Hydroxyapatite vs Fluoride Toothpaste in Human Clinical Trials 2010-2026: A PubMed-Based Structured Secondary Evidence Review

This structured secondary evidence review mapped comparative human clinical outcomes for hydroxyapatite-containing toothpaste versus fluoride toothpaste, placebo toothpaste, or no-HAp toothpaste. PubMed was searched on 13 September 2026 for publications from 1 January 2010 through 13 September 2026. Eligible studies involved human participants, routine home toothpaste use, an eligible comparator, at least four weeks of follow-up, and a plainly reportable patient-level outcome. Seventeen unique studies represented by 19 reports were included. Three fluoride-free HAp trials met study-specific non-inferiority criteria against fluoride toothpaste for caries outcomes, but populations, endpoints, and margins differed. Sensitivity evidence was larger but mostly short and heterogeneous. One eligible periodontal trial did not show HAp superiority. No eligible direct comparative human home-use trial supported a direct whitening or erosion claim. At least 8 of 17 studies were confirmed manufacturer-linked and funding was unclear for 7. Dr Mohammad Ibtehaz Alam, BDS, PhD, reviewed 14 proposed publication claims, approving 11 and revising 3. The review was limited to PubMed and did not include a formal risk-of-bias assessment or meta-analysis.