Improving Oral Health with Fluoride-Free Calcium-Phosphate-Based Biomimetic Toothpastes: An Update of the Clinical Evidence

As the demand for clinically effective fluoride-free oral care products for consumers increases, it is important to document which types of toothpastes have been shown in clinical studies to be effective in improving oral health. In this review, we included different indications, i.e., caries prevention, improving periodontal health, reducing dentin hypersensitivity, protecting against dental erosion, and safely improving tooth whitening in defining what constitutes improvement in oral health. While there are several professional and consumer fluoride-containing formulations fortified with calcium-phosphate-based ingredients, this review focuses on fluoride-free toothpastes containing biomimetic calcium-phosphate-based molecules as the primary active ingredients. Several databases were searched, and only clinical trials in human subjects were included; in vitro and animal studies were excluded. There were 62 oral health clinical trials on biomimetic hydroxyapatite (HAP), 57 on casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), 26 on calcium sodium phosphosilicate (CSPS, or so called Bioglass), and 2 on β-tricalcium phosphate (β-TCP). HAP formulations were tested the most in clinical trials for benefits in preventing caries, dentin hypersensitivity, improving periodontal health, and tooth whitening. Based on the current clinical evidence to date, fluoride-free HAP toothpaste formulations are the most versatile of the calcium phosphate active ingredients in toothpastes for improving oral health.

Clinical Evidence of Biomimetic Hydroxyapatite in Oral Care Products for Reducing Dentin Hypersensitivity: An Updated Systematic Review and Meta-Analysis

Dentin hypersensitivity (DH) is a very common dental problem that can have a negative impact on the quality of life and can lead to invasive dental procedures. Prevention of DH and control of symptoms are highly desirable. Hydroxyapatite (HAP) has been shown in vitro to block dentinal tubules and in vivo to be a safe and effective additive in oral care products that reduce DH clinically. This study's aim was to conduct a systematic review and meta-analysis of the current evidence that HAP-containing oral care products reduce DH. Databases were searched, and only clinical trials in humans were included; studies conducted in vitro or on animals were not included. Publications in a foreign language were translated and included. We found 44 published clinical trials appropriate for systematic analysis. More than half of the trials had high-quality GRADE scores. HAP significantly reduced dentin hypersensitivity compared to placebo (39.5%; CI 95% [48.93; 30.06]), compared to fluoride (23%; CI 95% [34.18; 11.82]), and with a non-significant tendency compared to other desensitizing agents (10.2%; CI 95% [21.76; -19.26]). In conclusion, the meta-analysis showed that HAP added to oral care products is a more effective agent than fluoride in controlling dentin hypersensitivity and may be superior to other desensitizers.

Effects of dentifrice containing hydroxyapatite on dentinal tubule occlusion and aqueous hexavalent chromium cations sorption: a preliminary study

In order to endow environmental protection features to dentifrice, hydroxyapatite (HA) was added to ordinary dentifrice. The effects on dentinal tubule occlusion and surface mineralization were compared after brushing dentine discs with dentifrice with or without HA. The two types of dentifrice were then added to 100 µg/ml of hexavalent chromium cation (Cr⁶⁺) solution in order to evaluate their capacities of adsorbing Cr⁶⁺ from water. Our results showed that the dentifrice containing HA was significantly better than the ordinary dentifrice in occluding the dentinal tubules with a plugging rate greater than 90%. Moreover, the effect of the HA dentifrice was persistent and energy-dispersive spectrometer (EDS) revealed that the atomic percentages of calcium and phosphorus on the surface of dentine discs increased significantly. Adding HA to ordinary dentifrice significantly enhanced the ability of dentifrice to adsorb Cr⁶⁺ from water with the removal rate up to 52.36%. In addition, the sorption was stable. Our study suggests that HA can be added to ordinary dentifrice to obtain dentifrice that has both relieving dentin hypersensitivity benefits and also helps to control environmental pollution.