Littleton, CO dentist Dr. Guy Grabiak and team celebrate case study award for long-term healthy results with their patient.

Real Tooth Decay Prevention with Hydroxyapatite

Feb 14, 2024 | Oral Health & Hygiene

It might surprise you to know that, strictly speaking, you don’t need toothpaste to brush your teeth.

When it comes to removing plaque, it’s the mechanical action of brushing that does most of the work. Your toothbrush cleans about two-thirds of your tooth surfaces, and flossing is needed to clean those areas your brush just can’t reach. Interdental brushes and oral irrigators can do the job, too, and some evidence suggests that interdental brushes may be even better than dental floss.

But we digress.

There are still things that make toothpaste a good thing even beyond the fresh, minty, “yes-my-mouth-is-clean” feeling that it leaves behind. For one, it provides a little bit of grit that makes it easier to break up the sticky biofilm we call plaque. It can also deliver ingredients that can help you maintain good oral health, such as herbal antimicrobials or probiotics.

But many brands can deliver not-so-nice ingredients, as well – ingredients such as fluoride.

Fluoride’s False Promise

Although fluoride is touted as a powerful tool against caries (tooth decay), evidence suggests that its benefits are modest at best.

Consider, for instance, the study of 1000 caries-free Irish toddlers who were randomly split into two groups. One group was given fluoride and dental advice on preventing decay; the other received only advice. This was repeated every six months for three years.

By the end of the study, 39% of kids in the advice-only group had developed caries. So had 34% of the kids in the fluoride group. The average number of decayed, missing, or filled tooth surfaces in the non-fluoride group was 9.6. It was only a bit lower in the fluoride group: 7.2.

This well-conducted trial failed to demonstrate that the intervention kept children caries free, but there was evidence that once children get caries, it slowed down its progression. [emphasis added]

Frankly, we don’t think that this is enough to offset the real health risks posed by fluoride, especially in young children and especially because we have better options for prevention.

Better Ways of Keeping Teeth Healthy

One of the most important factors in oral health is nutrition. It’s not just about limiting foods made with highly refined sugars, starches, and white flour – the favorite foods of harmful bacteria in the mouth. Just as important is making sure you get all the nutrients you need to keep your teeth, gums, and bones healthy, including fat soluble vitamins (A,E, D, and K) and minerals such as calcium, magnesium, and phosphorus.

Calcium and phosphorus also happen to be the two main minerals that combine to make hydroxyapatite, the main component of tooth enamel. This crystalline calcium phosphate material gives teeth their strength and durability. Hydroxyapatite also helps prevent dissolved minerals from leaving the tooth surface.

And it can be delivered to your teeth via toothpaste. Imagine: Giving your teeth the mineral they’re made of instead of a neurotoxic compound that isn’t even in natural tooth enamel!

Hydroxyapatite to Keep Your Teeth Strong

Last summer, a double-blind, randomized trial in Frontiers in Public Health compared hydroxyapatite toothpaste to fluoridated paste. About 200 younger adults took part. Each had a minimum of 10 caries-free teeth and no untreated dental problems.

man brushing teeth with electric toothbrushEach participant was randomly given one type of toothpaste and were not aware of its active ingredient. They were instructed to brush twice a day, stick with their usual diet, and not use any other oral hygiene products. Their teeth were examined at the start of the study and then every six months for a year and a half.

By the end of the study, most participants showed no signs of worsening decay, with results slightly better for the hydroxyapatite group – not enough to be statistically significant but enough for the research team to conclude that it is indeed “a safe and efficient anticaries agent” that has also been shown to decrease tooth sensitivity, improve gum health, and help whiten teeth.

“Research,” wrote the authors of a 2022 review “appears to demonstrate either its superiority or equivalency to fluoride toothpaste as anti-caries agents.”

In conclusion, HAP [hydroxyapatite] is a biomimetic oral care agent, and its caries prevention has been tested in vivo, in situ, and in vitro with a high safety profile and no risk of fluorosis…. In addition to perhaps reducing the need for traditional dental restorations, HAP also offers relief from dentin hypersensitivity and reduces biofilm formation making it a multifunctional agent for preventive oral health care.

