Hydroxyapatite is something I've championed as a safe way to remineralize your teeth compared to fluoride, as well as keep your enamel white and free of sensitivity.
It's been a while since I covered it and looking back on my original thread, I decided it was time for a refresher.
Everything you wanted to know about nano hydroxyapatite:
Nano-hydroxyapatite is a biocompatible material that closely mimics the mineral form of human tooth enamel and bone. Initially developed by NASA for astronauts to combat the demineralization of tooth enamel in zero-gravity conditions, n-HA has resurfaced as an effective way to recharge your teeth with the minerals they need.
n-HA is a form of calcium phosphate and works by incorporating into tooth enamel and providing a template for enamel crystals to grow, effectively filling in the tiny holes of the teeth and reducing tooth sensitivity.
Our diet is in a constant push/pull of pulling minerals out of the teeth and putting them back in. Saliva is incredibly effective at providing minerals to your teeth, but often times it can't compete with the presence of acid in the mouth.
n-HA provides assistance in depositing minerals back into the teeth using a replica of what is already there.
What this means:
- It can restore initial/early-stage cavities
- Highly effective at reducing sensitivity
- Protects enamel against the wear and tear of daily life
What it doesn't mean:
- It will not cure an infection
- It will not build up a tooth that's broken in half
"But I use fluoride as per my dentist and the American Dental association"
While fluoride has been the go-to mineral for tooth remineralization, concerns about its overuse and potential side effects have led many to seek alternatives. Fluoride is a mineral that incorporates into the tooth, transforming hydroxyapatite into fluorapatite. This creates a supra-physiological enamel that makes it resistant to demineralization.
Unlike fluoride, which works by creating a harder, more acid-resistant surface on the teeth, n-HA mimics the tooth's natural mineral, providing an alternative solution that restores the enamel's original structure and function.
It's important to understand the chemical differences between the two regardless of your stance on fluoride.
But where's the evidence this isn't some hippie nonsense?
Studies have shown that n-HA can be as effective as fluoride in remineralizing teeth and preventing cavities. Dental professionals are increasingly recognizing n-HA's benefits, incorporating it into their practices and recommending n-HA-based products to patients seeking a natural alternative.
From toothpaste and mouthwashes to varnish, n-HA is becoming a popular ingredient in a range of oral care products. These products offer an effective way to harness the benefits of n-HA daily, contributing to stronger, healthier teeth and improved oral health.
"It sounds scary, and it's a nano particle. This must be unhealthy/unsafe."
n-HA has been around for decades and has been studied quite a bit. This is not some new untested technology. Studies show it's not only safe for use in dental products, it's also shown to be biocompatible with the cells in our body.
There's a popular blog post on Bubble & Bee blog about how nano-hydroxyapatite is dangerous, and while there are merits to the article it's mostly focused on rat models blasting cells with extremely high concentrations. Do this with just about any compound and you'll find damage.
Not only that, but there is a "part two" blog post that clarifies the importance of the type of nano-hydroxyapatite, leading into the next misconception:
"Europe banned it!"
Actually they did the opposite: they approved it under certain conditions:
- Rod shaped particle
- Aspect ratio less than 3
- Concentration less than 10%
- Particles are not modified or surface-coated
Why does that matter?
There are different shapes of n-HA, depending on how it's synthesized.
Intuition would tell you the image on the right would be dangerous, and it would be correct. This is needle/fiber shaped and has been shown to have issues with cytotoxicity due to it's sharp edges.
The issue: the needle/fiber shape is much cheaper than the middle which is rod-shaped (approved by EU).
So people use needle-shaped particles?
Well, there's a consumer demand for nano-hydroxyapatite, but no federal regulation on the particle shape and size. Nano-hydroxyapatite is extremely expensive compared to fluoride, so it's only logical brands would opt for the cheapest option (needle) to crank up their percentage as a way to market their product as "better" but in reality it's worse in every way.
There are trusted brands, especially Fluidinova which was mentioned in the SCCS/EU final decision. They use a compliant particle shape and size and located in Portugal. The problem is that this product (while high quality) is "dog-fooded" by the European Union as a way to promote a European brand.
There are multiple manufacturers of nano hydroxyapatite that are compliant. I would be hesitant in falling into the trap of thinking Fluidinova's nanoXIM is the only n-HA worth buying because they are also the most expensive source by at least 2-3x.
This is a problem because brands have and will use a small percentage of Fluidinova nanoXIM to slap the logo on their product, and then backfill with cheaper n-HA to crank the percentage up to a reasonable concentration.
Moral of the story: If a brand is boasting about how much n-HA they have and it isn't clarified, it's probably not EU-compliant n-HA. Even if they use a brand name, it's extremely cost prohibitive to get to a therapeutic dose. This leads to morally flexible brands adding in junky n-HA on top of their formula to get the percentage higher.
Speaking of percentage, it's an abused metric that requires clarification.
There's a bit of a meme that "YOU NEED 10% OR ELSE IT WON'T WORK!"
1) That's absolutely not true
2) That's at the ceiling of the EU guidelines, how is it also the minimum percentage required for remineralization?
Percentage is merely what it is: an amount of n-HA per gram of toothpaste. It's not an absolute dosage, because 1g of toothpaste will not deliver the same amount as 10g of toothpaste.
Not only that, but the studies that show 10% efficacy compared to fluoride involved soaking bovine teeth in solution, not even using a toothbrush or toothpaste. That is a valuable study design, but not an applicable, real-world measure we should be designing products around.
In fact, there are some studies that show 5% is more effective than 10% because at 10% the n-HA starts to clump/aggregate, reducing the net effective concentration.
If you see someone parroting 10%, ask them to show the study that says this, then read it yourself. You can be the judge. Besides, they probably don't even know the study they're referencing.
Wrapping up:
Nano-hydroxyapatite is a promising, natural alternative to fluoride, backed by science and increasingly embraced by the dental community. We have a lot of work to do in educating dental professionals and the public before we can even consider FDA/ADA endorsement.
My goal with this breakdown is to dispell a lot of the myths around n-HA and to raise awareness to some under-discussed aspects of this amazing compound.