How Does Fluoride Toothpaste Work?

Your teeth have an outer covering called enamel that is made up of calcium and phosphate. Your saliva also contains calcium and phosphate that constantly bathe your teeth. These minerals keep your teeth strong.

Bacteria found in cavities can break down food particles and create an acidic environment in your mouth. This acidic environment is harsh and can strip away these beneficial minerals from the surfaces of your teeth. This process is called demineralization.

The fluoride in fluoridated toothpaste works by:

Teaming up with the calcium and phosphate in your saliva and teeth to form a compound called fluorapatite. This compound looks like a crystal lattice (apatite crystal lattice).
Covering demineralized enamel with the more acid-resistant fluorapatite. This remineralizes the teeth, restores their strength, and protects it from further damage by acid.

How Does Hydroxyapatite Toothpaste Work?

Hydroxyapatite is a form of calcium that makes up 97% of your tooth enamel and nearly 70% of the dentin of your teeth.

The rest of your enamel is actually composed of water, collagen, and other proteins.

Hydroxyapatite is absorbed by the teeth and fills the enamel fissures caused by demineralization.

The most widely studied type of hydroxyapatite is nano-hydroxyapatite. Toothpaste that contains nano-hydroxyapatite has particle sizes between 20-80 nanometers (nm). Because of its small size, it can insert into really small spaces, which leads to better benefits.

Unlike fluoride, hydroxyapatite works by:

Remineralizing enamel from within, reaching the innermost part of a dental cavity
Binding to plaque and harmful bacteria in our mouth

ow does Hydroxyapatite Compare to Fluoride in Efficacy?

When it comes to which toothpaste is more efficient, there is really no difference between hydroxyapatite and fluoride toothpastes.

One study compared 10% hydroxyapatite with 500 ppm F− (amine fluoride), which dentists typically prescribe.² The researchers discovered that the 10% hydroxyapatite worked just as well as 500ppm F− for remineralization and lesion depth (LD) reduction.

Benefits of Hydroxyapatite over Fluoride Toothpastes

Both fluoride and hydroxyapatite can remineralize tooth structure, but here’s why I prefer to recommend hydroxyapatite over fluoride:

Oral microbiome friendly: Although both have antibacterial properties, fluoride kills decay-causing bacteria and some good bacteria. On the other hand, hydroxyapatite does not kill the bacteria. It prevents harmful bacteria from attaching to the enamel.³
Fortifies enamel: Hydroxyapatite can increase the microhardness of enamel.⁴ The coating of hydroxyapatite reinforces the teeth better than the fluorapatite coating.
Non-toxic: Hydroxyapatite is biomimetic.⁵ There are no side effects with hydroxyapatite—in fact, it’s safe enough to swallow the entire tube of toothpaste! With fluoride, on the other hand, there’s a poison control label on the tube, and overexposure causes dental and skeletal fluorosis.
Kid-friendly: At an early age, children don’t have full control over swallowing and can ingest large amounts of toothpaste.⁶ When this happens, the fluoride in toothpaste can get absorbed into the bloodstream and cause dental fluorosis (a change in the appearance of tooth enamel). Toothpaste that contains hydroxyapatite reduces the risk of fluorosis.
Whitens: Hydroxyapatite toothpaste has been shown to lighten the shade of the teeth without the help of any additional abrasives or whitening agents.⁷

Is Fluorapatite Stronger than Hydroxyapatite?

Fluorapatite is generally considered to be stronger and more resistant to acid dissolution than hydroxyapatite. Here’s a brief comparison between the two:

Composition: Both fluorapatite and hydroxyapatite are forms of calcium apatite, which is the main mineral component of tooth enamel. The primary difference lies in their chemical composition. Fluorapatite contains fluoride ions (F-) substituted for some hydroxyl ions (OH-) in the crystal structure of hydroxyapatite. This substitution makes the crystal structure of fluorapatite more stable and less susceptible to acid attack.
Resistance to acid dissolution: Fluorapatite is more resistant to acid dissolution than hydroxyapatite. Acidic environments, especially when caused by bacteria metabolizing sugars, can lead to demineralization of tooth enamel. The presence of fluoride in fluorapatite helps to inhibit acid production by bacteria and makes the enamel more resistant to the acid attacks that can lead to tooth decay.
Strength and hardness: Fluorapatite is generally considered to be stronger and harder than hydroxyapatite. The presence of fluoride ions in the crystal lattice of fluorapatite strengthens the structure and enhances its ability to resist mechanical stress and wear. This increased strength contributes to the overall durability of tooth enamel.
Remineralization potential: Fluorapatite has a higher affinity for incorporating ions like calcium and phosphate during the remineralization process than hydroxyapatite. This means that when enamel is demineralized, fluorapatite is more effective in replenishing and restoring the lost minerals, helping to repair early signs of tooth decay.

