Fluoride vs Hydroxyapatite: Which toothpaste ingredient is best to prevent tooth decay and care for your smile?

At Foxley Lane Dental in Purley, we’re all about informed, gentle guidance. If you’re in Croydon, South London or nearby, our experienced dental clinicians can help you find the right routine for your teeth and gums.

What is fluoride, how fluoride works, and why dentists still recommend it

Fluoride is a naturally occurring mineral found in water and some foods, and it plays a vital role in preventing dental caries (cavities). When used in toothpaste, it strengthens enamel by helping it remineralise after everyday acid attacks from food and drink.

Fluoride encourages new, more acid-resistant crystals to form in the oral cavity, helping reduce dental plaque and bacterial activity. It protects both baby teeth and permanent teeth, supporting lifelong oral health.

Everyday benefits of fluoride toothpaste

• Helps prevent cavities and root decay through effective caries prevention
  
  
• Builds stronger, more acid-resistant enamel
  
  
• Reduces sensitivity (especially with stannous fluoride)
  
  
• Simple to use - brush twice daily, spit, don’t rinse
  
  
• Supported by decades of dental research and NHS guidance

People at higher risk of decay - such as those with dry mouth, gum recession, or frequent snacking - may be prescribed a high-fluoride toothpaste (e.g. 5,000 ppm). These are safe, regulated, and used under professional guidance to avoid overexposure.

What is Hydroxyapatite? The “enamel-like” mineral

Hydroxyapatite is the same mineral that makes up most of your enamel and dentine. Hydroxyapatite toothpaste works by replenishing lost minerals, filling microscopic defects, and smoothing the tooth surface so plaque is less able to cling.

Everyday benefits of hydroxyapatite toothpaste

• Remineralises and helps repair early enamel wear
  
  
• Smooths the surface to reduce plaque and sensitivity
  
  
• Fluoride-free option for those who prefer it

Hydroxyapatite is ideal for those with low-to-moderate decay risk, or who prefer a fluoride-free routine. For higher-risk mouths, fluoride remains the more widely proven defence.

Fluoride vs Hydroxyapatite: quick comparison

• Cavity protection: Fluoride still has the most robust long-term evidence for preventing tooth decay across all age groups. Hydroxyapatite shows promising results for remineralisation and early lesions, especially when used consistently. At the population level, water fluoridation and the use of fluoridated water are highly effective in preventing caries, with extensive research supporting their role in reducing dental caries rates in both children and adults.
• Sensitivity: Both can help; stannous fluoride and hydroxyapatite have particularly good reputations here.
• Suitability: Hydroxyapatite is a viable alternative for people who prefer to avoid fluoride; fluoride is often recommended for higher-risk mouths or where cavities are a recurring issue.
• Mouthwash pairing: If you use a fluoride mouthwash, don’t use it immediately after brushing - leave a gap or use it at a different time of day to avoid washing away your toothpaste benefits.

When might you need a high-fluoride toothpaste?

You might be offered a prescription (e.g., 5000 ppm) fluoride toothpaste if you have one or more of the following:

• Multiple fillings or a recent history of decay
• Dry mouth (medications, menopause, or health conditions)
• Gum recession exposing the softer root surfaces
• Orthodontic treatment, complex dental work, or implant care where plaque control is crucial
• Frequent snacking, sweet drinks, or enamel erosion

Prescription toothpastes contain fluoride at higher concentrations, so it’s important to monitor how much fluoride is used to avoid the condition called dental fluorosis. This isn’t forever - it’s a targeted, time-limited boost to get risk under control.

Risks of excessive fluoride intake

Whilst fluoride is brilliant for preventing tooth decay and keeping your smile healthy, it’s important to use it thoughtfully. Using too much fluoride, especially over longer periods, can occasionally lead to dental fluorosis or, very rarely, skeletal fluorosis.

Dental fluorosis occurs when developing teeth are exposed to excess fluoride. It can appear as fine pearly white lines or small flecks on the enamel – a mild, cosmetic-only change. Severe cases are uncommon and affect appearance rather than health. Skeletal fluorosis, which is far rarer, may affect bone mineral density or cause mild joint stiffness after long-term high intake.

Children need a little extra care as their teeth and bones are still developing. We recommend using only a pea-sized amount of fluoride toothpaste, helping little ones brush and spit rather than swallow. This simple step keeps fluoride exposure balanced while protecting against dental caries.

Fluoride comes from several sources – fluoridated drinking water, fluoride toothpaste, mouth rinses, and some foods that naturally contain fluoride. Health bodies set safe ranges for exposure; if you’re unsure about your family’s overall intake, your dentist or GP can advise.

People with certain health conditions, such as kidney issues, may process fluoride differently. If that applies to you, we recommend keeping an eye on your fluoride intake and speaking to your dentist for tailored advice.

Drinking water and fluoride: what you need to know

When it comes to preventing dental decay, what you drink matters just as much as what you brush with. The fluoride in drinking water can be one of your best allies in protecting enamel and reducing acid attacks.

