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Hydroxyapatite Toothpaste: What the Percentage on the Label Actually Tells You

Hydroxyapatite Toothpaste: What the Percentage on the Label Actually Tells You

By CleenBeez Team

Oral Care

CleenBeez may earn a commission if you buy through links on this page. We pick products based on facts shown on brand labels and product pages, not paid placement. This article is label education, not dental or medical advice. Talk to your dentist about what is right for your teeth, and your kids' teeth.

10%, 15%, nano, micro. The number on a hydroxyapatite tube tells you less than you think. Hydroxyapatite (HAP) is the mineral your enamel is made of, and it shows up in fluoride-free toothpastes, sometimes with a percentage front and center. Here is what that number can and can't tell you, starting with the part that matters most.

The line worth sending to the friend who just switched toothpaste: a bigger percentage is not the same thing as more evidence, and fluoride still has the deeper evidence base.

Want to skip ahead? If you have decided on a fluoride-free hydroxyapatite paste, the one we like is RiseWell PRO Mineral Toothpaste. Its CleenBeez product page lists hydroxyapatite and nano-hydroxyapatite in the ingredients and shows Fluoride-Free, SLS-Free, SLES-Free, and Vegan. The Buy Now link is on that page. Please read the fluoride section below first.

Myth: hydroxyapatite has replaced fluoride

It has not. Fluoride has the deeper evidence base for cavity prevention.

  • A Cochrane systematic review (Walsh et al., 2019) found fluoride toothpaste prevents tooth decay compared with non-fluoride toothpaste in children and adolescents, and that 1450 to 1500 ppm fluoride was slightly more effective than 1000 to 1250 ppm.
  • The CDC says fluoride toothpaste helps prevent cavities, at all ages.
  • The ADA Seal for anticavity toothpaste is for fluoride-containing toothpastes.
  • The FDA's anticaries monograph lists fluoride compounds as the active ingredients. Hydroxyapatite is not on that list.

Hydroxyapatite has a small number of promising trials, not a comparable body of evidence. It has not been shown to replace fluoride or reverse tooth decay.

What the hydroxyapatite trials actually found

The two trials you will see cited most often:

Adults (Paszynska et al., 2023). An 18-month, double-blind randomized trial in adults aged 18 to 45 compared a fluoride-free 10% hydroxyapatite toothpaste with a 1450 ppm fluoride toothpaste. 189 people were randomized and 171 completed per protocol. 89.3% of the hydroxyapatite group and 87.4% of the fluoride group had no new cavities. The hydroxyapatite paste was found non-inferior to fluoride, within a 20% margin. It was not found superior.

Children (Paszynska et al., 2021). A 336-day, double-blind randomized trial in 207 children aged 3 to 7 (177 per protocol) compared a 10% microcrystalline hydroxyapatite toothpaste with a 500 ppm amine fluoride toothpaste. The reported caries progression figures were 72.7% for the hydroxyapatite group and 74.2% for the fluoride group, and hydroxyapatite was found non-inferior. Important detail: the comparison was a low-fluoride toothpaste (500 ppm), not a standard 1000 ppm or higher paste.

Read these with the limits in view

  • Each is a single trial, and they come from overlapping investigator groups.
  • Both tested 10% hydroxyapatite. Neither tested nano-hydroxyapatite or a blend like the one described below.
  • Non-inferiority within a wide 20% margin is a narrower finding than "works as well in every case."
  • We could not confirm the funding or conflict-of-interest disclosures for either trial, so we make no claim about who funded them.
  • Whether other research teams have repeated the adult result against standard-strength fluoride is something we could not confirm.

Promising? Yes. Enough to say every hydroxyapatite toothpaste works like these did? No.

Myth: a higher percentage means a better toothpaste

The percentage on the tube only means something if you know what it is a percentage of, and what size the particles are.

Nano vs micro. These words describe particle size, and nano particles are the smaller ones. They are not interchangeable on a label. In the EU, Regulation 2024/858 permits nano-hydroxyapatite in toothpaste up to 10% in the ready-to-use product, only for specified uncoated rod-shaped particles, and not in products that may lead to inhalation exposure.