It’s worth noting that while fluorapatite is more resistant to acid dissolution and stronger than hydroxyapatite, the natural enamel in teeth contains a mixture of both forms. The presence of both hydroxyapatite and fluorapatite in the enamel structure contributes to its overall strength and resilience. Additionally, the benefits of fluoride extend beyond the mineral composition of the enamel and include its antibacterial properties and effects on oral health.

Should I Switch to Hydroxyapatite Toothpaste?

To me, this is a no-brainer. If you have a better alternative to fluoride toothpaste and it’s non-toxic, why wouldn’t you?

To most dentists, this is a no-brainer as well—however, fluoride is still taught as the “gold standard” in dental schools, and there are still some dentists out there who might be leery of hydroxyapatite. If this is your dentist, send them the research!

I recommend everyone talk to their dentist about switching to a hydroxyapatite toothpaste, especially the following categories of people:

Pregnant women
People who live in areas with fluoridated water supply
Babies and children, especially if they are below the age of six.
People with sensitive teeth, as hydroxyapatite treats the root cause of sensitivity.⁹

Which Toothpaste Brands Contain Hydroxyapatite?

There are two brands of hydroxyapatite toothpaste brands I recommend to readers because I use them myself and they also have an appropriate concentration of hydroxyapatite to be efficacious. There are many hydroxyapatite toothpastes out there, unfortunately, that don’t contain enough of the ingredient to have an effect—if you’re not sure, email the company and ask for the concentration. It should be 15% or more.

Should you Use Fluoridated or Non-Fluoridated Toothpaste?

Few minerals are as controversial as fluoride. For decades, people worldwide have questioned whether we should be using it as a necessary ingredient in toothpaste. So, should we be using fluoridated toothpaste, or should we opt for non-fluoridated products?

What is Fluoride?

Fluoride is a naturally occurring mineral found in freshwater and seawater. The mineral is also found in our bones and teeth. In the 1940s, scientists realised the link between high levels of naturally occurring fluoride in some communities’ water supplies and low levels of tooth decay. Fluoride was added to drinking water for the first time in 1945 in Michigan, while in Australia fluoride was added to the water supply in the 1960s.

Today, around 89% of the Australian population has fluoridated drinking water in their homes. The presence of fluoride in our water and toothpaste, as well as our improved diet and oral hygiene has seen a significant decrease in dental decay. The Australian National Health and Medical Research Council has found water fluoridation reduces tooth decay by 26-44% in children and adolescents and by 27% in adults. Drinking fluoridated water from an early age has been found to reduce the rate of tooth decay in adults.

What Are the Benefits of Using Fluoridated Toothpaste?

Fluoridated toothpaste offers several benefits for maintaining oral health. Here are some of the advantages of using toothpaste containing fluoride:

Strengthening tooth enamel: Fluoride helps to strengthen tooth enamel, which is the outer protective layer of the teeth. It promotes a process called remineralization, where essential minerals such as calcium and phosphate are absorbed by the enamel, making it more resistant to acid attacks and tooth decay.
Preventing tooth decay: Fluoride inhibits the growth of bacteria and reduces their ability to produce acid, which is a leading cause of tooth decay. Regular use of fluoridated toothpaste can significantly reduce the risk of cavities and decay in both children and adults.
Reversing early signs of tooth decay: In the early stages of tooth decay, fluoride can reverse the process by promoting remineralization. It can repair the weakened areas of enamel before they progress into cavities.
Protecting sensitive teeth: Fluoridated toothpaste can help reduce tooth sensitivity by strengthening the enamel and blocking exposed dentin tubules. This makes teeth less susceptible to pain caused by hot, cold, sweet, or acidic foods and beverages.
Supporting overall oral health: By preventing tooth decay and cavities, fluoride helps maintain good oral health. Healthy teeth contribute to proper chewing and digestion, clear speech, and a confident smile.
Cost-effective preventive measure: Using fluoride toothpaste is a simple and cost-effective preventive measure that can save you money in the long run. Regular brushing with fluoride toothpaste can reduce the need for costly dental treatments such as fillings, root canals, or extractions.

It’s important to note that while fluoride provides significant benefits, it should be used in moderation. It is recommended to follow the guidelines provided by dental professionals and use fluoride toothpaste appropriate for your age and risk of tooth decay.