Latest news with #fluoride
CNN
a day ago
- Health
- CNN
Prescription fluoride faces FDA scrutiny despite widespread support from providers and the public
The US Food and Drug Administration appears poised to continue with a plan to ban prescription fluoride supplements at a time when many experts say that access to the products has become especially important. Most US residents live in a community where fluoride is added to the public drinking water, according to federal data from 2022. But this year, Utah and Florida became the first states to ban the practice, and similar legislation has been introduced in several other states. Fluoride is a mineral that can be found naturally in some foods and groundwater. It can help prevent tooth decay by strengthening the protective outer layer of enamel that can be worn away by acids formed by bacteria, plaque and sugars in the mouth. Adding fluoride to public water systems started in the US in 1945, and is considered by many public health experts – including the US Centers for Disease Control and Prevention – to be one of the top public health success stories of the last century. In places where fluoride is not in the drinking water, fluoride tablets or drops may be prescribed for babies and children to reduce the risk of tooth decay. Fluoride prescriptions spiked in Utah this spring amid changes to the public drinking water. An analysis of electronic health records conducted for CNN by Epic Research showed that the share of the population with a prescription for fluoride supplements jumped 30% in a matter of months, from about 1% at the start of the year to 1.3% by May. However, the FDA announced in May that it plans to remove ingestible fluoride prescription drug products for children from the market by the end of October – marking clear intentions before conducting the necessary safety review or public comment period. On Wednesday, the Regan-Udall Foundation, an independent nonprofit organization created by Congress to advance the FDA's mission, hosted a public meeting to discuss the risks and benefits of the prescription fluoride supplements. Dozens of dentists, researchers, public health experts and other members of the public spoke at the meeting, and thousands of others shared their thoughts in the federal register ahead of time. Among those expressing support for prescription fluoride were the American Dental Association, the American Academy of Pediatrics, the American Academy of Pediatric Dentistry and the American Association of Public Health Dentistry. Dr. George Tidmarsh, who was announced as the new director of the FDA's Center for Drug Evaluation and Research on Monday, was present at the meeting and shared his thoughts early on. 'Our job at FDA is to balance risk and benefit, and every day we have to make that balance,' Tidmarsh said. 'It's frequently a challenge, not always, but nothing is without risk, and you have to make sure that if there is risk, there's a clear benefit. And that analysis needs to be done with data.' He critiqued the first two presenters who were in favor of fluoride supplements largely for their lack of data. However, one presenter was tasked with sharing a 'lived patient experience.' The other, Dr. James Bekker, a pediatric dentist from Utah, agreed on the importance of data but said that his goal was not to overwhelm the audience with numbers-heavy slides using information that is 'readily available all across the country.' Just 30 minutes into an hours-long meeting that was meant to offer robust discussion on a much broader set of research on the topic of fluoride supplements, Tidmarsh also chose to single out two studies that highlight risks. One was a lengthy federal review published in August by the National Institutes of Health's toxicology program, which concluded that higher levels of fluoride exposure are linked to lowered IQ in children. This has become a key argument for proponents of banning fluoride, but others have said the work lacks key context. Fluoridated water is the most common exposure noted in this analysis and the focus of most research on the topic, and the potential risks are identified with exposure at much higher levels than what is used in the US. Prescription fluoride supplements that are available to children in the US in tablet and drop form are not formally FDA-approved, but are also well below recommended levels. Experts on both sides of the issue on Wednesday agreed in large part that more research is needed to better understand the risks and benefits of fluoride supplements in general. Dr. Susan Fisher-Owens, a pediatrician and clinical professor at the University of California San Francisco, shared a presentation on Wednesday about the links between fluoride and neurocognitive development. 'In general, I am an optimist, who believes good science can change people's minds and lives for the better. It would be easy to believe this is a foregone conclusion, given the announcement of removing supplements from market came before the science was presented, and Tidmarsh stated his opinion after only the first round,' she said. 'Still, I hope, for my patients' sake, that the presentations emphasizing safety at levels as seen in the US will convince the FDA.' As the national conversation around fluoride has ramped up in recent months, dentists and doctors say that they're getting more questions about fluoride from patients and parents who want to better understand the risks and benefits – but evidence suggests that most still remain largely in favor of fluoride. 