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Table 1 Comparison of the effects of HAP and fluoride toothpastes

From: The use of hydroxyapatite toothpaste to prevent dental caries

  Hydroxyapatite toothpaste Fluoride toothpaste
Mechanism of Action Deposition of HAP particles either in the micro or nanocrystalline form, which bind to enamel surfaces to fill in demineralized surface defects and micropores [14] Improvement of the natural tooth surface remineralization process [65]
Remineralization of enamel/dentin Reports of increased surface remineralization by SEM and light microscopy, surface hardness, and mineralization as measured by TMR of HAP toothpaste compared to fluoride toothpaste in vitro and in situ [66]
Similar results were found in terms of surface hardness between HAP toothpaste and 1450 ppm fluoride toothpaste [3]
The effects on dentin remineralization
In situ studies demonstrate equivalency of HAP toothpaste to 500 ppm fluoride toothpaste as measured by TMR
Fluoride toothpaste can lead to a limited increase in remineralization at the outer tooth surface [19, 67]
Caries Prevention Non-inferiority of 10% microcrystalline HAP toothpastes compared with fluoride toothpastes in caries progression as measured by ICDAS score progression in both primary and permanent dentition [4, 5] The caries prevention of fluorides is well-established [68]
Source of calcium and phosphate Does not rely on calcium and phosphate in saliva [6] Relies on salivary flow for calcium and phosphate ions [67]
Adverse effects No adverse health events have been reported [63] Dental fluorosis, systemic toxicity leading to bone fracture [69], developmental neurotoxicity [70, 71] and gastric irritation when used in excess [72]
Whitening HAP gel found to produce increased brightening effects in vitro and in vivo [53, 58, 59] No significant difference in tooth shade score from baseline [73]
Sensitivity Decreased dentinal hypersensitivity compared to fluoridated toothpaste and tubule occlusion [20, 56, 57] No significant difference between fluoride toothpaste and placebo [62]