TL;DR: Hydroxyapatite (HAp) toothpaste is a legitimate, research-backed ingredient that can remineralize tooth enamel — but it is NOT proven to be more effective than fluoride at preventing cavities in children.
Most U.S. and international pediatric dental associations, including the American Academy of Pediatric Dentistry (AAPD) and American Dental Association (ADA), continue to recommend fluoride toothpaste as the gold standard for cavity prevention in kids.
If your child is at low cavity risk and you prefer fluoride-free, HAp may be a reasonable alternative — but talk to your child’s dentist first.
Why Hydroxyapatite Toothpaste Is Trending Right Now
If you’ve been on TikTok or Amazon lately, you’ve probably seen hydroxyapatite toothpaste everywhere.
Brands like Boka, RiseWell, and Happy Tooth have exploded in popularity, with HAp toothpaste now ranking as one of the top-selling toothpaste categories on Amazon.
The trend has been turbocharged by a few recent developments: the FDA’s October 2025 restrictions on fluoride supplements for children under 3, ongoing political debate about water fluoridation (Utah and Florida banned it in 2024–2025, and 19+ other states have introduced similar bills), and high-profile anti-fluoride messaging from public figures including RFK Jr.
The result: millions of parents are questioning fluoride for the first time — and HAp toothpaste marketers are ready with an answer.
But before you make a switch that affects your child’s long-term dental health, it’s worth understanding what the science actually says.
What Is Hydroxyapatite Toothpaste?
Hydroxyapatite is a naturally occurring mineral that makes up approximately 97% of your tooth enamel and 70% of dentin (the layer beneath enamel).
When used in toothpaste, nano-hydroxyapatite (n-HAp) particles are designed to fill microscopic gaps in enamel, remineralize early lesions, and strengthen the tooth surface over time.
It’s not a new invention: HAp toothpaste has been widely used in Japan since the 1980s, where it was developed by NASA-affiliated researchers and approved by the Japanese Ministry of Health.
In the United States, it remains an “inactive ingredient” under FDA classification — meaning it can be sold in toothpaste but does not yet carry the FDA’s “anticavity” drug designation that fluoride holds.
This distinction matters more than most TikTok videos will tell you.
What Does the Research Say About HAp for Kids?
The research on hydroxyapatite toothpaste is genuinely promising — but it’s also limited compared to the decades of evidence behind fluoride in pediatric dental health.
A 2019 randomized controlled trial published in the Journal of Dentistry found that 10% HAp toothpaste was non-inferior to 1,000 ppm fluoride toothpaste for remineralizing early enamel lesions in children aged 3–10 over an 18-month period.
A 2022 systematic review in the Journal of Clinical Medicine concluded that HAp showed comparable remineralization effects to fluoride in in-vitro (lab) studies, but called for more large-scale, long-term clinical trials in children before drawing firm conclusions.
A 2024 meta-analysis in Frontiers in Dental Medicine found “no statistically significant difference” between HAp and fluoride for preventing new cavities in children — but noted that most included studies had small sample sizes and short follow-up periods.
The honest summary: HAp works.
But “works” and “works as well as fluoride in all children” are not the same statement, and the evidence is not yet strong enough to make that leap.
What the AAPD and ADA Say
The American Academy of Pediatric Dentistry’s 2023–2024 guidelines continue to recommend fluoride toothpaste as the first-line recommendation for all children, regardless of cavity risk.
The ADA’s Seal of Acceptance is currently not awarded to any hydroxyapatite-only toothpaste, because no HAp product has yet completed the clinical trial requirements the ADA requires for its anticavity seal.
The Canadian Dental Association has been more open: it released a position statement in 2022 stating that HAp toothpaste can be used as an alternative for patients who cannot use or refuse fluoride — with the caveat that it should be considered primarily for low-risk patients.
The European Academy of Paediatric Dentistry similarly acknowledged HAp as a “viable alternative” while maintaining that fluoride remains the most evidence-supported choice.
Hydroxyapatite vs. Fluoride: Key Differences for Parents
Fluoride works through two main mechanisms: it strengthens enamel by converting hydroxyapatite to fluorapatite (a harder, more acid-resistant mineral), and it actively inhibits the bacteria that cause cavities.
Hydroxyapatite primarily works through remineralization — filling in early enamel damage — but does not have the same proven antibacterial effect against Streptococcus mutans, the primary cavity-causing bacteria.
For children at high cavity risk — those with a history of cavities, sugary diets, or limited access to dental care — this antibacterial distinction is clinically significant.
For children at low cavity risk, with excellent brushing habits, low sugar intake, and regular dental visits, the gap between HAp and fluoride narrows considerably.
What About Fluoride Safety Concerns?
This is the question driving most of the trend, so it deserves a direct answer.
Fluoride at recommended levels (0.7 mg/L in water; age-appropriate amounts in toothpaste) has a strong, decades-long safety record in children.
The concerns that are currently circulating — primarily from a 2024 National Toxicology Program (NTP) meta-analysis — involved fluoride exposure at levels approximately 2–3 times higher than the U.S. water fluoridation standard.
A landmark November 2025 study published in Science Advances, which followed 26,820 students, actually found that children exposed to fluoride at recommended levels showed modestly better cognitive outcomes than those in lower-fluoride areas — directly contradicting the IQ-lowering narrative.
Dental fluorosis (mild white spots on teeth) is a real possibility when young children swallow too much fluoride toothpaste — which is why the AAPD recommends a rice-grain-sized amount for children under 3 and a pea-sized amount for ages 3–6.
Use the right amount, and fluoride risk drops dramatically.
