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Studies on the active ingredient Hydroxyapatite are continuously being published. Those with a scientific interest can, for example, get a comprehensive overview through the international study database PubMed.
Numerous scientific publications confirm the efficacy of Hydroxyapatite in dental care. Biomimetic Hydroxyapatite (BioHAP) is a synthetic form of Hydroxyapatite that mimics the natural properties of the Hydroxyapatite found in the human body.
Hydroxyapatite is an important component of bones and teeth and consists primarily of calcium and phosphate. BioHAP is used in dentistry and orthopedics to promote the regeneration of bone and tooth enamel and to support the healing and restoration of damaged structures.
A systematic literature review and meta-analysis of study data are always necessary to verify the evidence of the efficacy of an application. This Canadian-German collaboration is the first scientific evaluation of all studies on Hydroxyapatite of this kind.
A total of 291 studies were identified that examined BioHAP in the context of dental care. From this selection, a total of 3 current clinical studies were used for the meta-analysis. BioHAP accordingly reduces cavities by 17%.
Since BioHAP was compared to fluoride in the majority of studies with regard to its cavity-protective effect, one key finding of this scientific review is: BioHAP is (at least) just as effective as fluoride in cavity prophylaxis.
Source: Limeback, H., Enax, J. & Meyer, F. (2021): Biomimetic hydroxyapatite and caries prevention: a systematic review and meta-analysis. Can J Dent Hyg 55, 148-159
Healthy tooth enamel consists of approximately 97% Hydroxyapatite. Biomimetic Hydroxyapatite (BioHAP) is increasingly being used in dental care products, as it is chemically and structurally similar to tooth enamel. The most interesting question is whether and how HAP contributes to the natural remineralization of tooth enamel and thus helps in the repair of cavity or erosion damage.
This study conducted at the Max Planck Institute aims to provide quantitative information on the relationship between concentration and particle size of BioHAP and its adhesion efficiency on the tooth. The analysis revealed that BioHAP particles adhere directly to the tooth enamel surface.
BioHAP forms a protective layer on the tooth surface. This layer makes it more difficult for bacteria and acids to attack the natural tooth enamel.
Source:
Fabritius-Vilpoux, K., Enax, J., Herbig, M., Raabe, D. & Fabritius, H.-O. (2019): Quantitative Affinity Parameters of Synthetic Hydroxyapatite and Enamel Surfaces in vitro. Bioinspired, Biomimetic and Nanobiomaterials 8, 141-153
BioHAP repairs the enamel and remineralizes small lesions evenly down into the underlying layers of the tooth.
In this way, BioHAP also protects against the development of new cavities.
The microcrystalline structure of BioHAP forms a protective layer on the tooth surface during dental care.
Acids and bacteria cannot attack the enamel directly.
During bacterial acid attacks, BioHAP releases calcium, which maintains the healthy mineralization of the enamel and reduces the tooth-damaging acidic pH value in the oral cavity.
The bacteria in the oral cavity are bound by BioHAP and prevented from forming a biofilm on the teeth – but not killed.
In this way, BioHAP helps to keep the oral flora in its natural balance.
BioHAP is effective in cavity prophylaxis. Dental care products with BioHAP offer an effective alternative to fluoride — particularly for children and all individuals who do not want fluoride in their dental care products.
Through the use of BioHAP in toothpastes and mouthwashes, tooth enamel is remineralized and strengthened. BioHAP fills microscopic defects in the tooth enamel and forms a protective layer that protects against acid attacks and bacteria. This reduces the risk of cavities and sustainably improves dental health.
The clinical multicenter study examined the efficacy of a fluoride-free Hydroxyapatite toothpaste compared to a fluoride-containing toothpaste (1450 ppm) for cavity prevention over a period of 18 months. The study shows that the Hydroxyapatite toothpaste is equally as effective in preventing cavities as the fluoride-containing toothpaste. 89.3% of participants in the Hydroxyapatite group and 87.4% in the fluoride group showed no increase in the DMFS index (Decayed Missing Filled Surfaces). The results confirm that Hydroxyapatite is a safe and effective alternative to fluoride in toothpastes.