Fluoride is a natural mineral found in many water sources, and community water fluoridation is recognised as one of the most effective NHS oral health programmes for keeping smiles healthy. In fluoridated areas, levels are set at about 1 mg per litre – enough to strengthen enamel without unwanted effects.

If you’re in Purley, Croydon, Coulsdon, Selsdon or Addington, local tap water fluoride levels can vary. Some areas have naturally optimal levels, others very little, and a few exceed what’s needed. It’s worth checking with your water supplier to understand what’s in your area’s water, especially if you’re mindful of your family’s overall fluoride intake.

While fluoridated water offers valuable benefits, balance is key. Too much fluoride during early tooth development can cause mild dental fluorosis – those same pearly white lines sometimes seen on children’s enamel. Severe cases are rare. Experts recommend aiming for roughly 0.05 mg of fluoride per kilogram of body weight per day to stay within safe limits.

Beyond your glass of water, fluoride is also found in foods like fish and tea, as well as in toothpaste and mouth rinses. For higher-risk patients, we may suggest fluoride mouth rinses or professional treatments using sodium fluoride or stannous fluoride. Before taking fluoride supplements, always check with your dentist or healthcare provider – we’ll help ensure your fluoride levels are just right for your needs.

A balanced view on fluoride-free choices

In recent years, more people have started exploring fluoride-free toothpastes and natural alternatives such as hydroxyapatite toothpaste. Brands like ORL and Gutology have become popular options for those seeking a more minimalist or natural approach to daily oral care.

These can be suitable for some - particularly those at low risk of decay or who prefer to avoid certain ingredients - but it’s important to understand how non-fluoridated oral care products differ from traditional fluoride toothpaste. Making an informed choice means recognising both the benefits and the potential downsides of going fluoride-free.

The potential downsides of non-fluoridated oral care products

1. Higher risk of tooth decay, cavities, and enamel wear
   Without fluoride, enamel loses one of its key defences against acid attacks. Over time, this increases the likelihood of decay, especially in people who snack frequently, have dry mouths, or already have early signs of enamel thinning. Hydroxyapatite toothpaste can help remineralise, but long-term studies show fluoride toothpaste still provides the strongest cavity protection.
   
   
2. More sensitivity in exposed areas
   When enamel is worn or gum recession exposes the softer root surface, fluoride helps to harden these vulnerable areas and reduce sensitivity. Using fluoride-free toothpaste can mean these spots stay more sensitive and less resistant to daily wear.
   
   
3. Missed benefits for children and teens
   For younger patients - especially those still learning good brushing habits - fluoride plays a key role in strengthening developing teeth. Fluoride helps prevent dental caries during the years when cavities are most common. Relying solely on non-fluoride toothpaste or unfortified mouthwash may limit that protection.
   
   
4. “Natural” doesn’t always mean safer
   Many fluoride-free oral care products promote natural, organic or clean formulations. While these can be excellent when well-formulated, not all natural toothpastes contain active remineralising ingredients. Some rely on flavour oils or mild abrasives that may irritate gums or increase enamel wear if overused. Always look for low-abrasive, dentist-approved formulations - ideally those that include hydroxyapatite for added protection.
   

Choosing what’s right for you

If you prefer a fluoride-free routine, choose products that include hydroxyapatite, which has been shown to support enamel remineralisation and reduce sensitivity. Pair it with excellent brushing technique, daily flossing, and regular hygiene visits.

And if you’re unsure whether your local water supply already contains fluoride (many parts of the UK, including much of London, don’t), you can check using an official “fluoride in water UK” postcode tool or simply ask your dentist.

At Foxley Lane Dental, we’re here to guide you - not persuade you. Whether you choose fluoride or fluoride-free oral care, our goal is to help you protect your smile confidently and safely.

For advice tailored to your unique needs, we recommend consulting dental professionals who can help you select the most appropriate oral care products.

Fluoride, Hydroxyapatite, or fluoride-free: The bottom line

• Fluoride remains the most proven way to prevent cavities day-to-day - one we recommend to almost all our patients here at Foxley Lane Dental. It’s important to use it appropriately to avoid severe fluorosis - a rare, advanced form of dental fluorosis that can cause enamel pitting and discolouration.
• Hydroxyapatite is a solid, biocompatible option - especially if you prefer fluoride-free - and can help with sensitivity and early enamel repair.
• Your decay risk (diet, saliva, health history) should guide which product takes the lead.

Still not sure? 

Let’s look at your smile, chat through your preferences, and create a tailored dental care plan together that’s right for you.

Your local, friendly fluoride-guidance dentist in South London

Looking for a Purley dentist or Croydon dentist who’ll give clear, friendly advice on fluoride toothpaste, fluoride mouth rinses, fluoride varnishes, and hydroxyapatite toothpaste?

At Foxley Lane Dental in Purley, we care for patients across Croydon, South London, Selsdon, Coulsdon, Wallington, Addington and New Addington. Whether you prefer fluoride or fluoride-free options, we’ll tailor a plan that fits your smile, lifestyle and goals.

Book a consultation today