubiril-Taylor says. In a statement to NPR, an ADA spokesperson acknowledged that more people are using hydroxyapatite products and that some evidence suggests they can contribute to remineralization. But the spokesperson said the evidence on clinical effectiveness “remains limited and ambiguous.”

Who should try hydroxyapatite toothpaste, and who should skip it?

If your teeth are in good shape or you’re dealing with sensitivity, hydroxyapatite toothpaste may be worth a try. For kids, Najafi calls it “a reasonable option for some children, particularly those at low risk for cavities.”

But some people are better off sticking with fluoride. “Right now fluoride has a much longer track record of large-scale cavity prevention, so I don’t recommend swapping it out entirely, especially for kids, anyone prone to cavities or patients with dry mouth or gum recession where roots are exposed,” Skiba advises.

Can you use both?

Yes. Skiba says some people brush with hydroxyapatite, then get their fluoride from a mouthwash or a quick treatment at checkups.

Switching toothpastes is another option, but Najafi doesn’t see a clear payoff. “You could use fluoride at one brushing and hydroxyapatite at another, although we don’t have strong evidence that alternating them offers an additional benefit.” She adds, “At the end of the day, consistency matters more than having two different toothpastes.” 

Hydroxyapatite toothpastes our dentists named

These are the brands our dentists mentioned, from nano to micro to a hybrid with fluoride.

Amazon

A popular fluoride-free pick for anyone curious about nano.

Amazon; background generated/edited with ChatGPT

RiseWell’s original formula uses micro-hydroxyapatite, at a 10% concentration.

Amazon; background generated/edited with ChatGPT

If you can’t decide, get both. Niaraki calls this one “interesting because it combines hydroxyapatite with fluoride.”

Amazon; background generated/edited with ChatGPT

Najafi points parents to this fluoride-free option for little brushers. RiseWell’s cake batter flavor may help win over a picky child.

Looking for more options? Browse our lineups of best toothpastes and best natural toothpastes.

When to see a dentist

Even the best toothpaste can only do so much. “If you’re seeing new cavities or sensitivity that isn’t improving after switching products, that’s your sign to come in and get it checked rather than troubleshooting it yourself,” Skiba says.

Niaraki also recommends a visit if it hurts to bite down or one tooth is especially sensitive. The same goes for white spots that seem to be growing, since chalky white patches are often the first sign of decay. And if you’ve ditched fluoride, let your dentist know.

The bottom line

Hydroxyapatite is a reasonable option to try for sensitive teeth and people with few cavities, while fluoride remains the go-to for everyone else. Your dentist can help you decide which is the right choice for you. 

Meet our experts

• Nayson Niaraki, DMD, MS, orthodontist and co-founder of Smilebar in Boston

• Shannon Skiba, DDS, dentist and owner of Highmark Dental in Jonesboro, Georgia

Our health content is for informational purposes only and is not intended as professional medical advice. Consult a medical professional on questions about your health.