top of page

The Truth About Hydroxyapatite and Oral Care: Fads Versus Facts

Gerry Curatola, DDS

two contrasting molars - one yellow and pitted, the other white and sparkling

Fizzling Fads in Oral Care 

Over the past 40 years of my clinical practice of dentistry, I have witnessed many alleged advances in oral care that have turned out to be “fizzling fads” in the quest for innovations in oral health. There’s been a potpourri of fluoride compounds since the 1950’s, including stannous fluoride, sodium fluoride, acidulated phosphate fluoride, and systemic fluoridation of municipal water supplies with hydrofluosilicic acid, a toxic waste product - all introduced under the banner of preventative dentistry. 

Few Beneficial Effects From Fluoride 

Yet many epidemiological studies have shown few beneficial effects of fluoridation on decay rates, while an epidemic of dental and skeletal fluorosis has emerged. 

Paradoxically, a lower rate of decay per capita has been observed in some non-fluoridated communities like New Hampshire and most of Western Europe.

Even more concerning, ongoing research consistently associates water fluoridation with severe systemic illnesses such as osteoporosis, diminished IQ in children, kidney disease, and even cancer. 

Growing Interest in Fluoride-Free Products 

The growing interest in fluoride-free products has led to a surge in alternative oral care options. Various toothpaste formulations, including those with baking soda, triclosan, chlorhexidine, antimicrobial essential oils, xylitol, erythritol, charcoal, and more, have been widely promoted. However, it's essential to note that many of the chemicals and compounds in these toothpaste alternatives have limited research backing them, and some scientific papers supporting their efficacy and safety are poorly controlled and have been disproven by subsequent analysis. 

The Latest Oral Care Buzz - Hydroxyapatite 

The latest oral care buzz involves incorporating the hydroxyapatite (HA) mineral into toothpaste as a substitute for chemical fluoride. This shift is driven by a growing perception that fluoride, employed in public health for the past 75 years, is considered by many as a failed public health experiment. 

What Is Hydroxyapatite? 

Hydroxyapatite (HA) is a bioactive and non-toxic ceramic that has a close analogy to the inorganic portion of human teeth and bone. As HA is naturally found in enamel and dentin of teeth, synthetic HA has been incorporated into many dental products in various examples such as dental cement, fillings, and oral care products, including toothpaste, mouthwash, and gels.


Hydroxyapatite (HA) toothpaste is nothing new. In 1970, a synthetic HA dentifrice for teeth brushing was first produced by NASA (U.S. National Aeronautics and Space Authority) as a trial repairing material for the astronauts who lost minerals in their teeth and bones due to the absence of gravity. In 1993, nano-HA was approved as an anti-caries agent. 

The Research

Research has looked at both nanohydroxyapatite and micro-hydroxyapatite in toothpaste to promote remineralization of teeth that are depleted in low-ph environments with limited and varied results. Despite a long history of use, the effectiveness of these “apatite compounds'' as an alternative ingredient to fluoride has not been established, and a recent in vitro study comparing the remineralization effect between nano-HA paste and fluoride varnish on young permanent teeth concluded no significant difference in remineralization between nano-HA and fluoride. 

4 illustrations of tooth remineralization

The Dangers of Nanoparticles 

With the recent popularity of nanoparticles in oral care products that demonstrated better remineralization effects over micro-HA due to its smaller particle size, there are also many documented dangers from the small size of nanoparticles and the use of nanoparticles in dental products that can have toxic effects on the human body. Nanoparticles incorporated into toothpaste are small enough to penetrate cell membranes causing cell damage and damage to the mitochondria and cellular DNA. 

Hydroxyapatite, and specifically Nano-hydroxyapatite toothpaste, appear to be another mixed bag of a “right church-wrong pew” product in oral care. 

A Different Perspective 

Instead, an understanding of the metabolism of the oral microbiome demonstrates the amazing ability for the body to self-regulate and heal. The relationship between saliva, microbiome and teeth, the “sialo-microbial-dental complex”, provides many oral health benefits and offers a different perspective to the old dental paradigm that only associated oral biofilms (plaque) with disease (caries). This new paradigm emphasizes that the oral microbiome is essential for the “mineral maintenance” of teeth. 

Balancing the Microbiome to Promote Remineralization 

A healthy balanced oral microbiome provides physical protection from dietary acid and can promote remineralization of teeth, a process necessary for tooth maturation. The increase in consumption of carbohydrates, refined sugars and acidic drinks changes the ecology of the microbiome, tipping the balance of the “demineralization-remineralization” cycle towards net mineral loss and hence caries. Remineralization of teeth occurs in a balanced oral microbiome which acts as an intelligent semipermeable membrane transferring ionic minerals such as calcium and phosphorus from saliva to the surface of teeth enamel to remineralize without the need for any outside minerals in toothpaste. 

Revitin toothpaste - both box and product

Revitin - A Pro-Microbial Formulation 

Revitin toothpaste contains a proprietary prebiotic formulation that is specifically designed to promote balance of the oral microbiome. With an all-natural formulation that is safe to swallow, Revitin is the only pro-microbial formulation that focuses on the new science which emphasizes the beneficial nature of the oral microbiome in a balanced state for a healthy mouth.

Restoring The Oral Microbiome 

In a recent randomized double-blind clinical trial, Revitin was found to restore microbial homeostasis in less than 14 days, and a balanced microbiome was found to restore healthy teeth and gums. 

headshot of Dr. Gerry Curatola

With over four decades of experience as a clinician, educator, researcher, and humanitarian, Dr. Gerry Curatola is an internationally renowned figure in biologic dentistry and biologic. Graduating from Colgate University and NYU College of Dentistry, he now shapes the future of dental professionals as an Adjunct Clinical Associate Professor both at NYU, and in lectures around the world. 

He is listed in the Leading Physicians of The World, America’s Top Dentists, and Top Doctors of New York for more than two decades and he has appeared extensively in the media. His groundbreaking work on the Oral Microbiome is the subject of his latest book, The Mouth-Body Connection published by Hachette. His charitable ventures include the current construction of a medical and dental clinic to the underserved in Anathavarum, India.


BRMI does not receive any financial compensation or incentives from Revitin or its affiliated entities for featuring this product in the article. Mentioning this product is solely for the purpose of providing comprehensive and relevant content.

bottom of page