Why not try it for yourself? While many options are now available, our favorite remains Risewell. It’s fluoride-free and contains no SLS, propylene glycol, artificial flavors, dyes, or other problem ingredients. In fact, we like it so much that we keep it stocked in our Littleton office. Pick up a tube your next visit!

The foundation of providing safe and personalized holistic care begins by getting to know you and your goals for your oral health and overall health, both short term and long term. Dr. Grabiak will then learn about your family’s dental and medical history, along with your dental and medical history. Afterwards, we begin your exam by taking a sample of your saliva (Sillha), checking for seven different biomarkers. That same day, we will send you home with a report showing how you scored in those different biomarker categories.

The head and neck examination is often overlooked by busy clinicians but it is as crucial as an element of the oral cancer examination. Dr. Grabiak begins his exam outside of the mouth by starting with a soft tissue check of the neck and the jaw. A thorough head and neck examination is essential for detecting early skin cancers, any overdeveloped jaw muscles that may be contributing towards bruxism, and enlarged lymph nodes that may indicate an active virus or infection.

After the extraoral exam, Dr. Grabiak begins his extensive intraoral exam. During Dr. Grabiak’s exam he is evaluating the teeth, uvula, mucosal tissues, tongue, floor of the mouth, hard and soft palate, and the oropharynx. Part of this exam includes taking high-definition photos of the mouth, all at different angles so you can see exactly what he is seeing. Our hygienist will then come in and complete a comprehensive periodontal assessment. In some cases, Dr. Grabiak and your hygienist may recommend additional testing to get to the root cause of the evidence of symptoms they are seeing in your mouth. This entire process takes roughly an hour. In some cases, depending on what Dr. Grabiak and your hygienist had found during their exam we will invite you back for a follow-up appointment called review of findings.

In preparation for the review of findings, Dr. Grabiak and your hygienist will take the time to evaluate all of the data that was collected from your examination and testing to determine your specific needs. At your review of findings appointment Dr. Grabiak will sit down with you one on one to review the data that was collected from your appointment, along with any recommendations. This allows you the time to ask Dr. Grabiak any questions that you may have about your treatment recommendations and expectations from treatment.

Jeromy Mulkey

Jeromy Mulkey

Operations Manager

Jeromy received his Bachelors of Science in Finance from New Mexico State University in Las Cruces, New Mexico. He moved to Colorado in 2015 from Hannibal, New York (a small town outside of Syracuse) and that is when his career in the dental field began. Jeromy started in corporate dental as a patient coordinator and quickly progressed to office manager and then running multiple specialty practices over the next 5 years. Holistic dentistry was an exciting new challenge and Jeromy couldn't be happier with his family at Denver Dentistry. Holistic dentistry was a breath of fresh air and gave a new excitement and passion for learning of all the new sciences and technologies the Denver Dentistry team has integrated into their practice. Jeromy currently lives in Sheridan and enjoys living close to the mountains. In his free time he enjoys spending time with family, snowboarding, playing soccer and basketball, camping, and hiking. Jeromy is passionate about delivering excellent customer service and assisting the team in bringing more smiles to satisfied patients.
Chelsea White

Jazmin Contreras

Dental Hygiene Assistant

In 2020 Jazmin graduated from Colorado Mesa University at the top of her class with a degree in Kinesiology. From a young age Jazmin knew she had a passion and interest in the medical field which led her to gain various experiences in the medical field. However, when she first came to Denver Dentistry, she fell in love with dentistry and knew this was her passion. Dr. Grabiak and his team offered a unique holistic approach to the field; something Jazmin has always been highly interested in. She quickly realized this is where she was meant to be and Denver Dentistry instantly felt like home. In her free time she and her fiance enjoy traveling and participating in outdoor activities like hiking, camping, and kayaking.
Chelsea White

Chelsea White


Chelsea is a born and raised Florida girl and has now been a Colorado resident for 5 years. She has loved dentistry for a long time, and couldn’t see herself in any other profession. Knowing her career path, she went to school at Central Florida Institute to become a dental assistant with an extended program. Graduated in 2012 as a Dental Assistant and as an EDDA, she looks forward to esthetics and happiness with patients. As someone who has been in the field for almost 10 years, she strives to work as a team to meet all expectations with the patient. In her free time she loves to hike, and explore the beautiful places Colorado has to offer.

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