Short answer: in a head to head clinical trial, a fluoride free hydroxyapatite toothpaste performed as well as fluoride at preventing cavities in adults. Hydroxyapatite does it with the same mineral your enamel is made of. It is safe to swallow, and it helps with sensitivity too. That is why we built Bastét around it.
The trial that changed the conversation
For years, the case for fluoride rested on one idea: nothing else had been shown to work as well. That changed in 2023.
An 18 month, double blind, randomized clinical trial published in Frontiers in Public Health compared a fluoride free hydroxyapatite toothpaste with a standard adult fluoride toothpaste (1,450 ppm). Of the adults who finished the study, 89.3% in the hydroxyapatite group had no new cavities, compared with 87.4% in the fluoride group. The researchers concluded that hydroxyapatite "was proven to be a safe and efficient anticaries agent."
It is not the only study. A 2011 study in the Journal of Clinical Dentistry, using enamel worn inside the mouth, found 10% nano hydroxyapatite produced results similar to 1,100 ppm fluoride on early enamel lesions.
The same mineral, not a different one
About 97% of your enamel is one mineral: hydroxyapatite.
Fluoride works by changing that mineral. It helps turn the outer surface of your enamel into fluorapatite, a slightly different compound that holds up better against acid.
Nano hydroxyapatite (nHA) works by giving your teeth more of what they are already made of. The particles are small enough to settle into the microscopic gaps on the surface of your enamel, helping support the mineral layer with an exact match.
What nano hydroxyapatite does that fluoride doesn't
- Helps with sensitivity. A 2019 meta analysis of six randomized clinical trials, published in the Journal of Dentistry, found nHA treatments gave better relief from tooth sensitivity than the other treatments they were compared with.
- Leaves teeth smoother and brighter. By filling tiny surface gaps, nHA helps leave a smoother surface that reflects more light. It is the clean feeling your tongue keeps going back to.
- Is safe to swallow. In 2025, the EU Scientific Committee on Consumer Safety concluded that nano hydroxyapatite is safe in toothpaste at up to 29.5%, for rod shaped, uncoated particles, and that particles swallowed while brushing dissolve quickly in stomach acid.
What is worth knowing about fluoride
- Dental fluorosis. Too much fluoride while adult teeth are still forming can leave permanent white marks or streaks on the teeth.
- The warning on the tube. In the US, fluoride toothpaste labels must tell you to get medical help or contact a Poison Control Center if more than a brushing amount is swallowed. That is why children are told to use only a smear.
- Skin around the mouth. The Merck Manual lists fluoride toothpaste as a proposed cause of perioral dermatitis, a red, bumpy rash around the mouth and chin, and advises people who have it to stop using toothpaste with fluoride.
Fluoride is effective, and for many people it is the right choice. But if you would rather go without it, you no longer have to give up the research to do so.
Side by side
| Fluoride | Nano hydroxyapatite | |
|---|---|---|
| What it is | A mineral ion that changes the surface of enamel | The same mineral that makes up 97% of your enamel |
| Cavity prevention in adults | The long standing standard | Performed as well as 1,450 ppm fluoride in an 18 month clinical trial |
| Sensitivity | Depends on the formula | Better relief than other treatments in a meta analysis of six clinical trials |
| If swallowed | US labels carry a Poison Control warning | Dissolves in stomach acid |
| Fluorosis | Possible with too much in childhood | Not possible without fluoride |
| Skin around the mouth | A proposed cause of perioral dermatitis | No known link |
How to choose a hydroxyapatite toothpaste
Look for a stated percentage, ideally 10%, which is the level used in most of the research. Make sure it says nano, and that the percentage refers to the nHA powder itself, not a diluted suspension. Then use it properly: brush for two minutes, spit, and don't rinse.
Quick answers
Is hydroxyapatite as good as fluoride?
In an 18 month randomized clinical trial in adults, a fluoride free hydroxyapatite toothpaste performed as well as a 1,450 ppm fluoride toothpaste at preventing cavities.
Does nano hydroxyapatite help with sensitive teeth?
Yes. Sensitivity happens when tiny channels in your teeth are left open to hot, cold and touch. nHA helps seal them with the same mineral your teeth are made of. In a 2019 meta analysis of six clinical trials, nHA gave better sensitivity relief than the other treatments it was compared with.
Does nano hydroxyapatite whiten teeth?
Yes, without bleach or peroxide. nHA fills the microscopic scratches and gaps on your enamel, so the surface is smoother and reflects more light. Teeth look brighter and feel glassy smooth, and you are not stripping anything away to get there.
Is nano hydroxyapatite safe to swallow?
The EU's scientific safety committee concluded in 2025 that swallowed particles dissolve quickly in stomach acid and are safe in toothpaste at up to 29.5%.
Can fluoride toothpaste cause perioral dermatitis?
Fluoride toothpaste is listed in the Merck Manual as a proposed cause, and people with perioral dermatitis are advised to stop using it.
Can you use hydroxyapatite and fluoride together?
Yes. Some people use fluoride in the morning and hydroxyapatite at night. Your dentist can help you decide what fits your teeth.
Why we chose nano hydroxyapatite
We wanted a toothpaste that cares for the whole mouth with nothing it doesn't need. Bastét French Mint Toothpaste is made with 10% pure, rod shaped, uncoated nano hydroxyapatite, stated on the tube. No fluoride, no Sodium Lauryl Sulphate, no sugar. Made in Canada.
Shop French Mint Toothpaste · Read the science behind 10% nHA
Written by Alexandra Baker, co-founder of Bastét.