'There's a changing political conversation, but it's not necessarily changing where the average American perception of fluoride is yet,' said Melissa Burroughs, senior director of public policy at CareQuest Institute for Oral Health, a nonprofit focused on equitable access to dental care. A poll conducted by the organization in July found that most US adults support community water fluoridation. 'Removing fluoride without a plan to try to support those communities will only keep it an already serious oral health crisis,' Burroughs said. An analysis of electronic health records conducted for CNN by Truveta found that fluoride prescription rates among children in the US have been declining for the past few years – but rates are consistently about 20 times higher in states where community fluoridation is least common compared to rates in states where it is most common. As in Florida and Utah, decisions to add – or remove – fluoride to public water are determined at the local level. The question is sometimes put to public vote, and community members almost always vote in favor of adding fluoride. Similar data showing a decline in fluoride prescription rates among children was presented at the meeting on Wednesday. Dr. David Krol, a pediatrician representing the American Academy of Pediatrics, said that the trend was 'really hypothesis-generating.' He theorized that it could be evidence of more thorough conversations between providers and their patients about all of the different ways they might already be getting fluoride and their individual risk assessments for cavities and tooth decay. 'After that conversation, there's still a need for the provision of supplementation for some patients,' Krol said. Others have suggested that there may be a link to more widespread hesitancy around government intervention on individual health that ramped up during the Covid-19 pandemic. But as community water fluoridation starts to roll back, experts say that protecting the option to use prescription fluoride supplements is key. In fact, the legislation in Utah that banned the addition of fluoride to the public drinking water included provisions to expand access to prescription fluoride – emphasizing the desire for choice. 'We're talking about supplements here today, and we're talking about a choice, and giving people a choice if they want to have that benefit of fluoride. In a non-fluoridated area or where it doesn't occur naturally, supplement is the only tool they have,' Bekker said at the meeting Wednesday. 'So as we consider supplements, the opportunity to have them available is a matter of people's choice. We're not forcing anyone to take them, we're allowing them to have an option and to have a choice.'
CNN
a day ago
- Health
- CNN
Prescription fluoride faces FDA scrutiny despite widespread support from providers and the public
Water availability Federal agencies Children's healthFacebookTweetLink Follow The US Food and Drug Administration appears poised to continue with a plan to ban prescription fluoride supplements at a time when many experts say that access to the products has become especially important. Most US residents live in a community where fluoride is added to the public drinking water, according to federal data from 2022. But this year, Utah and Florida became the first states to ban the practice, and similar legislation has been introduced in several other states. Fluoride is a mineral that can be found naturally in some foods and groundwater. It can help prevent tooth decay by strengthening the protective outer layer of enamel that can be worn away by acids formed by bacteria, plaque and sugars in the mouth. Adding fluoride to public water systems started in the US in 1945, and is considered by many public health experts – including the US Centers for Disease Control and Prevention – to be one of the top public health success stories of the last century. In places where fluoride is not in the drinking water, fluoride tablets or drops may be prescribed for babies and children to reduce the risk of tooth decay. Fluoride prescriptions spiked in Utah this spring amid changes to the public drinking water. An analysis of electronic health records conducted for CNN by Epic Research showed that the share of the population with a prescription for fluoride supplements jumped 30% in a matter of months, from about 1% at the start of the year to 1.3% by May. However, the FDA announced in May that it plans to remove ingestible fluoride prescription drug products for children from the market by the end of October – marking clear intentions before conducting the necessary safety review or public comment period. On Wednesday, the Regan-Udall Foundation, an independent nonprofit organization created by Congress to advance the FDA's mission, hosted a public meeting to discuss the risks and benefits of the prescription fluoride supplements. Dozens of dentists, researchers, public health experts and other members of the public spoke at the meeting, and thousands of others shared their thoughts in the federal register ahead of time. Among those expressing support for prescription fluoride were the American Dental Association, the American Academy of Pediatrics, the American Academy of Pediatric Dentistry and the American Association of Public Health Dentistry. Dr. George Tidmarsh, who was announced as the new director of the FDA's Center for Drug Evaluation and Research on Monday, was present at the meeting and shared his thoughts early on. 