Efficacy comparison of nano-hydroxyapatite and fluoride for dentin hypersensitivity: a systematic review and meta-analysis

Dentin hypersensitivity (DH) is a common clinical oral disease. Nano-hydroxyapatite (n-HAP) toothpaste and fluoride toothpaste are widely used treatment options; however, their comparative efficacy is still unclear. This study aimed to systematically evaluate the clinical efficacy of n-HAP toothpaste and fluoride toothpaste in the treatment of DH. This systematic review was prospectively registered on PROSPERO (CRD420251272119) and conducted following the PRISMA 2020 guidelines. Seven databases (PubMed, Embase, Web of Science, Cochrane Library, CNKI, Wanfang Data and SinoMed) were comprehensively retrieved from the establishment of the library to December 2025.Two independent reviewers performed study selection, data extraction, and quality assessment. Risk of bias was evaluated using the Cochrane Risk of Bias (RoB 1) tool. The certainty of evidence for each major outcome was evaluated using the GRADE approach. Statistical analyses were conducted using RevMan 5.4, Stata 17.0, and R 4.2.1 software, with the standardized mean difference (SMD) employed as the effect size measure. This systematic review included a total of 13 randomized controlled trials involving 609 patients (n-HAP group: 296; fluoride group: 313). The majority of included studies raised some concerns regarding risk of bias, primarily related to blinding of participants and outcome assessors .The meta-analysis revealed that at short-term follow-up (2 weeks), compared with fluoride toothpaste, n-HAP toothpaste demonstrated greater reductions in visual analog scale (VAS) scores (standardized mean difference SMD = 8.81, 95% CI [0.31, 17.30], p = 0.0017; positive SMD favors n-HAP) and tactile sensitivity (SMD = -1.31, 95% CI [-1.80, -0.82], p < 0.00001; negative SMD favors n-HAP). However, in long-term follow-up (8 weeks), fluoride demonstrated superior efficacy in alleviating cold air sensitivity (SMD = 0.35, 95% CI [0.05, 0.65], p = 0.02). Subgroup analysis revealed that n-HAP at 15%-20% concentration produced the optimal therapeutic effect (SMD = -0.77, 95% CI [-1.16, -0.39], p < 0.0001) with low heterogeneity (I² = 11%). Based on current evidence, n-HAP may serve as a rapid-acting desensitizing agent, providing benefits for patients requiring immediate pain relief or those with mechanical stimulus sensitivity. However, fluoride may remain the preferred option for patients presenting with severe cold/heat hypersensitivity or those requiring long-term maintenance of desensitizing effects. The optimal concentration range of n-HAP toothpaste appears to be 15%-20%.However, some outcomes showed substantial heterogeneity; therefore, interpretation should be cautious, and longer-term studies are warranted.