Why the Quantity of Hydroxyapatite in Toothpaste Matters for Remineralizing Cavities

Why the Quantity of Hydroxyapatite in Toothpaste Matters for Remineralizing Cavities

In our quest to get beyond any marketing hype–and find the best and safest products for our family–many of us turn to the list of ingredients.

And there’s plenty that this list can tell us.

For example, it reveals both what’s in and what’s NOT in a formula, helping us ensure that the product only contains the ingredients we want to be using and no junk that we’re looking to avoid.

However, there’s another critical piece of information that a product ingredient label provides. In the US and other countries, by law, the ingredients in a formula must be listed in descending order of concentration. In other words, the ingredients with the highest concentrations must be stated first, and then the list continues until you get to the last ingredient, which has the smallest quantity in that formula.

That’s good to keep in mind, because when it comes to oral hygiene products, the quantity of certain ingredients matters.

Today, we’re diving deep into this topic to explore the different categories of ingredients, why quantity really matters for some of them, and why it’s common for companies to minimize the amount of ‘good stuff’ in formulas.

First, let’s take a look at the two main categories of ingredients and the purposes they each serve.

‘Active’ vs. ‘inactive’ ingredients

Product developers (in every market) choose each ingredient in their formulas for specific purposes.

The ‘active’ ingredients in a formula (which we sometimes refer to as the ‘functional’ ingredients) are there to try to produce a desired effect or result for the user. The ‘inactive’ ingredients weren’t included in the formula to produce a result for the user, but they still serve a purpose. For example, inactive ingredients might be there to create a certain texture, to extend a product’s shelf life, to sweeten it, to color it, etc.

To illustrate this point, let’s take a look at the ingredients for our HealThy Mouth Blend.

The Blend only includes 100% organic essential oils and a certified organic carrier oil base. There are no fillers, colors, or sweeteners. Why? Our formulas contain as many active ingredients and as few inactive ingredients as possible, so we can offer the greatest value for supporting oral health.

The essential oils in the Blend are what we consider to be the active or functional ingredients that produce a result for the user. They’re in the formula because they’re known to balance the oral microbiome, freshen breath, soothe sensitivity, and help reduce or prevent plaque buildup.

The carrier oil base is an inactive ingredient. It’s in the formula to dilute the essential oils to levels that are safe to use in the mouth. If you’d like to learn more about the specific role for each of the Blend’s ingredients, head over to our article, “What’s in the HealThy Mouth Blend? (And why is it so effective?).”

Zooming out to look at other oral hygiene products, we see that a common goal for most toothpaste and tooth powder formulas is to help the user prevent tooth decay.

Now, we acknowledge that a toothpaste can be formulated with more than one goal in mind, like remineralizing and whitening teeth. (As a matter of fact, when we formulated our Shine Remineralizing Tooth Whitening Powder, our primary goal was to create a product that would help protect the user from future tooth decay and provide remineralization support to stop existing decay. Our secondary goal was to help gently whiten teeth without harming them. We wanted to achieve all of that without negatively impacting other systems throughout the body.)

To keep things simple for this discussion, we’ll center our attention on the ‘stop tooth decay / remineralize cavities’ goal only.

The three most common active ingredient options that help to remineralize teeth and/or protect against the decay process are fluoride, hydroxyapatite (aka ‘HA’ or ‘HAP’), and xylitol.

In most remineralizing oral hygiene products, you’ll find some combination of those three active ingredients.

But does their concentration in a formula make a difference?

Q1: Does the quantity of these active ingredients impact the product’s ability to prevent cavities?

Absolutely!

We’re going to share a few studies that touch on fluoride, hydroxyapatite, and xylitol.

To be clear, the overall purpose of this particular article is not to compare the efficacy or risks of various remineralizing agents (although, we will give a brief overview of our thoughts about hydroxyapatite vs. fluoride in a bit).

Our main objective here is to show what the research says about how the quantity of these ingredients impacts their ability to help us protect our teeth against decay.

On fluoride …

A 2010 review of 74 different studies on the effectiveness of different concentrations of fluoride-containing toothpastes states, “The relative caries preventive effects of fluoride toothpastes of different concentrations increase with higher fluoride concentration.”

Another meta-analysis from 2019 states, “Regular toothbrushing with fluoride toothpaste is the principal non‐professional intervention to prevent caries, but the caries‐preventive effect varies according to different concentrations of fluoride in toothpaste, with higher concentrations associated with increased caries control.”

Ok, so more fluoride = more protection. No surprise there.

What about hydroxyapatite?