'Our job at FDA is to balance risk and benefit, and every day we have to make that balance,' Tidmarsh said. 'It's frequently a challenge, not always, but nothing is without risk, and you have to make sure that if there is risk, there's a clear benefit. And that analysis needs to be done with data.' He critiqued the first two presenters who were in favor of fluoride supplements largely for their lack of data. However, one presenter was tasked with sharing a 'lived patient experience.' The other, Dr. James Bekker, a pediatric dentist from Utah, agreed on the importance of data but said that his goal was not to overwhelm the audience with numbers-heavy slides using information that is 'readily available all across the country.' Just 30 minutes into an hours-long meeting that was meant to offer robust discussion on a much broader set of research on the topic of fluoride supplements, Tidmarsh also chose to single out two studies that highlight risks. One was a lengthy federal review published in August by the National Institutes of Health's toxicology program, which concluded that higher levels of fluoride exposure are linked to lowered IQ in children. This has become a key argument for proponents of banning fluoride, but others have said the work lacks key context. Fluoridated water is the most common exposure noted in this analysis and the focus of most research on the topic, and the potential risks are identified with exposure at much higher levels than what is used in the US. Prescription fluoride supplements that are available to children in the US in tablet and drop form are not formally FDA-approved, but are also well below recommended levels. Experts on both sides of the issue on Wednesday agreed in large part that more research is needed to better understand the risks and benefits of fluoride supplements in general. Dr. Susan Fisher-Owens, a pediatrician and clinical professor at the University of California San Francisco, shared a presentation on Wednesday about the links between fluoride and neurocognitive development. 'In general, I am an optimist, who believes good science can change people's minds and lives for the better. It would be easy to believe this is a foregone conclusion, given the announcement of removing supplements from market came before the science was presented, and Tidmarsh stated his opinion after only the first round,' she said. 'Still, I hope, for my patients' sake, that the presentations emphasizing safety at levels as seen in the US will convince the FDA.' As the national conversation around fluoride has ramped up in recent months, dentists and doctors say that they're getting more questions about fluoride from patients and parents who want to better understand the risks and benefits – but evidence suggests that most still remain largely in favor of fluoride. 'There's a changing political conversation, but it's not necessarily changing where the average American perception of fluoride is yet,' said Melissa Burroughs, senior director of public policy at CareQuest Institute for Oral Health, a nonprofit focused on equitable access to dental care. A poll conducted by the organization in July found that most US adults support community water fluoridation. 'Removing fluoride without a plan to try to support those communities will only keep it an already serious oral health crisis,' Burroughs said. An analysis of electronic health records conducted for CNN by Truveta found that fluoride prescription rates among children in the US have been declining for the past few years – but rates are consistently about 20 times higher in states where community fluoridation is least common compared to rates in states where it is most common. As in Florida and Utah, decisions to add – or remove – fluoride to public water are determined at the local level. The question is sometimes put to public vote, and community members almost always vote in favor of adding fluoride. Similar data showing a decline in fluoride prescription rates among children was presented at the meeting on Wednesday. Dr. David Krol, a pediatrician representing the American Academy of Pediatrics, said that the trend was 'really hypothesis-generating.' He theorized that it could be evidence of more thorough conversations between providers and their patients about all of the different ways they might already be getting fluoride and their individual risk assessments for cavities and tooth decay. 'After that conversation, there's still a need for the provision of supplementation for some patients,' Krol said. Others have suggested that there may be a link to more widespread hesitancy around government intervention on individual health that ramped up during the Covid-19 pandemic. But as community water fluoridation starts to roll back, experts say that protecting the option to use prescription fluoride supplements is key. In fact, the legislation in Utah that banned the addition of fluoride to the public drinking water included provisions to expand access to prescription fluoride – emphasizing the desire for choice. 'We're talking about supplements here today, and we're talking about a choice, and giving people a choice if they want to have that benefit of fluoride. In a non-fluoridated area or where it doesn't occur naturally, supplement is the only tool they have,' Bekker said at the meeting Wednesday. 'So as we consider supplements, the opportunity to have them available is a matter of people's choice. We're not forcing anyone to take them, we're allowing them to have an option and to have a choice.'
