Hydroxyapatite in toothpaste for prevention and treatment of dental caries

Caries is caused by loss of mineral from the dental hard tissues (enamel, dentine, and root cementum) when exposed to acids. The acids are produced by bacteria during digestion of sugar. Initially the dental surface is demineralised and becomes porous and subsequently a cavity can be formed. Fluoride containing toothpaste is used to remineralise the dental hard tissue and to prevent lesion growth. Hydroxyapatite crystals have also been shown to remineralize enamel in laboratory studies.

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SBU Enquiry Service

Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

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Published: Report no: ut202122 Registration no: SBU 2021/292

Question

What systematic reviews or scientific studies are there on hydroxyapatite in toothpaste for prevention and treatment of dental caries?

Identified literature

No relevant systematic review was identified but four primary studies were found [1-4]. The primary studies were not assessed for risk of bias.

References

  1. Badiee M, Jafari N, Fatemi S, Ameli N, Kasraei S, Ebadifar A. Comparison of the effects of toothpastes containing nanohydroxyapatite and fluoride on white spot lesions in orthodontic patients: A randomized clinical trial. Dent Res J (Isfahan) 2020;17:354-359.
  2. Bossu M, Saccucci M, Salucci A, Di Giorgio G, Bruni E, Uccelletti D, et al. Enamel remineralization and repair results of Biomimetic Hydroxyapatite toothpaste on deciduous teeth: an effective option to fluoride toothpaste. J Nanobiotechnology 2019;17:17.
  3. Paszynska E, Pawinska M, Gawriolek M, Kaminska I, Otulakowska-Skrzynska J, Marczuk-Kolada G, et al. Impact of a toothpaste with microcrystalline hydroxyapatite on the occurrence of early childhood caries: a 1-year randomized clinical trial. Sci Rep 2021;11:2650.
  4. Schlagenhauf U, Kunzelmann KH, Hannig C, May TW, Hosl H, Gratza M, et al. Impact of a non-fluoridated microcrystalline hydroxyapatite dentifrice on enamel caries progression in highly caries-susceptible orthodontic patients: A randomized, controlled 6-month trial. J Investig Clin Dent 2019;10:e12399.

Search strategies

Cochrane Library via Wiley 30 August 2021 (CDSR, Cochrane Protocols & CENTRAL)

Title: Hydroxyapatite in tooth-paste
The final search result, usually found at the end of the documentation, forms the list of abstracts.

:au = Author; MeSHthis term only = Does not include terms found below this term in the MeSH hierarchy; :ti = Title; :ab = Abstract; :kw = Keyword; * = Truncation; “ “ = Citation Marks; searches for an exact phrase; CDSR = Cochrane Database of Systematic Review; Cochrane Protocols = Protocols of systematic reviews registered in Cochrane Library; CENTRAL = Cochrane Central Register of Controlled Trials, “trials”
Search termsItems found
Population:
1. MeSH descriptor: [Dental Caries] explode all trees 2 722
2. caries OR carious OR dental lesion* OR white spot* (word variations) 9 242
3. #1 OR #2 9 250
Intervention: / Index test:
4. MeSH descriptor: [Hydroxyapatites] in all MeSH products 429
5. hydroxyapatite* OR HAP 1 397
6. #4 OR #5 1 464
7. MeSH descriptor: [Dentifrices] explode all trees 1 610
8. dentifrice* OR tooth paste* OR toothpaste* 4 430
9. #7 OR #8 4 475
Combined sets
10. #3 AND #6 AND #9 36
Final result
11. Final CDSR/4
Cochrane Protocols/1
CENTRAL/31

Embase via Elsevier 30 August 2021

Title: Hydroxyapatite in tooth-paste
The final search result, usually found at the end of the documentation, forms the list of abstracts.

/de = Term from the EMTREE controlled vocabulary; /exp = Includes terms found below this term in the EMTREE hierarchy; /mj = Major Topic; :ab = Abstract; :au = Author; :ti = Article Title; :ti,ab = Title or abstract; * = Truncation; ' ' = Citation Marks; searches for an exact phrase; NEAR/n = Requests terms that are within 'n' words of each other in either direction; NEXT/n = Requests terms that are within 'n' words of each other in the order specified
Search termsItems found
Population:
1. 'dental caries'/exp 58 733
2. caries:ab,ti OR carious:ab,ti OR 'dental lesion*':ab,ti OR 'white spot*':ab,ti 53 677
3. 1 OR 2 73686
Intervention: / Index test:
4. 'hydroxyapatite'/exp 32 105
5. hydroxyapatite*:ab,ti OR hap:ab,ti 33 956
6. 4 OR 5 42 908
7. ‘toothpaste'/exp 8 817
8. dentifrice*:ab,ti OR 'tooth paste*':ab,ti OR toothpaste*:ab,ti 7 891
9. 7 OR 8 10 943
Combined sets
10. 3 AND 6 AND 9 86
Final result
11. Final 86

PubMed via NLM 30 August 2021

Title: Hydroxyapatite in tooth-paste
Search termsItems found
The final search result, usually found at the end of the documentation, forms the list of abstracts.

[MeSH] = Term from the Medline controlled vocabulary, including terms found below this term in the MeSH hierarchy; [MeSH:NoExp] = Does not include terms found below this term in the MeSH hierarchy; [MAJR] = MeSH Major Topic; [TIAB] = Title or abstract; [TI] = Title; [AU] = Author; [OT] = Other term; [TW] = Text word; Systematic[SB] = Filter for retrieving systematic reviews; * = Truncation
Population:
1. "Dental Caries"[Mesh] OR caries [tiab] OR carious [tiab] OR “dental lesion*” [tiab] OR “white spot*” [tiab] 67 283
Intervention: / Index test:
2. "dentifrice*"[Title/Abstract] OR "tooth paste*"[Title/Abstract] OR "toothpaste*"[Title/Abstract] OR "Dentifrices"[MeSH Terms] 9 720
3. "hydroxyapatites"[MeSH Terms] OR "hydroxyapatite*"[Title/Abstract] OR "HAP"[Title/Abstract] 35 952
Combined sets
4. 2 AND 3 222
5. 1 AND 4 73
Final result
6. Final 73
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