Should You Switch to HAp Toothpaste for Your Child?
Here is a practical framework for making this decision:
Consider sticking with fluoride if: Your child has a history of preventing cavities in children, has dietary habits that include frequent sugary snacks or drinks, has limited access to fluoridated water (well water or bottled water households), or is under the care of a dentist who recommends it based on their specific cavity risk assessment.
Consider HAp as an option if: Your child is low-risk for cavities (no history, excellent brushing, low sugar intake, regular dental care), you have specific concerns about fluoride that you’ve discussed with your dentist, or your child is under 2 and the no-swallow requirement for fluoride is difficult to enforce.
Always do this first: Talk to your child’s pediatric dentist before switching. Risk-based care is the foundation of modern pediatric dentistry — and what’s right for one child may not be right for another.
Age-Specific Toothpaste Guidance
Follow our complete kids oral hygiene guide for a full routine — here’s a quick age-by-age toothpaste reference:
Under 12 months: Wipe gums with a clean, damp cloth. No toothpaste needed yet.
12 months to 3 years: AAPD recommends a smear (rice grain) of fluoride toothpaste. If using HAp, confirm the product is safe for this age group and does not contain any contraindicated ingredients.
3 to 6 years: Pea-sized amount of fluoride toothpaste (1,000 ppm minimum). HAp products in this range are available but choose one without SLS (sodium lauryl sulfate) and without abrasive whitening agents.
6 years and older: Standard adult fluoride toothpaste (1,000–1,450 ppm) is appropriate. HAp is a viable option at this age for low-risk children.
Bottom Line
Hydroxyapatite toothpaste is not a scam — it’s a real ingredient with real science behind it.
But it’s also not a proven replacement for fluoride in children, especially those at moderate or high cavity risk.
The best toothpaste for your child is the one your pediatric dentist recommends based on your child’s specific risk profile — not the one going viral on TikTok this week.
If you’re concerned about fluoride, bring those concerns to your next first dental visit. A good pediatric dentist will take your questions seriously and help you make an evidence-based decision for your child.
This article provides general information about toothpaste ingredients for children. It does not replace professional dental or medical advice. Always consult your child’s pediatric dentist before making changes to their oral care routine.
Frequently Asked Questions
Is hydroxyapatite toothpaste safe for toddlers?
Yes, nano-hydroxyapatite toothpaste is generally considered safe for toddlers, and it has the advantage of being safe to swallow in small amounts — which is beneficial for young children who haven’t mastered spitting yet. However, check labels carefully, as some HAp toothpastes contain other ingredients that are not appropriate for young children.
Which HAp toothpastes are recommended for children?
Popular options include Boka Kids, RiseWell Kids, and Remi Children’s Toothpaste. Always check that the product is free of SLS, artificial sweeteners, and any ingredients not appropriate for the child’s age. Consult your pediatric dentist before making a switch.
Does hydroxyapatite toothpaste prevent cavities as well as fluoride?
Current evidence suggests HAp may be comparable to fluoride for low-risk children, but the research base is smaller and shorter-term than the evidence for fluoride. For higher-risk children, fluoride remains the better-supported choice according to the AAPD and ADA.
Can I use HAp toothpaste alongside fluoride treatments at the dentist?
Yes. Using HAp toothpaste at home does not preclude your child from receiving fluoride varnish treatments at dental checkups. Many dentists recommend this approach for families who prefer to minimize daily fluoride exposure while still protecting against cavities.
Why did the FDA restrict fluoride supplements for children under 3?
In October 2025, the FDA restricted prescription fluoride supplements (drops and tablets) for children under 3, citing new safety review concerns including potential gut microbiome effects and the NTP meta-analysis. This action did not restrict fluoride toothpaste, which remains the primary recommended tool for cavity prevention in young children according to the AAPD and AAP.
Source List
- American Academy of Pediatric Dentistry. Fluoride Therapy. Pediatric Dentistry Reference Manual 2023-2024. https://www.aapd.org/research/oral-health-policies–recommendations/fluoride-therapy/
- Limeback H, et al. (2022). Hydroxyapatite vs. Fluoride: A Systematic Review. Journal of Clinical Medicine.
- Najibfard K, et al. (2019). Clinical trial of 10% HAp toothpaste in children. Journal of Dentistry.
- Chun-Hung Chu et al. (2024). Meta-analysis: HAp vs. fluoride for caries prevention. Frontiers in Dental Medicine.
- Canadian Dental Association. (2022). Position Statement on Hydroxyapatite Toothpaste.
- European Academy of Paediatric Dentistry. (2021). Guidelines on fluoride use in children.
- Broadbent JM et al. (2025). Fluoride at recommended levels and cognitive outcomes in children. Science Advances.
- National Toxicology Program. (2024). NTP Monograph on Fluoride Exposure and Neurodevelopment.
- ADA. Seal of Acceptance program requirements. https://www.ada.org/resources/research/science/ada-seal-of-acceptance/how-to-earn-the-ada-seal
Mary – Queens Pediatric Dental Resource Manager. I’m a dental health researcher and parent advocate based in Queens, NY. After struggling to find reliable pediatric dental information during my own child’s dental emergency, I created this resource to help other Queens families navigate their children’s oral health needs.
I curate evidence-based information from leading pediatric dental organizations, peer-reviewed research, and trusted dental health experts. While I’m not a dentist, I’m committed to providing accurate, practical guidance that helps parents make informed decisions.
All content is thoroughly researched and includes proper medical disclaimers directing families to consult qualified pediatric dentists for their children’s specific needs.