Do we have enough evidence to recommend hydroxyapatite toothpaste for preventing dental caries?

Pawinska M, Paszynska E, Amaechi B T, Meyer F, Enax J, Limeback H Clinical evidence of caries prevention by hydroxyapatite: an updated systematic review and meta-analysis. J Dent 2024; https://doi.org/10.1016/j.jdent.2024.105429 . The search strategy for this review aimed at finding the published articles in which hydroxyapatite has been used as an intervention agent for caries prevention, compared with either active control like fluoride-products, placebo, or no interventions. For this, authors used a combination of keywords indicative of various PICOS framework elements. The search was carried out in various electronic databases, including Pubmed, Embase, Scopus, Web of Science, and Google Scholar. Both clinical trials and in-situ studies were included in this review. A total of 1245 articles were retrieved from the search, but 1227 articles were removed as they did not meet the inclusion/exclusion criteria. A total of 18 articles, including clinical trials and in-situ studies, were included in the review. All the included articles were assessed for quality using NHLBI criteria before including them in the meta-analysis. The outcome measures from the clinical trials mainly included the caries incidence, recorded as dmft(s)/DMFT(S) or using ICDAS criteria, while the data for outcome measures from in-situ studies included different surrogate markers. The meta-analysis done for the included clinical trials depicted HAP toothpastes to be significantly better for caries prevention when compared with the placebo toothpastes (pooled OR = 2.51). The results also favored HAP toothpaste when compared with fluoride toothpaste (pooled OR = 1.1) but the results were non-significant. For in-situ studies too, significant results were obtained, favouring HAP toothpaste in terms of lesion depth (overall mean change of 1.15 µm) and bacterial loads (overall mean reduction of 65%), while non-significant results, favouring HAP, were obtained in terms of remineralization (overall mean change of 2.8%). HAP toothpastes are found to be effective in preventing caries and can be considered as good alternative for fluoride.