As you may have already discovered, at OraWellness, we’re not fans of fluoride. That’s why our products use hydroxyapatite for supporting tooth remineralization. However, to choose a hydroxyapatite that’s effective and doesn’t come with potential negative ‘downstream’ impacts for the rest of the body, details like the particle size are important.

At this time, we use microparticles in our formulas instead of nanoparticles. We’ve chosen to avoid nanoparticles in all of our ingredients because in our opinion, just like fluoride, the current data suggests that the risks of nanoparticles outweigh any potential benefits. To learn more about our concerns with nanoparticles, feel free to check out our article, “Nano or No-No? Hydroxyapatite Particle Size Matters.”

But, while there’s plenty of research that demonstrates how microcrystalline hydroxyapatite helps support teeth, since nanoparticles are all the rage right now, it’s challenging to find a study that specifically evaluates what concentrations of microcrystalline hydroxyapatite are most beneficial. Because of this, we’ll share information that we found about nano-hydroxyapatite.

In a 2009 study titled, “Effect of nano-hydroxyapatite concentration on remineralization of initial enamel lesion in vitro,” researchers stated, “When the concentration of nano-HA was under 10%, SMH [surface microhardness] and %SMHR [percentage of surface microhardness recovery] increased with increasing nano-hydroxyapatite concentrations.”

As you can see, research exists that suggests hydroxyapatite’s remineralization benefit increases with increased quantity (which is why we made microcrystalline hydroxyapatite, MCHA, the #1 ingredient in Shine).

And xylitol …

In the “Meta-analysis on the effectiveness of xylitol in caries prevention” from 2022, researchers concluded that, “The review of the literature has also concluded that the most effective xylitol product in caries prevention was the xylitol (100%), chewed or consumed three to five times per day, after meals with a total dose of 5–10 g/day. Frequencies less than three times a day (less than 3.44g/day) did not show any caries preventive benefit.”

Now that we’ve confirmed that quantity matters, it begs a question …

Q2: Why would companies choose to reduce the quantity of active ingredients in their formulas?

If the concentration of the active ingredient in a formula increases its effectiveness, why wouldn’t a company put as much ‘good stuff’ in the formula as possible?

Let’s address this elephant in the living room …

The 2 main reasons why active ingredients would have smaller quantities in formulas

It often boils down to safety and cost.

First, let’s talk about the safety factor.

We’ll start with fluoride-based oral hygiene products. Excessive fluoride has been shown to negatively impact the brain, thyroid gland, bones, nervous system, and a whole host of other organs and systems in the body.

In fact, companies that produce oral hygiene products with fluoride are required to include text on their label that cautions the user to immediately contact a poison control center if they’ve swallowed more than a certain amount (the iconic “not more than a pea-sized amount” for children).

Similarly, as we explained in the ”Hydroxyapatite” section of our Dental Floss Comparison Guide and in our Nano or No-No article, when it comes to nanoparticles, there are some serious whole-body-health concerns being brought to light from peer-reviewed, published research.

The European Union’s Scientific Community on Consumer Safety originally stated, “. . . the SCCS cannot conclude on the safety of the hydroxyapatite composed of rod–shaped nanoparticles for use in oral-care cosmetic products . . . This is because the available data/information is not sufficient to exclude concerns over the genotoxic potential of HAP-nano . . . the SCCS has concluded that there is a basis for concern that the use of HAP-nano in cosmetic products can pose a risk to the consumer.”

Later, they updated their stance to specify that for non-coated/non-modified, rod-shaped nanoparticles, “Based on the data provided, the SCCS considers hydroxyapatite (nano) safe when used at concentrations up to 10% in toothpaste, and up to 0.465% in mouthwash . . .”

(As an interesting side note, in that update, they also stated, “This Opinion is not applicable to hydroxyapatite (nano) composed of needle-shaped particles,” and “ . . . this Opinion is not applicable to sprayable products that might lead to exposure of the consumer’s lungs to nanoparticles by inhalation.”)

In other words, companies might like to be able to use more fluoride and/or nano-HA in their over-the-counter products, but they’re limited due to safety regulations.

And, since there are ‘professional grade’ fluoride AND nano-HA products that can only be purchased and applied by dental professionals, we surmise that products with higher concentrations of fluoride, nano-HA, or other functional ingredients probably yield better remineralization results (otherwise, companies wouldn’t produce these additional products).

It’s important to note that the European Union’s Scientific Community on Consumer Safety has no regulations on micro-sized hydroxyapatite particles. In fact, microcrystalline hydroxyapatite is commonly used and sold worldwide as a dietary supplement because it’s a very bioavailable source of calcium. So, the scientific literature only demonstrates safety concerns for the nanoparticle sized HA.

Now let’s look at the second factor that impacts the amount of active ingredients that companies include in their formulas: cost.

