A structured narrative review of 15 clinical studies found that HAp is a safe and effective alternative to fluoride, particularly for children or those at risk of fluoride overexposure, with similar caries prevention efficacy and additional advantages in managing hypersensitivity and molar-incisor hypomineralization.

An updated meta-analysis of 18 studies concluded that hydroxyapatite-containing oral care products are effective as a fluoride-free anti-caries ingredient, and as a sole active ingredient that is safe if swallowed, HAp is an ideal fluoride substitute for toothpastes and mouthwashes for young children and adults alike.

This landmark 18-month RCT found that in 89.29% of subjects using the HAp toothpaste, there was no increase in the DMFS (Decayed Missing Filled Surfaces) index — virtually identical to the 87.36% result in the fluoride group — leading the authors to conclude not just non-inferiority but effective equivalence between HAp and 1,450ppm sodium fluoride toothpaste.  Critically, HAp is safe if accidentally swallowed and does not interfere with the oral microbiome or stain the tooth surface  — unlike fluoride.

In this large 24-month triple-blind RCT, the HAp group exhibited a statistically significant reduction in enamel lesions compared to the standard fluoride group (P < .01), with nearly three-quarters of active caries lesions becoming inactive by the 2-year follow-up — a markedly superior result to the mono-fluoride control group.

Synthetic HAp toothpastes were originally developed by NASA for astronauts experiencing bone and tooth mineral loss in zero gravity. The Japanese company Sangi Ltd acquired the rights in 1970 and launched the first HAp toothpaste, with HAp approved as an anti-caries agent in Japan in 1993, reaching European markets in 2006 and Canada in 2015.  A compelling origin story for the ingredient.

The first scientific studies on HAp in dentistry date back to the 1980s, conducted initially in Japan, with the first biomimetic synthetic toothpaste containing HAp as a remineralising agent launched in 2006 — establishing a now 40-year evidence base for the ingredient’s safety and efficacy in oral care.