Source:
Paszynska, E., Pawinska, M., Enax, J., Meyer, F., Schulze zur Wiesche, E., May, T. W., Amaechi, B. T., Limeback, H., Hernik, A., Otulakowska-Skrzynska, J., Krahel, A., Kaminska, I., Lapinska-Antonczuk, J., Stokowska, E., & Gawriolek, M. (2023): Caries-preventing effect of a hydroxyapatite-toothpaste in adults: a 18-month double-blinded randomized clinical trial.Frontiers in Public Health, 11
Baby teeth require special care. The enamel is thinner than that of permanent teeth. Children often do not brush their teeth thoroughly enough, because not all of them have yet developed the necessary motor skills for this. In addition, children swallow a large portion of the toothpaste. It is therefore important that parents support their children and brush after them. It is also important that, in addition to a suitable toothbrush, an effective toothpaste is used. It is essential that the toothpaste is safe when swallowed and also prevents cavities.
Source:
Paszynska, E., Pawinska, M., Gawriolek, M., Kaminska, I., Otulakowska-Skrzynska, J., Marczuk-Kolada, G., Rzatowski, S., Sokolowska, K., Olszewska, A., Schlagenhauf, U., May, T. W., Amaechi, B. T., & Luczaj-Cepowicz, E. (2021): Impact of a toothpaste with microcrystalline hydroxyapatite on the occurrence of early childhood caries: a 1-year randomized clinical trial. Scientific Reports, 11, Article number: 2650
BioHAP is a modern and safe active ingredient for cavity prophylaxis.
Dr. Erik Schulze zur Wiesche
Head of Research & Development at Dr. Wolff Group
Chalk teeth are uncomfortable and often painful for children. Depending on the severity, a decision is made whether to preserve, restore, or extract the teeth. Dentists frequently apply high-concentration fluoride varnish, which is intended to protect against cavities but does not repair chalk teeth.
Toothpaste with BioHAP, on the other hand, replenishes the calcium deficit and forms a protective layer of Hydroxyapatite. This not only protects chalk teeth from cavities but also reduces their sensitivity to pain.
Molar Incisor Hypomineralization (MIH) is a widespread dental developmental disorder with a significant health burden for patients and a high need for treatment. MIH-affected teeth exhibit lower mineral density and hardness, leading to sensitivity and loss of function. Therefore, the use of formulations containing calcium phosphates for the remineralization of these teeth is reasonable.
Source:
Enax, J., Amaechi, B. T., Farah, R., Liu, J. A., Schulze Zur Wiesche, E., & Meyer, F. (2023): Remineralization Strategies for Teeth with Molar Incisor Hypomineralization (MIH): A Literature Review. Dent J (Basel), 11(3), 80
The study examines the use of Hydroxyapatite (HAP) as a remineralization agent in dental care for children, particularly in Molar Incisor Hypomineralization (MIH). HAP proves to be an effective agent for the remineralization of enamel and dentin by forming a protective layer on the teeth and releasing calcium, which supports acid buffering.
HAP also reduces the formation of dental plaque and alleviates tooth sensitivity, which is beneficial in chalk teeth (MIH). It is biocompatible and safe when swallowed, making it a suitable alternative to fluoride for dental care in children.
Source:
Inchingolo, A. M., Inchingolo, A. D., Viapiano, F., Ciocia, A. M., Ferrara, I., Netti, A., Dipalma, G., Palermo, A., & Inchingolo, F. (2023): Treatment Approaches to Molar Incisor Hypomineralization: A Systematic Review. Journal of Clinical Medicine, 12(22), 7194
Chalk teeth (MIH) are a completely new challenge that many parents and dentists are facing. The molars ("M") and incisors ("I") are not sufficiently developed ("Hypomineralization"). According to current figures, over 30% of 12-year-olds show this condition of porous teeth.
