The role of hydroxyapatite-based, fluoride-free toothpastes on the prevention and the remineralization of initial caries lesions: A systematic review and meta-analysis.

Summary

This systematic review and meta-analysis of in situ RCTs found hydroxyapatite toothpaste comparable to fluoride in preventing lesion development/progression by DMFS/ICDAS, with significant benefits in lesion size and fluorescence at 6 months. Pooled RR (0.98) and OR (0.90) were non-significant, supporting HAP as a fluoride-free alternative.

Key Findings

• No significant differences between HAP and fluoride toothpastes for lesion development/progression (DMFS/ICDAS).
• Significant improvements at 6 months in lesion size (p < 0.0001) and fluorescence values (p = 0.01) favoring HAP.
• Meta-analysis: RR 0.98 (p = 0.61; 95% CI 0.85–1.12) and OR 0.90 (p = 0.68; 95% CI 0.57–1.42) showed no significant differences.

Clinical Implications

Hydroxyapatite toothpaste can be recommended as a fluoride-free option for patients seeking non-fluoride products, particularly for early enamel lesions, with monitoring as standard of care.

Limitations

• Only four eligible studies; limited power and generalizability
• In situ RCT context and short follow-up (6 months) may not fully reflect clinical conditions

Future Directions

Conduct pragmatic, longer-term clinical RCTs across age groups to confirm equivalence and evaluate caries incidence, safety, and adherence in real-world settings.