Fluoride vs Hydroxyapatite

(Note from Coast Pediatrics: We have been getting questions from our patients about hydroxyapatite for prevention of cavities, and asked Dr Reid to address them for us.  We do consider fluoride to be the gold standard, but it is always nice to be informed about options.)

by Breanne Reid, DDS

We all want to avoid cavities!  Do you know how they form?  Cavities begin when bacteria present in the mouth feed on sugars and fermentable carbohydrates that we eat.  They then digest the sugars and carbohydrates and release acid.  These acids gradually break down enamel, leading to loss of the natural minerals in the tooth via a process called demineralization.  If left unchecked, the enamel becomes porous, weak, and eventually a cavity forms.

When we think about preventing cavities and protecting our teeth, fluoride is usually the first thought that comes to mind.  The American Academy of Pediatric Dentistry recognizes that drinking fluoridated water (at a level of 0.7 ppm) and brushing with fluoridated toothpaste twice daily are the most effective methods of reducing the prevalence of dental cavities, or “caries” in children.  Fluoride has been shown to be safe and effective in small doses.  The recommended dose is 0.7 ppm in the water and a pea-size amount of toothpaste on the toothbrush for children age 3 and older.

Fluoride acts in three important ways to prevent caries:

1. Strengthens the existing enamel through creation of fluoroapatite.
2. Remineralizes weakened enamel.
3. Disrupts the bacteria’s metabolism & reduces acid production.

Despite many documented, peer reviewed studies that support the use of fluoride, some may choose to avoid fluoride due to concerns about fluorosis (stains on teeth) or known fluoride sensitivity.  What are some alternatives that you can use to protect your teeth?  There have been scientific, well-controlled studies that show there are other options. In the study “In Vitro Effects of Three Fluoride-Free Pastes on Remineralization of Initial Enamel Carious Lesions” recently published in the Journal of Pediatric Dentistry by Biria DDS, Mac et al, the authors used 3 fluoride free pastes on extracted, demineralized teeth and then tested the hardness of them after 30 days.  The three different pastes contained either nanohydroxyapatite, casein phosphopeptide-amorphous calcium phosphate, or calcium sodium phosphosilicate.  All 3 pastes significantly remineralized the incipient (very minor) enamel lesions after 30 days.

In stores you will now be able to find toothpastes that contain hydroxyapatite instead of fluoride.  How does hydroxyapatite prevent cavities?  It remineralizes the weakened enamel by filling in microscopic cracks and weak spots on enamel, making teeth smoother, stronger, and more resistant to acid attack.  It is biocompatible and safe since it’s the same mineral that teeth are naturally made of.  Additionally, it is safe to swallow (in small doses) and non-toxic.  It is a good alternative choice for children, pregnant women, and anyone sensitive to fluoride.  Your pediatric dentist is a great resource for discussing whether a toothpaste with hydroxyapatite is an option for your family.