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

Abstract

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.

Prevention of Dental Caries: A Review on the Improvements of Toothpaste Formulations from 1900 to 2023

“…The class of calcium phosphates contains different substances [ 19 ]. Out of different calcium phosphates, hydroxyapatite has been most extensively studied in clinical studies in the field of oral care [ 6 , 20 ]. Therefore, the development of the number of toothpaste products containing hydroxyapatite was analyzed ( Figure 4 ).…”

“…Different calcium phosphates are used in toothpastes for caries prevention [ 6 ]. This includes hydroxyapatite (HAP), casein phosphopeptide–amorphous calcium phosphate (CPP-ACP), calcium sodium phosphosilicate (CSPS, or so called Bioglass), β-tricalcium phosphate (β-TCP), and calcium glycerophosphate (CaGP) [ 6 ].…”

“…Different calcium phosphates are used in toothpastes for caries prevention [ 6 ]. This includes hydroxyapatite (HAP), casein phosphopeptide–amorphous calcium phosphate (CPP-ACP), calcium sodium phosphosilicate (CSPS, or so called Bioglass), β-tricalcium phosphate (β-TCP), and calcium glycerophosphate (CaGP) [ 6 ]. Calcium phosphates have remineralizing effects on enamel and dentin [ 6 , 24 ], and they are also suitable for remineralization of teeth affected by molar incisor hypomineralization (MIH) [ 25 ].…”

“…Besides fluoridated toothpastes, fluoride-free toothpastes without or with proven anti-caries agents are also commercially available. Fluoride-free toothpastes can contain agents such as calcium phosphates or xylitol for protection against caries [ 6 , 7 ]. Calcium phosphates used in toothpastes for caries prevention are mainly hydroxyapatite (HAP), casein phosphopeptide–amorphous calcium phosphate (CPP-ACP), calcium sodium phosphosilicate (CSPS, or so called Bioglass), or β-tricalcium phosphate (β-TCP) [ 6 ].…”

“…Various ingredients are used in toothpastes [ 1 ]. Nowadays, toothpastes can also contain ‘new’ classes of ingredients such as minerals (e.g., calcium phosphates), enzymes/proteins (e.g., lactoferrin, amyloglucosidase, glucose oxidase, and lactoperoxidase), or natural extracts (e.g., bisabolol) [ 6 , 17 ]. Moreover, besides sodium lauryl sulfate, various other surfactants are used in modern toothpastes such as cocamidopropyl betaine or certain types of sarcosinates [ 1 ].…”