Yahoo
2 days ago
- Health
- Yahoo
Do fluoride supplements harm children? FDA panel discussion turns into heated debate
A meeting Wednesday at the Food and Drug Administration about fluoride supplements became, at one point, a contentious back-and-forth over whether the ingestible tablets harm children's microbiomes or play a vital role in helping protect them from tooth decay. Pediatric dentists consider the chewable tablets, available only by prescription, as particularly important for families who live in areas without fluoride in drinking water, who don't have dental insurance or who can't afford regular visits to dentists. Under Commissioner Marty Makary, however, the FDA has been taking steps to remove fluoride supplements from the market. A final decision isn't expected until October, although advocates and critics at the meeting didn't agree on basic scientific methods or even responsible dental practices. During the public meeting held in Silver Spring, Maryland, dental experts outlined the careful balance of getting the right amount of fluoride to their patients. Too little can result in weakened tooth enamel, said Dr. James Bekker, a member of the Utah Dental Association. Too much can lead to fluorosis, a condition that leaves white or brown spots on the teeth. 'There are areas where we have community water fluoridation. We don't need supplements in those areas,' said Bekker, who was invited to speak at Wednesday's meeting. 'But there are many areas of our country where we either don't have community water fluoridation or we don't have naturally occurring fluoride. In those places, supplements are the key to achieving that balance.' A panelist, Dr. Bill Osmunson, a retired dentist who now works for the Fluoride Action Network, an anti-fluoride group, peppered Bekker about how he determines whether a child needs fluoride supplements. 'You ask where they live?' Osmunson asked. 'You ask where they go to school?' Bekker explained how he does comprehensive assessments of his young patients, including reviewing dietary issues and whether they use other supplements, before he prescribes the fluoride tablets or drops. 'Really, you ask all those questions?' Osmunson said. 'You bet,' Bekker said. Osmunson's 'inquisition of Dr. Bekker was a tactic to attempt to make him look incompetent,' said Dr. Johnny Johnson, president of the American Fluoridation Society. 'That type of exchange is meant as a popularity contest.' Johnson spoke in favor of the supplement during a public comment session. Osmunson and other critics relied on data that didn't necessarily prove their criticism of the products. For example, Makary, the FDA commissioner, has said ingested fluoride alters the gut microbiome. His assertion appears to hinge on a 2023 review of research by scientists in Ireland. That analysis noted that animal studies suggested that ingesting fluoride affected the microbiome but that none of the studies examined fluoride and the human microbiome. The researchers concluded that any possible effect of fluoride on the microbiome is 'still in its early days, and studies investigating the impact of fluoride on the human microbiome have only begun to appear in the literature.' One of the authors of that study also spoke at Wednesday's meeting. 'Fluoride consumption at levels which we consider good for maintaining good oral health probably have limited impact on the oral and gut microbiomes,' said Gary Moran of Trinity College Dublin in Ireland. But, he added, 'we certainly need more studies.' There was no vote for or against fluoride supplements. Dr. David Krol, a representative of the American Academy of Pediatrics, spoke in favor of fluoride supplements as one of many tools physicians need to ensure their patients' teeth are as strong as possible. 'Fluoride supplementation, as well as conversations about diet and conversations about hygiene, are the kinds of things that take place between pediatricians and patients,' Krol said. 'We have to have that opportunity to continue those conversations and have those multifactorial tools to address this disease.' Even though Medicaid covers oral health for children, fewer than half went to the dentist at least once a year. Cavities that erupt in those kids' mouths get worse if they're left untreated, and they can cause widespread damage. The decay 'eats away at the bone' around the tooth and sometimes gets into the bloodstream, said Dr. Steven Levy, a professor of preventive and community dentistry at the University of Iowa. 'This is more than just a garden-variety, middle-class person's experience with a cavity,' he said. Major public health groups, including the American Academy of Pediatrics and the U.S. Preventive Services Task Force, recommend prescribing supplements for children starting at 6 months if the water supply isn't fluoridated. Fluoride supplements are often given to kids from age 5 until they have their permanent teeth, around age 13 or 14, Bekker said in an interview before the meeting. Babies get drops until they're old enough to chew tablets. They're generally inexpensive. Over-the-counter vitamins and supplements don't contain fluoride. Fluoride is available over the counter only in toothpaste and mouthwashes. Makary also objects to the fluoride supplements because they aren't approved by the FDA. Because the supplements had been in use for decades before Congress mandated that drug manufacturers show that their products were not only safe but also effective, they were never required to go through the approval process. For almost as long as the supplements have been prescribed, critics have been concerned about the lack of rigorous data showing their potential health effects and how they protect kids' teeth. 'I think we really need to understand the benefits,' said Linda Birnbaum, a toxicologist and former director of the National Institute of Environmental Health Sciences and the National Toxicology Program. Birnbaum also spoke during the FDA meeting. Dr. Brett Kessler of the American Dental Association acknowledged that prescription fluoride supplements should be administered only after a 'thoughtful decision' based on conversations between physicians and families. 'I'm hoping we can all take a breath, filter out all the noise and not give in to the anti-fluoride hysteria,' he said during the meeting. This article was originally published on Solve the daily Crossword
