Hydroxyapatite in toothpaste for prevention and treatment of dental caries

Caries is caused by loss of mineral from the dental hard tissues (enamel, dentine, and root cementum) when exposed to acids. The acids are produced by bacteria during digestion of sugar. Initially the dental surface is demineralised and becomes porous and subsequently a cavity can be formed. Fluoride containing toothpaste is used to remineralise the dental hard tissue and to prevent lesion growth. Hydroxyapatite crystals have also been shown to remineralize enamel in laboratory studies.


What systematic reviews or scientific studies are there on hydroxyapatite in toothpaste for prevention and treatment of dental caries?

Identified literature

No relevant systematic review was identified but four primary studies were found [1-4]. The primary studies were not assessed for risk of bias.


  1. Badiee M, Jafari N, Fatemi S, Ameli N, Kasraei S, Ebadifar A. Comparison of the effects of toothpastes containing nanohydroxyapatite and fluoride on white spot lesions in orthodontic patients: A randomized clinical trial. Dent Res J (Isfahan) 2020;17:354-359.
  2. Bossu M, Saccucci M, Salucci A, Di Giorgio G, Bruni E, Uccelletti D, et al. Enamel remineralization and repair results of Biomimetic Hydroxyapatite toothpaste on deciduous teeth: an effective option to fluoride toothpaste. J Nanobiotechnology 2019;17:17.
  3. Paszynska E, Pawinska M, Gawriolek M, Kaminska I, Otulakowska-Skrzynska J, Marczuk-Kolada G, et al. Impact of a toothpaste with microcrystalline hydroxyapatite on the occurrence of early childhood caries: a 1-year randomized clinical trial. Sci Rep 2021;11:2650.
  4. Schlagenhauf U, Kunzelmann KH, Hannig C, May TW, Hosl H, Gratza M, et al. Impact of a non-fluoridated microcrystalline hydroxyapatite dentifrice on enamel caries progression in highly caries-susceptible orthodontic patients: A randomized, controlled 6-month trial. J Investig Clin Dent 2019;10:e12399.

SBU Enquiry Service Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

Published: 10/11/2021
Report no: ut202122
Registration no: SBU 2021/292