The financial reason why some companies choose to use a lower quantity of functional ingredients

Unfortunately, the financial component often plays a central role in the formulation process.

To stay in business, companies have to keep their products within a price range that their customers are willing / able to pay.

Some companies may want to include a buzzworthy ingredient in their formula deck so they can capitalize on its popularity and increase their sales, but they’re unwilling or unable to adjust their production budget (or sacrifice their profit margin).

So rather than increasing their product prices, they may use one or two common cost-savings tactics.

Let’s explore both of these so you can learn to spot them yourself.

First, they may simply add a sprinkling of a functional product into a formula.

We call this ‘pixie dusting’.

When a company wants to be able to market their product as containing some popular functional ingredient (that happens to be expensive), they’ll include it in the formula, but it will be WAY down on the ingredient list.

We see this often with hydroxyapatite.

To cut through the advertisement noise, simply check the ingredients list.

If hydroxyapatite isn’t towards the top (and especially if the top of the list is full of cheap fillers, like hydrated silica, bentonite clay, and glycerin), it may be best to steer clear of that option and find a different one with more effective concentrations of active ingredients.

The second cost-savings tactic that companies may use is including a bit of a functional ingredient and supplementing the formula with a similar, cheaper ingredient, too.

For example, companies will commonly include some xylitol in their remineralizing formula (because according to the research, xylitol is the most effective sugar alcohol for supporting tooth remineralization and protecting against decay), and they’ll also include sorbitol, because it’s substantially cheaper than xylitol, it still offers some remineralization support, and it helps sweeten the formula.

By including both xylitol and sorbitol in the formula (normally more sorbitol), the company can lower the production cost while still being able to say “Contains xylitol!”.

A peek into how we at OraWellness approach the R&D process

The main focus of our research and development is to use the very highest quality ingredients (that don’t have negative ‘downstream’ impacts in the rest of the body), in concentrations that are optimized to provide benefits for the user.

We want to make sure our products are as effective as possible. After all, we’ll be using them daily, and so will our friends, family, and our beloved community!

We simply don’t allow cost to be a factor for our decisions around which ingredients–or how much of them–to include in a formula. This helps us to make the best products possible. Then, we focus on educating you (our community) about why our products are more expensive than others on the market, and we let you decide if there is value in our products for you.

And while it’s true that we’ll never be able to compete with the super low price points of most of the neighboring products on a retail shelf, at the end of the day, we know that the quality, quantity, safety, and efficacy of our ingredients are what matter to us the most.

We’re not here to make a fortune selling products.

We’re here to offer you the very best product and information solutions that we can, leveraging our unique blend of modern research, ancient holistic longevity arts, and our deep desire to contribute to the betterment of humanity.

Thankfully, there are plenty of you around the world who appreciate the focus, prayer, and research we put into our solutions. And at the end of the day, the results our happy customers get from using our products prove that our “quantity & quality first” strategy is working to make the world a healthier place.

Wrapping up

Simply put, quantity matters.

The higher the concentration of the remineralizing agent, the more positive impact it can have on our oral health.

And if you choose the right type and particle size for the remineralizing agent too, it can support your oral health without risking creating problems for the whole body.

If you’ve enjoyed learning about ingredients, we invite you to check out our videos on xylitol and glycerin to learn about whether they help or hinder our oral (and whole-body) health!

So far in our series on hydroxyapatite, we’ve explored why particle size matters and in this article why quantity matters. In a future article, we’ll wrap up this three-part series by checking out two more fascinating aspects of hydroxyapatite that can help you most effectively remineralize your teeth: the hydroxyapatite’s quality as well as any other ingredients or compounds that are delivered with it. Stay tuned!

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Comments

  1. MJ says

    Will and Susan’s approach is why I trust and use their products.

    Reply

  2. Alexander Snobgrass says

    You guys support the so-called “studies” showing more cavity prevention using fluoride? Serious? My respect for your business just dropped several notches.

    Reply

  3. Julie says

    👍👍👍

    Reply

  4. Mindy Gail Goldis says

    FANTASTIC ARTICLE!! THANKS TO EVERYONE AT ORAWELLNESS AND FOR PROVIDING US WITH TRUTH, INTEGRITY, SMILES, GOOD VIBES AND THE BEST PRODUCTS EVER!!! MINDY-GAIL AKA THERAWSOMEVEGANGAL 🙂

    Reply

    • Will And Susan says

      Thanks for the love, Mindy Gail!!

      Reply

      • Mindy Gail Goldis says

        YOU BOTH DESERVE IT, AS WELL AS THE WHOLE TEAM FOR BEING REAL AND TRUE TO YOURSELVES AND TO USE ALL!!! 🙂

        Reply