Yahoo
2 days ago
- Health
- Yahoo
FDA to review prescription fluoride supplements for kids at risk for tooth decay
The Trump administration is inching closer to banning fluoride tablets and drops often prescribed to kids who don't have access to fluoridated drinking water and are at high risk for mouths full of decayed teeth. On Wednesday, the Food and Drug Administration will host a public meeting featuring both supporters and opponents of fluoride supplements. While dentists overwhelmingly say the tablets have been used safely for decades, more than half of the meeting will be spent 'identifying safety concerns and potential risk' associated with the supplements. A final decision about whether to pull fluoride supplements off the market isn't expected until the end of October. In May, the FDA commissioner, Dr. Marty Makary, announced the agency's intention to get rid of them. Wednesday's meeting includes 18 speakers, including well-known fluoride skeptics like Dr. Bill Osmonsun, a retired dentist now with the Fluoride Action Network, and Dr. Bruce Lanphear, a professor of health sciences at Simon Fraser University in Canada. Lanphear published a controversial 2019 study suggesting that IQ levels were slightly lower in kids whose mothers had ingested more fluoride while pregnant, research that's frequently cited by Health Secretary Robert F. Kennedy Jr. Dr. Charlotte Lewis, a professor of pediatrics at the University of Washington School of Medicine, and Dr. Jayanth Kumar, who previously was dental director for California, will counter those presentations. Dr. James Bekker, a pediatric dentist and a member of the Utah Dental Association who is scheduled to speak at Wednesday's meeting, said: 'Say we take supplements off the market. What's the alternative? There is none.' Utah and Florida have banned fluoride from public water systems. Similar legislation is under consideration in Kentucky, Massachusetts and Nebraska. Critics say the risks from fluoride during a child's early years override the benefit of protecting against tooth decay, a disease that can cause pain, infection and other possible health problems. In an interview with Fox News, Kennedy acknowledged that areas without fluoride in their water are likely to have 'slightly more cavities.' Bekker was more blunt. 'Buckle up,' he said. 'We're going to have an onslaught of cavities.' What are fluoride supplements? Nearly two-thirds of dentists in the United States prescribe fluoride supplements to their patients, especially in areas without community water fluoridation, according to a American Dental Association report this year. Sodium fluoride tablets and drops are prescription only, and they have been used for decades to prevent tooth decay. A 2011 analysis of 11 studies, including some randomized controlled trials, by French researchers found that 0.25 mg up to 1 mg a day of the supplements reduced rates of cavities in kids by nearly a quarter. The chewable tablets come in several doses and are particularly important for families who live in areas without fluoride in drinking water and who don't have dental insurance or can't afford regular visits to dentists. Even though Medicaid covers oral health for children, fewer than half went to the dentist at least once a year. Cavities that erupt in those kids get worse if they're left untreated, and they can cause widespread damage. The decay 'eats away at the bone' around the tooth and sometimes gets into the bloodstream, said Dr. Steven Levy, a professor of preventive and community dentistry at the University of Iowa. 'This is more than just a garden-variety, middle-class person's experience with a cavity,' he said. Major public health groups, including the American Academy of Pediatrics and the U.S. Preventive Services Task Force, recommend prescribing supplements for children starting at 6 months if the water supply isn't fluoridated. Fluoride supplements are often given to kids from age 5 until they have their permanent teeth, around age 13 or 14, Bekker said. Babies get drops until they're old enough to chew tablets. They're generally inexpensive. Over-the-counter vitamins and supplements don't contain fluoride. Fluoride is available over the counter only in toothpaste and mouthwashes. Limited research on fluoride supplements According to Makary, the FDA commissioner, ingested fluoride alters the gut microbiome. That assertion appears to hinge on a 2023 review of research on the matter. Scientists in Ireland noted that animal studies suggested ingesting fluoride affected the microbiome but that none of the studies examined fluoride and the human microbiome. They concluded that any possible effect of fluoride on the microbiome is 'still in its early days, and studies investigating the impact of fluoride on the human microbiome have only begun to appear in the literature.' Makary also objects to the fluoride supplements because they aren't approved by the FDA. Because the supplements had been in use for decades before Congress mandated that drug manufacturers show that their products were not only safe but also effective, they were never required to go through the approval process. For almost as long as the supplements have been prescribed, critics have been concerned about the lack of rigorous data showing their potential health effects and how they protect kids' teeth. 