Unlike healthy permanent teeth, chalk teeth are not fully mineralized. Normally, tooth enamel consists of approximately 97% Hydroxyapatite — a calcium-containing compound. This Hydroxyapatite is already formed while the teeth are not yet visible in the oral cavity. Many different proteins are responsible for the formation of healthy, hard tooth enamel, and these proteins do not function properly in chalk teeth.
Unfortunately, researchers and dentists are in the dark when it comes to the exact cause of chalk teeth in children. Plasticizers in plastic are frequently cited as a cause of chalk teeth. However, infectious diseases, upper respiratory tract infections, medications such as antibiotics are also considered. Environmental toxins are also not ruled out as a cause of chalk teeth.
Chalk teeth are uncomfortable and often painful for children. Depending on the severity, it is decided whether the teeth should be preserved, restored, or extracted. Dentists frequently apply high-concentration fluoride varnish, which is meant to protect against cavities but does not repair chalk teeth. Toothpaste with BioHAP, on the other hand, replenishes the calcium deficit and forms a protective layer of Hydroxyapatite. This not only protects chalk teeth from cavities but also reduces their sensitivity to pain.
The uncontrolled swallowing of fluoride toothpaste can be particularly harmful to children. Therefore, the common recommendation is to use a rice-grain-sized amount of toothpaste. Overdosing can lead to fluorosis. Fluorosis refers to unsightly white spots on the teeth that result from excessive fluoride intake and persist for a lifetime.
The study examined how much fluoride-containing toothpaste parents give their toddlers. It was found that parents used, on average, 5.9 to 7.2 times more toothpaste than the recommended rice-grain-sized amount. This overdose is statistically significant.
Additionally, 39.3% of parents were not informed about the usage instructions and warnings on the toothpaste packaging.
To avoid fluoride intake, it is recommended to use fluoride-free alternatives for dental care in toddlers.
Source:
Sudradjat, H., Meyer, F., Fandrich, P., Schulze zur Wiesche, E., Limeback, H., & Enax, J. (2024): Doses of fluoride toothpaste for children up to 24 months. BDJ Open, 10, Article number: 7
This systematic review and meta-analysis examines the association between fluoride exposure and IQ in children. The analysis of 74 studies shows that higher fluoride levels in water and urine are associated with lower IQ scores in children. The negative association persists particularly at fluoride concentrations above 1.5 mg/L. The study highlights the need for further research to better understand the effects of fluoride on cognitive development and to inform future public health guidelines.
Source:
Taylor, K. W., Eftim, S. E., Sibrizzi, C. A., Blain, R. B., Magnuson, K., Hartman, P. A., Rooney, A. A., & Bucher, J. R. (2025): Fluoride Exposure and Children’s IQ Scores: A Systematic Review and Meta-Analysis. JAMA Pediatrics, 179(3), 282-292
Fluoridation preserves approximately one permanent tooth from cavities over a lifetime of exposure. The negative effects of fluoride intake far outweigh the benefits.
Dr. Hardy Limeback
Dentist, BSc, PhD (Biochem), DDS Toronto, Canada
The addition of fluoride in toothpaste is particularly controversial for children under 6 years of age. Children in particular swallow a large portion of their toothpaste.
The uncontrollable swallowing of fluoride toothpaste can be particularly harmful to children. Therefore, the common recommendation is to use a rice grain-sized amount of toothpaste.
An overdose can cause fluorosis.
With KAREX, swallowing toothpaste is no longer a risk. Swallowing the active ingredient BioHAP is completely safe and without risk.
Fluoroses are unsightly white spots on the teeth that are caused by excessive fluoride intake and remain for a lifetime.
While most children's toothpastes contain fluoride, KAREX toothpaste offers a modern alternative with BioHAP. This nature-inspired active ingredient works without fluoride and reduces the risk of fluorosis.
KAREX is different, because Dr. Wolff is different. And so is our research. We not only sell oral care products with clinically proven efficacy, we also actively ensure that research in dental health continues to progress.