Percent of what? A percentage can describe a paste-form ingredient rather than pure hydroxyapatite solids. When it does, the actual amount of hydroxyapatite can be lower than the number suggests.

Here is how that plays out on the toothpaste we like. RiseWell says PRO contains "5% NanoXIM CarePaste" and "10% micro hydroxyapatite." Those are RiseWell's own stated figures. The 5% figure, as RiseWell states it, is for a paste ingredient, so the actual nano-hydroxyapatite solids percentage may be lower, and we could not find that number. Adding RiseWell's two stated numbers together gives 15, but that is not a lab-verified "15% hydroxyapatite," and we will not call it one.

How to read a hydroxyapatite label in 30 seconds

  1. Is a percentage disclosed at all?
  2. Nano, micro, or both?
  3. Percent of what? Pure hydroxyapatite, or a paste-form ingredient?
  4. Whose number is it? A brand's stated formula is a brand claim, not a lab result you can check.
  5. Fluoride or not? If it is fluoride-free, that is a choice to make with your dentist, given the evidence above.

The hydroxyapatite toothpaste we like: RiseWell PRO Mineral Toothpaste

View RiseWell PRO Mineral Toothpaste on CleenBeez

Why this one: it tells you which forms of hydroxyapatite are in the tube, and RiseWell publishes its stated percentages, so you can actually run the label checklist above.

Ingredients. The CleenBeez product page lists Hydroxyapatite and Nano-Hydroxyapatite. See the product page for the full list.

What RiseWell says about the amounts. RiseWell states "5% NanoXIM CarePaste" and "10% micro hydroxyapatite." Treat both as RiseWell's claim. We could not find the actual nano-hydroxyapatite solids percentage.

Marks on the product page. Fluoride-Free, SLS-Free, SLES-Free, and Vegan.

Honest note. Fluoride-free is the point of this product, and it is also the trade-off. Fluoride has the deeper evidence base for cavity prevention. If cavities are a concern for you, ask your dentist before switching.

See RiseWell PRO Mineral Toothpaste (Buy Now link on the product page)

FAQ

Is hydroxyapatite as good as fluoride?

Two trials found a 10% hydroxyapatite toothpaste non-inferior to the fluoride toothpaste it was compared with, one in adults against 1450 ppm fluoride and one in children against a low 500 ppm fluoride paste. That is promising, but it is not a comparable body of evidence. Fluoride has the deeper evidence base for cavity prevention, and hydroxyapatite has not been shown to replace fluoride or reverse decay.

Can I use both?

That is a question for your dentist, who knows your cavity risk. This article cannot give you a routine.

Is nano-hydroxyapatite safe?

What we can tell you is how the EU regulates it: Regulation 2024/858 allows nano-hydroxyapatite in toothpaste up to 10% in the ready-to-use product, only for specified uncoated rod-shaped particles, and not in products that may lead to inhalation exposure. For anything beyond that, ask your dentist.

Is a fluoride-free hydroxyapatite toothpaste OK for kids?

Ask your child's dentist. The children's trial above compared hydroxyapatite with a low 500 ppm fluoride toothpaste, not a standard-strength one, and the CDC says fluoride toothpaste helps prevent cavities at all ages.

Does RiseWell PRO have 15% hydroxyapatite?

RiseWell says PRO contains "5% NanoXIM CarePaste" and "10% micro hydroxyapatite." Because the 5% figure, per RiseWell, refers to a paste ingredient, the actual nano-hydroxyapatite solids may be lower. We could not verify a total hydroxyapatite percentage, so we do not describe it as 15%.

Bottom line (the screenshot version)

  1. Fluoride has the deeper evidence base for cavity prevention (Cochrane, CDC, ADA, FDA).
  2. Hydroxyapatite has a small number of promising trials. It has not been shown to replace fluoride or reverse decay.
  3. The trials tested 10% hydroxyapatite, not nano or blends, and the kids' trial compared it with low-fluoride paste.
  4. On a label, ask: nano or micro, percent of what, and whose number is it?
  5. RiseWell's percentages are RiseWell's claim. If you have chosen fluoride-free with your dentist, start with RiseWell PRO Mineral Toothpaste.

Sources

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