For as long as I can remember, I have believed the gospel of fluoride and that without its protection, our teeth would surely rot. So when I recently bought a box of fluoride-free children’s toothpaste made in Germany for my daughter, I felt a little immoral. The toothpaste came in an unassuming blue package, without any cartoon characters or candy flavors. I thought it represented German practicality. And instead of fluoride, it contained a cavity-fighting ingredient called hydroxyapatite, which is vouched for by several dental researchers I interviewed for this article. As I clicked “buy,” I wondered if toothpaste didn’t need to contain fluoride after all.
The scientific basis for hydroxyapatite toothpaste is actually very simple. Hydroxyapatite, which is made up of calcium and phosphate, is the same mineral that primarily makes up our bones and teeth. Tooth enamel is a hard, protective layer that protects the teeth. 96% Hydroxyapatite. NASA researchers He first patented the idea of repairing teeth with a precursor to hydroxyapatite in the 1970s, but nothing came of it at the time. However, a Japanese company acquired the patent and eventually developed a popular toothpaste called Apagard. Hydroxyapatite toothpaste has been approved in Japan for preventing cavities since 1993. Approved in Canada and Canadian Dental Association ApprovedIt is sold in Europe and the European Commission has Toothpaste safe.
But fluoride continues to dominate in the United States. You’re unlikely to find toothpaste with hydroxyapatite at your local drugstore. A few boutique brands based on hydroxyapatite have sprung up, but they must be approved by the FDA before they can be sold as a cavity preventative. That’s a lengthy and expensive process, and no hydroxyapatite toothpastes have been approved yet. Meanwhile, the American Dental Association (ADA) has said: Stamp of Approval Only toothpaste that contains fluoride.
Fluoride works amazingly well. It incorporates itself into the enamel structure of the tooth itself, forming mineral crystals that are significantly more resistant to cavity-causing acids than the tooth’s natural material, according to Bernhard Gans, a scientist at the University of Toronto’s School of Dentistry. “The orthodox wisdom in dentistry has always been that fluoride is a good thing.”
The problem with fluoride is that it becomes toxic in very high concentrations. Too much fluoride can cause: FluorosisPeriodontal disease, in mild cases, can leave teeth mottled and in severe cases structurally weakened. It can do the same to bones. More controversially, high levels of fluoride in drinking water (higher than recommended levels in the U.S., but below current EPA limits) can also lead to: Leads to lower IQ in childrenToothpaste typically contains over 1,000 times the amount of fluoride recommended for drinking water. Of course, the amount of toothpaste used is much less than the amount of water, and it’s not meant to be swallowed, but young children have a hard time spitting out the toothpaste.
Hydroxyapatite is a way around the fluoride controversy. It has the cavity-preventing benefits of fluoride, but without the risks. Bennett Amaechi, a professor of dentistry at the University of Texas Health Science Center at San Antonio, says he now recommends it to parents who are worried about fluoride. He has worked with toothpaste companies to study hydroxyapatite, and Felicitas Bidlack told me the same thing about its usefulness. Bidlack is not a dentist, but she studies tooth enamel and was recommended to me by the American Dental Association. The American Dental Association is far from being anti-fluoride. But I would probably choose hydroxyapatite for kids under 2, who are still learning not to swallow toothpaste. “That’s what I would choose as a mother,” she told me.
Fluoride toothpaste faces a dilemma, Bidlack adds: Sweet candy flavors, bright colors and glitter toothpaste are tempting enough to make kids want to brush their teeth, but if they’re too tempting, kids might eat it. “If you put fluoride in this tasty goo that kids put in their mouths, there’s definitely a risk of unintentional ingestion,” says Gans, who co-authored a paper on hydroxyapatite with scientists at German toothpaste maker Dr. Wolff Group. With very young children, he adds, “I would actually stand up and say no to any fluoride whatsoever.”
These conversations were clarification for me, as they cleared up the conflicting advice I’d been receiving about fluoride in one-year-olds. Toothpaste marketed for children under the age of two in the U.S. doesn’t actually contain fluoride (it usually contains a sugar alcohol called xylitol). And toothpaste that contains fluoride is labeled as not suitable for children under two unless recommended by a doctor. However, the American Academy of Pediatrics states: Guidelines Pediatricians repeatedly recommend using fluoride toothpaste as soon as the first tooth appears, but only using a rice-sized amount will limit fluoride exposure. So is fluoride a good thing? Is it safe? Wouldn’t it be nice to never have to come into contact with fluoride at all?
Hydroxyapatite does not have as long a track record as fluoride, but the evidence so far is good. Clinical test have continue Studies of children and adults over a period of six months to a year and a half, mostly funded by toothpaste manufacturers, have found that hydroxyapatite and fluoride are about equally effective at preventing cavities. Chemically, hydroxyapatite is not as resistant to cavity-causing acids as the mineral formed by fluoride, but Gans says that daily brushing replenishes enough hydroxyapatite that the actual preventative effect is the same. The mineral may have some other benefits as well. Studies have shown that hydroxyapatite is effective at preventing cavities. Reduces tooth sensitivity And that The amount of bacteria on the teethThe only thing it can’t do is resolve the controversy over fluoridating drinking water, a public health measure used in most of the United States to prevent tooth decay. Hydroxyapatite cannot be put into drinking water because it doesn’t dissolve at neutral pH. “The tap water would turn milky,” Gans says. “All the pipes would probably get clogged within a few days.”
The researchers I spoke to believed that fluoride could still have a place as a treatment or toothpaste for adults, especially if they were careful not to swallow too much. Amaechi brushes his teeth with Colgate, which he’s used his whole life, because he doesn’t see a need to change his habits as an adult. But he does recommend hydroxyapatite for certain situations, such as for patients. Dry mouthHe says they may particularly benefit from this regimen.
Of course, age 2 isn’t some magic threshold where the math suddenly changes when it comes to toddler toothpaste — in fact, Canada recommends forgoing fluoride for most children. Up to 3 years oldIn the U.S., fluoride-free options for children are expanding, even though hydroxyapatite is not FDA-approved. While German children’s toothpaste only comes in a boring white mint flavor, we found that several brands in the U.S. already sell more appealing flavors, such as orange creamsicle and birthday cake.