'I think we really need to understand the benefits,' said Linda Birnbaum, a toxicologist and former director of the National Institute of Environmental Health Sciences and the National Toxicology Program. Birnbaum is listed as a speaker at the FDA meeting Wednesday. Bekker said safety and efficacy of fluoride supplements for kids have long been established. 'Why is this even a question? This is the biggest no-brainer since sliced bread,' he said. This article was originally published on
CNET
2 days ago
- Health
- CNET
Nano-Hydroxyapatite Toothpaste: The Benefits and Risks of the Fluoride-Free Alternative
As health concerns around fluoride in public drinking water continue to swirl, nano-hydroxyapatite toothpastes are becoming increasingly popular substitutes for fluoride toothpaste. Popular brands include Boka Davids and NOBS (No Bad Stuff), which are touted as fluoride-free alternatives that whiten teeth, repair enamel and prevent cavities. "As ingredient labels shift toward cleaner, fluoride-free formulas, one compound is taking center stage in modern oral care: nano-hydroxyapatite," Dr. Pia Lieb, DDS, cosmetic dentist and clinical assistant professor emerita at NYU College of Dentistry, explains. If you're thinking about replacing your fluoride toothpaste with a nano-hydroxyapatite alternative, this is what dental experts want you to know before you brush your teeth. What is nano-hydroxyapatite? "Nano-hydroxyapatite is a synthetic calcium phosphate compound that's used in some oral care products, including toothpastes," explains Dr. Ada Cooper, consumer advisor and spokesperson for the American Dental Association, says. "[It] has a structure that is similar to hydroxyapatite found in enamel, and nHAP gets incorporated into the tooth structure preferentially in demineralized areas." Nano-hydroxyapatite is also abbreviated as n-HA and n-HAp. Dr. Royce Lai of King Village Dental adds that this is technically a two-part question, since "hydroxyapatite has been around for decades and has been studied for at least 20 years." Newer and less studied, nano-hydroxyapatite is a version of hydroxyapatite with small, rod-shaped particles. "Hydroxyapatite is natural. It is a type of calcium that makes up bones and teeth," says Lai. "Nano-hydroxyapatite relates to the particle size. These are between 20 and 80 nanometers and are much smaller than the hydroxyapatite tubules that are a part of your teeth." According to Dr. Daniela Eversgerd, a cosmetic dentist and the founder of Allure Dental, nano-hydroxyapatite was developed by NASA in the 1970s for astronauts dealing with bone and enamel loss during long periods of space travel. Since the early 1990s, it has been approved for oral care products in Japan. Nano-hydroxyapatite toothpaste benefits "Nano-hydroxyapatite doesn't just protect your teeth -- it helps rebuild them," says Dr. Catrise Austin, a cosmetic dentist, author of Gum Health Made Simple and host of the Let's Talk Smiles podcast. She lists the following as potential nano-hydroxyapatite benefits: Enamel remineralization Tooth sensitivity relief Reduced bacterial adhesion Whitening and gloss enhancement "n-HA can actually fill microscopic cracks and help reverse or arrest early cavities," adds dentist Dr. Sandip Sachar. Austin cites a 2019 study that found a 10% hydroxyapatite toothpaste is equivalent or non-inferior to fluoride toothpaste for preventing and remineralizing dental cavities (or caries) in children. When it comes to teeth sensitivity, Lai cites a 2014 study concluding that 15% nano-hydroxyapatite helped sensitive teeth. "The particle size could get into space and work better than larger particles in micro-hydroxyapatite or fluoride," he explains. "The conclusion was that nano-hydroxyapatite could significantly reduce tooth sensitivity to hot and cold in two to four weeks of use." Referencing an 18-month 2023 clinical trial finding that a 10% n-HAp toothpaste protected adult teeth from new cavities as well as a standard 1,450-ppm fluoride paste, Dr. Christopher Tolmie, DDS, MBA, of PDS Health, states, "By patching enamel and calming swollen gums, nano-hydroxyapatite may cut off a hidden spark of chronic inflammation linked to heart disease and diabetes." Since nano-hydroxyapatite toothpastes are fluoride free, Dr. Yenile Y. Pinto, DDS, functional and biomimetic dentist and founder of Deering Dental, adds, "It's also been shown to reduce sensitivity and strengthen the enamel surface without the risk of fluorosis." Fluorosis occurs when you get too much fluoride as a child, causing white or brown spots on the teeth. The CDC reports that fluorosis typically doesn't affect tooth function and isn't painful. A 2020 systematic review of 32 studies concluded that "Nano-HA is a relatively novel material with outstanding physical, chemical, mechanical and biological properties that makes it suitable for multiple interventions. It outperformed most of the classic materials used in implantology and surgery, but it should be further investigated for bone engineering and caries prevention therapy." HengleinA 2023 comprehensive review found that, while more long-term studies are