The oral wellness guide
Hydroxyapatite vs. fluoride toothpaste
Understand the ingredients. Find your everyday fit.
Which one should you choose?
Fluoride is the established choice for cavity prevention. Hydroxyapatite has promising clinical evidence, but results depend on the formula studied. Your cavity risk, preferences and dentist’s advice should guide the choice.
Compare the ingredientsTwo ingredients. Different evidence.
Start with what each ingredient does, then look at the complete toothpaste. An ingredient name alone cannot tell you everything about a formula.
| Fluoride | Hydroxyapatite | |
|---|---|---|
| What it is | A mineral used in toothpaste to help prevent cavities. | A calcium phosphate mineral also found in teeth. Toothpaste uses manufactured particles. |
| How it helps | Helps strengthen enamel and replace minerals lost in early decay. | Studied for remineralization and protecting tooth surfaces from mineral loss. |
| What to know | Decades of cavity-prevention research. The ADA requires fluoride in toothpastes carrying its anticavity Seal. | Encouraging clinical studies of specific formulas. Concentration, particle characteristics and the full formula matter. |
Sources: ADA toothpaste guidance and Paszynska et al., 2023.
Read the study. Know its limits.
An 18-month randomized trial in adults compared a 10% hydroxyapatite toothpaste with a 1,450 ppm fluoride toothpaste. Of 171 people who completed the study as planned, 89.3% in the hydroxyapatite group and 87.4% in the fluoride group had no increase in the study’s measure of decayed, missing or filled tooth surfaces.
The hydroxyapatite formula met the trial’s predefined non-inferiority criterion. That finding supports the formula tested; it does not establish that every hydroxyapatite toothpaste equals every fluoride toothpaste.
Read the full study: Paszynska et al., Frontiers in Public Health, 2023 (PDF). Funded by Dr. Kurt Wolff and two universities; three authors were employees of the company.
A few things worth understanding.
Can either toothpaste repair a cavity?
Remineralization means replacing minerals lost from enamel in the early stages of decay. It does not mean regrowing a missing piece of tooth. Once decay creates a hole, toothpaste cannot fill it. NIDCR explains the difference between early decay and a cavity.
Is nano-hydroxyapatite the same as hydroxyapatite?
“Nano” describes particle size. Hydroxyapatite formulas can differ in particle characteristics and concentration, so a study of one formula should not be treated as proof for another. Check the product’s full ingredient list and the research behind its specific claims.
What if my teeth are sensitive?
Look beyond the fluoride question. Ingredients such as potassium nitrate are used in sensitivity toothpastes. TWICE Wintergreen and Peppermint includes potassium nitrate alongside fluoride. See the ADA’s guide to toothpaste ingredients.
How should I use my toothpaste?
Follow your toothpaste’s directions and spit it out after brushing. For children, the ADA recommends supervised brushing with an age-appropriate amount of fluoride toothpaste. Read the ADA’s guidance for children. Ask your dentist which formula fits your needs, especially if you get frequent cavities.
Find your TWICE.
We offer both fluoride and fluoride-free toothpastes. Explore the full ingredients and directions for the formula you choose.
Happy Mint
Fluoride-free. Made with 5% nano-hydroxyapatite and enzymes to help lift surface stains.
Explore Happy Mint
Charcoal Icy Mint
Fluoride-free. Made with nano-hydroxyapatite, activated charcoal and baking soda.
Explore Charcoal Icy Mint
Wintergreen and Peppermint
Fluoride for cavity protection, with potassium nitrate for sensitivity relief.
Explore Wintergreen and Peppermint
Cooling Spearmint
A fluoride formula for everyday cavity protection and fresh breath.
Explore Cooling Spearmint