Recently, I've been experimenting with hydroxyapatite toothpaste as a replacement for fluoride. > [!info] Takeaways > - I started using hydroxyapatite toothpaste because my fluoride toothpaste wasn't helping with whitening, didn't solve sensitivity issues, didn't (solo) solve cavity issues, and wasn't pleasant to use. > - Hydroxyapatite seems to address these problems, and is likely overall healthier for the mouth microbiome. I've been using it for a few weeks and have had good experiences (will report back after a dentist visit). > - Both micro (MHA) and nano-hydroxyapatite (NHA) seem safe, though nano-hydroxyapatite should be rod-shaped (and ideally gotten via NanoXIM). > - RiseWell and Fygg seem like the best choices, though BIOM is likely also good. > - BONUS: Hydroxyapatite gum! I've been using [[Fluoride]] toothpaste for my entire life. For the last 5 years, that's been the Sensodyne brand ProNamel toothpaste, from a dentist's recommendation. This seems to have been fine, but I still had cavities, I still had sensitivity issues, and the "whitening" did not seem to do anything for me at all. And on a sensory level, this toothpaste had an incredibly strong burning sensation every time I brushed my teeth (arctic blast something something). Which is frustrating since I know that has nothing to do with the actual cleaning effect. Also, I don't think I'm at risk for fluorosis, but I think I may have had more fluoride exposure than is standard due to not rinsing after brushing + using retainers which may keep fluoride in my mouth for longer + using a higher concentration fluoride toothpaste, in addition to the existing fluoride in the water supply. ## Enter [[Hydroxyapatite]] (HA). [[Hydroxyapatite]] seems to be the most empirically validated and most useful active toothpaste ingredient after fluoride. It has a remineralizing effect, it reduces tooth sensitivity, and it whitens. It's already been in use in Japan for decades and has a very solid safety profile. This is in large part because teeth are primarily made from hydroxyapatite anyway. (The safety question gets more complicated once nano-hydroxyapatite comes into play, but I'll get to that) ### Micro vs Nano [[Hydroxyapatite]] Both seem useful. But in particular, nano-hydroxyapatite's smaller size enables it to better address tooth sensitivity, by plugging micro-tubules in the teeth (that can otherwise expose nerve endings). Nano-hydroxyapatite carries some concerns around toxicity or cell buildup (addressed below). ## Efficacy of [[Hydroxyapatite]] vs [[Fluoride]] Both remineralize teeth, and in some comparative studies, hydroxyapatite toothpaste users had fewer cavities compared to fluoride users. All agree that their effects here are similar. One downside of HA compared to fluoride is that its protective effect doesn't seem to last as long. In addition to remineralizing, fluoride (after being processed into fluorapatite in your mouth) seems to add another protective layer, which can prevent bacteria from attaching to teeth. I think this can be offset by increasing frequency of HA use (see section on mints). HA has two benefits that fluoride doesn't: Whitening, and mouth pH balance. It also creates a noticeably smoother tooth for some people (myself included). ## Safety of [[Hydroxyapatite]] vs [[Fluoride]] Micro-hydroxyapatite seems to be almost universally safe. Any extra amounts get broken down in the stomach ([though milk may slow down the process](https://pubmed.ncbi.nlm.nih.gov/33683238/)). Nano-hydroxyapatite (NHA) may be somewhat cytotoxic IF it's in a needle-shaped form. There are conflicting studies on this. However, as far as I can tell, rod-shaped NHA is safe, and doesn't carry the same risks. I'm not enough of a bio guy to fully understand why, but I believe it has to do with how easily the NHA attaches to cells. Specifically rod-shaped NHA is approved for use in the EU with concentrations up to 10% for reasons along these lines. ## ⭐ My results with it so far (3 weeks) No pics, but (I think) gum inflammation in my mouth has gone down, my teeth appear noticeably smoother, noticeably whiter, and I have less sensitivity. Will report back with a dentist's impressions later. The rest of my oral care routine remains the same (water flosser, tongue scraper, physical floss every couple days bc lazy). ## Top hydroxyapatite toothpaste brands, and my personal choice I have tried four of these. Currently choosing between RiseWell and Fygg for long-term use. Here are my thoughts for each: ### RiseWell Has the highest dose of both micro and nano hydroxyapatite (10% and 5% respectively). Furthermore, their nano-hydroxyapatite is rod-shaped and sourced from the main reputable supplier, NanoXIM. Good for yeeting a lot of hydroxyapatite at your teeth. For some reason, doesn't disclose NanoXIM on their site, I had to email them to find out. ### BIOM / NOBS Comes in a tablet form that you chew. I like it, but it's strange to get used to. Has 5% NHA (ideal dose range), and they say it's rod-shaped but they don't mention their source for it. I'll bring it when I travel, seems great for that, and I love that it's a glass container, but otherwise there's not enough to distinguish it for me over RiseWell (for also having micro-HA) or Fygg (for cleanest ingredients). ### Fygg Super clean ingredients list, best on the list for that. No menthol! ~3% concentration of nano-hydroxyapatite, which is in the range of ideal dose like the others. Doesn't contain any micro-hydroxyapatite though. Tastes a lil weird but is very mild. ## BONUS: Micro-hydroxyapatite is safe enough to use more often, so I've started using HA mints. Brushing your teeth after meals is not recommended due to your teeth being somewhat softer after eating. That brushing could potentially erode enamel. Additionally, brushing more than twice a day with fluoride may be inadvisable due to the increased cumulative fluoride dose. However, no such overuse concern exists with hydroxyapatite. This means, theoretically, you can apply some (without brushing) multiple times a day and get the benefits without any of the risks. I've started using a HA mint after every meal. I'm experimenting with gum vs mints here. Most of these incorporate xylitol, which is also helpful from a mouth pH and oral microbiome perspective. RiseWell mints (over email) say they have a 10% concentration of micro-hydroxyapatite. Underbrush gum (over email) say they use a non-coated rod-shaped type of NHA that's less than 100nm in size at 0.5% concentration. Dose may be a little low, but it's hard to tell. Have yet to receive the Underbrush. May or may not update later. *Written Dec 31 2024*