Nano-hydroxyapatite toothpaste vs. a CPP-ACP crème: What’s the Difference?

When we tell people that EvaGlo contains nano-hydroxyapatite (n-Ha), we have received the following response “Oh so is it basically the same thing as Tooth Mousse (CPP-ACP crème)?” While both products aim to remineralise teeth and promote oral health, they have different active ingredients, they work through different mechanisms, and they have unique targeted benefits.

Nano-hydroxyapatite Toothpaste

A n-Ha toothpaste, like EvaGlo, is meant to be used as part of a regular toothbrushing routine to remove plaque and food debris and remineralise the enamel. Nano-hydroxyapatite is a naturally occurring calcium phosphate mineral. It is chemically and structurally very similar to the mineral found in human tooth enamel. When used at an effective concentration in toothpaste, n-Ha can:

• Remineralise enamel: n-HA can help repair microscopic damage to tooth enamel caused by acids from bacteria and dietary acids [1]. It does this by incorporating itself into the enamel structure, strengthening it and making it more resistant to future decay [2].
• Reduce sensitivity: Due to its small size, n-Ha can plug open dentine tubules. This prevents fluid from flowing in the tubules and stimulating the tooth’s nerves. In doing so, it helps prevent any painful sensation when hot or cold beverages and food are consumed [3].
• Whiten teeth: Nano-hydroxyapatite whitens teeth by creating a new protective surface layer that blocks incoming light and reflects white light. It also helps to gently remove surface stains, contributing to a brighter smile [4].

What is a CPP-ACP crème?

Popular crèmes with CPP-ACP include Tooth Mousse and MI Paste. A CPP-ACP crème is not a toothpaste, it is designed to be an adjunct that offers additional remineralisation support over and above regular tooth brushing. The active ingredient is a milk derived product, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP). The casein phosphopeptide (CPP) is able to stabilise calcium and phosphate ions in a bioavailable form [5].

• Remineralisation: CPP-ACP facilitates the deposition of bioavailable calcium and phosphate ions into demineralised enamel.
• Enhances fluoride remineralisation: Fluoride alone cannot rebuild enamel; it needs calcium and phosphate ions to form new mineral deposits. CPP-ACP binds and stabilises calcium and phosphate, preventing them from precipitating too soon. When fluoride is present, CPP-ACP helps bring all three ions (Ca²⁺, PO₄³⁻, and F⁻) together at the tooth surface. Because more ions are available at the tooth surface, they diffuse into the enamel more efficiently [6].
• Demineralisation Inhibition: Enamel that has been remineralised by CPP-ACP may be more resistant than normal enamel to acid attacks, because unlike normal enamel it contains a higher concentration of calcium [7]. Additionally, after remineralisation with CPP-ACP and fluoride, it is likely that the mineral fluorapatite is formed in the enamel. Fluorapatite is less soluble than hydroxyapatite and may be more resistant to demineralisation upon acid exposure [6].

n-Ha versus CPP-ACP, which is better?

Both nano-hydroxyapatite (n-Ha) and CPP-ACP have been extensively researched, with over 60 clinical studies conducted for each ingredient. Most of these studies used fluoride toothpaste as a positive control rather than directly comparing the two, n-Ha versus CPP-ACP [8].

Limited in vitro studies have directly compared n-Ha toothpaste to CPP-ACP products. However, these studies present mixed results and have some important limitations:

• Study inconsistencies: Some studies included fluoride in either the n-Ha or CPP-ACP product but not in the other [9,10], making direct comparisons challenging since the presence of fluoride may influence the results.
• Low n-Ha concentration: Most of the studies utilised n-Ha toothpastes with only 1% n-Ha concentration, while optimal concentrations for remineralisation are considered to be around 10% [11].

Despite these limitations, both active ingredients are generally considered to be effective remineralising agents. However, it is worth noting two in vitro studies that directly compared fluoride-free CPP-ACP crème and n-Ha toothpaste. The findings demonstrated that even at a 1% concentration, the n-HA toothpaste exhibited superior microhardness enhancement compared to the CPP-ACP product [12,13].

Although existing in vitro studies have some interesting findings, it is difficult to extrapolate their results to draw a direct comparison between EvaGlo (containing 10% n-Ha) to a commercial CPP-ACP crème.

Key differences between a n-Ha toothpaste and CPP-ACP crème

Conclusion

While both a n-Ha toothpaste and a CPP-ACP crème contribute to better oral health, they are not the same thing. Understanding their unique mechanisms and benefits can help you tailor your oral care routine for optimal results.

• A CPP-ACP crème may be a good option for fluoride users that want to enhance remineralisation, or for people that consume acidic diets.
• A n-Ha toothpaste is a versatile product that can be used as your daily toothpaste for effective cleaning, or it can be smeared on the teeth between brushings for an extra boost of remineralisation. Unlike many conventional toothpastes it is fluoride-free, it can be used frequently as there is no risk of fluoride overexposure and possible fluorosis.

All of EvaGlo’s toothpastes utilise 10% nano-hydroxyapatite as an effective remineralising agent to deliver the targeted benefits mentioned in this article.