needed to establish the safety of regular use, "Nanohydroxyapatite is a promising revolutionary material in the prevention of early carious lesion mainly due to a greater source of free calcium." Ultimately, providing a 2021 review and 2022 scoping review, Cooper concludes, "Although there is some evidence that alternative ingredients, such as [nano] hydroxyapatite, prevent tooth decay by acting as a remineralizing or anti-cavity agent, the studies are preliminary. The only anti-cavity agent recognized by the Food and Drug Administration in its over-the-counter monograph is fluoride, a naturally occurring chemical." Cooper adds that all toothpastes with the ADA Seal of Acceptance contain fluoride. The administration specifically recommends brushing your teeth twice a day with fluoride toothpaste and regularly visiting your dentist. Nano-hydroxyapatite toothpaste risks "According to a [2021] narrative review from Odontology, the official journal of the Society of the Nippon Dental University, so far, there have been no reports of adverse dental or systemic effects of HAP-containing toothpastes because HAP has an excellent biocompatibility," states Cooper. According to Austin, the concern with nano-hydroxyapatite is that, because it's made of nanoparticles, some worry about how much might get absorbed into the body if regularly swallowed. "The European Commission's Scientific Committee raised concerns due to the lack of long-term safety data on ingestion, particularly in children," she says. This has led to temporary nano-hydroxyapatite restrictions (not a full-on banning) in Europe. The European Scientific Committee deems nHA safe in toothpaste up to 29.5% and up to 10% in mouthwash, per Tolmie. However, he states, "Regulators still bar it from breath-spray products to avoid lung exposure, so stick to pastes and rinses." Key concerns around nano-hydroxyapatite, according to Lieb, are: Potential ingestion and systemic absorption, especially in nano form Lack of long-term studies in humans on the cumulative effects Unknown impact of inhalation from aerosol products (not toothpaste) In terms of systemic absorption, Sachar specifies, "Because nano-hydroxyapatite particles are similar in composition to bone mineral, there has been some theoretical concern that if absorbed systemically, they could potentially contribute to unwanted calcifications in soft tissues (like blood vessels or kidneys)." However, she states that this is speculative and not supported by any current clinical nano-hydroxyapatite toothpaste only effective at 10%? "Most clinical formulations of nHA range from 5%-15%, with 10% emerging as the benchmark concentration in several Japanese and European studies," answers Lieb. "This concentration has demonstrated reliable enamel restoration while maintaining product stability and usability." However, she states that newer formulations are experimenting with lower concentrations and enhanced delivery systems (such as encapsulation or synergistic minerals), which may improve efficacy at reduced levels. "The effectiveness isn't just about percentage, it's also about particle quality and how it's delivered to the tooth surface," she explains. Tolmie adds, "Effective repair starts as low as 5% and plateaus around 10-15%. Several studies show that 5% n-HAp can mend enamel dings, divots and dents in the teeth, with benefits leveling off somewhere between 10% and 15%. One review even noted that 5% sometimes beats 10% because fewer particles clump, making them easier to slip into enamel defects; hence, most US brands sit comfortably in the 5-10% sweet spot." We also reached out to Dr. Foti Panagakos, who's a part of Boka's Oral Health Advisory Committee. "While there is a lot of discussion around nano-hydroxyapatite concentration and its effectiveness, what matters most is how it is formulated and the fact that the ingredient is backed by research," he explains. "This includes how nano-hydroxyapatite is stabilized, delivered and supported by other ingredients, which is why at Boka, years were spent working with oral health professionals to ensure our formula delivers on both safety and performance. Each tube of Boka toothpaste contains a precisely balanced concentration of nano-hydroxyapatite -- high enough to deliver measurable benefits and safe for daily use, with a formula that's gentle on dentin." Should people replace fluoride toothpaste with nano-hydroxyapatite? Eversgerd states that it all depends on each person's oral health needs. "Fluoride remains the gold standard for cavity prevention, supported by decades of large-scale, randomized controlled trials," she explains. "However, for patients seeking a fluoride alternative -- whether due to sensitivity, allergies, personal preferences or a desire for a biomimetic approach -- nano-hydroxyapatite provides a scientifically supported option." According to the Academy of Biomimetic Dentistry, a biomimetic approach is one in which damaged teeth are restored using materials mimicking natural teeth in function, strength and appearance. For high-risk patients, Eversgerd recommends fluoride, while she may recommend n-Ha to low-risk or fluoride-averse individuals. Austin seconds this, but adds that she also recommends fluoride toothpaste to children with poor brushing habits or communities with limited dental access. "nHA is a great option, but it's not a one-size-fits-all replacement for fluoride -- yet," Austin says. Lieb explains that nHA may also be a compelling alternative for patients with aesthetic concerns, such as whitening-induced sensitivity, and individuals in preventive care regimens post-restorative treatment. Pinto agrees that it depends on the person, stating, "For most of my patients, especially those with low to moderate cavity risk, nano-hydroxyapatite is an excellent option; gentler on the mouth, less drying and effective at rebuilding early damage. For people with high cavity risk, fluoride might still be the best choice, at least short term. For my high-risk patients, I often recommend a combo toothpaste that includes both ingredients when appropriate." Ultimately, if a patient isn't high risk and has health or safety concerns about fluoride, she thinks hydroxyapatite is a great option. When asked if there's a reason people should choose n-HAp over other anti-cavity toothpastes, Tolmie answers, "No, as long as patients are brushing their teeth with an anti-cavity toothpaste. There are differences in the way an n-HAp toothpaste and a fluoride toothpaste work to prevent decay, and some n-HAp toothpastes may feel smoother on the teeth. But anti-cavity toothpastes as a whole accomplish the same task. Do I wash a car with tap water or bottled water? We know that both of them get the job done." What's most important, according to Tolmie, is that patients ensure they're not swallowing toothpaste. What does the American Dental Association think? Cooper states that the ADA recommends brushing teeth twice daily for two minutes with fluoride toothpaste, as the naturally occurring mineral has been proven to remineralize weakened enamel and reverse early signs of tooth decay. "Additionally, the fluoride you take in from drinking water and other beverages continues to provide a topical benefit because it becomes part of your saliva, constantly bathing the teeth and helping to rebuild weakened tooth enamel," Cooper further explains. "The best scientific evidence has shown that adding fluoride to community water supplies is safe and effective. This is backed by decades of research and recognized by more than 100 health organizations." GoodboyDoes nano-hydroxyapatite toothpaste work? All of the dentists we consulted agree that nano-hydroxyapatite toothpaste works, but in the right context and with the right product. It's also not a miracle cure and should not replace your entire oral care routine, dentist's recommendations or regular appointments. Plus, Eversgerd adds that more long-term, large-scale trials are needed to fully validate whether it's equal to fluoride in preventing cavities. When asked if it's effective, Austin says, "Yes -- particularly for enamel remineralization and sensitivity. In my practice, I've seen patients who switched to nHA toothpaste experience noticeable improvements in comfort, plaque control and surface smoothness. But like any product, it works best when paired with consistent brushing, flossing and professional cleanings." Pinto agrees and has also seen the results firsthand. "It helps remineralize enamel, soothe sensitivity and support a healthier oral microbiome, especially when paired with a good routine (good home hygiene, healthy diet, hydration and nasal breathing)," she explains, noting that it's not a miracle cure, but does offer many benefits. On behalf of the ADA, Cooper echoes Eversgerd's earlier statement: "The use of nano-hydroxyapatite (nHAP) in over-the-counter products is growing, and some evidence shows that nHAP may contribute to remineralization, but the evidence is fairly new and often ambiguous, especially regarding clinical indications. " Do experts recommend nano-hydroxyapatite toothpaste? All of the experts we consulted do recommend nano-hydroxyapatite toothpaste, but only for certain patients. After all, according to Austin, "Nearly half of US adults over 30 have some form of gum disease, and you can't out-toothpaste a bad hygiene routine." Brushing your teeth regularly, flossing and regularly visiting your dentist are still essential, no matter what toothpaste you use. Though Lieb recommends nHA toothpaste for adult patients experiencing post-whitening sensitivity or early enamel erosion, low-caries risk individuals seeking natural alternatives and adults undergoing cosmetic dental work who want to protect their investment with gentle, remineralizing care, she doesn't recommend nano-hydroxyapatite for children with deciduous dentition. "In my professional opinion, fluoride remains the safest and most effective option for all patients under 14," says Lieb. "Its protective effect during the development of permanent dentition is unmatched, and its caries-prevention record is well established." Sachar states that she often recommends it for "patients seeking fluoride-free options, those with mild tooth sensitivity and for children at risk of swallowing fluoride toothpaste." However, she advises that patients with moderate to high cavity risk not fully abandon fluoride. Again, it's important to note that the "ADA recommends that adults brush their teeth twice daily with fluoride toothpaste for at least two minutes each time, or as directed by a licensed dentist," according to Cooper. This is because the proposed benefits of nHAP are fairly new and ambiguous. Getty Images The bottom line Though more research is needed, the dentists we consulted explained that nano-hydroxyapatite toothpaste can be an effective alternative to fluoride -- but only in the right context. The ADA doesn't recommend it. It's also not a miracle cure or a replacement for brushing regularly, flossing and professional dental appointments. If you're considering nano-hydroxyapatite toothpaste, consult your dentist first before making the switch. They know your teeth best and will be able to help you find the best toothpaste for your smile.
