Erythritol Is More Effective Than Xylitol and Sorbitol in Managing Oral Health Endpoints

Table 1

Summary of in vitro and in vivo bacterial (dental plaque) growth inhibition studies with erythritol.

Study type	Substance tested	Subjects or strain		Age (years)	Dose or concentration	Results	Reference
Randomized, double-blinded clinical study	Erythritol or xylitol	Healthy adults and physically or mentally disabled adults	15	~30	5.2 g/day, 5x/day for 2 months (tablets)	Xylitol, but not erythritol, showed a statistically significant reduction of dental plaque and saliva and plaque levels of S. mutans	Mäkinen et al. (2001); [8]
Clinical study	Erythritol/xylitol, sorbitol/xylitol, xylitol, or sorbitol	Mentally disabled adults	22–26	~30	5.4 g/day (2.7 g of each polyol), 5x/day for 64 days (tablets)	A significant reduction in plaque and saliva counts of S. mutans was demonstrated for xylitol alone and for the 1 : 1 xylitol mixture with erythritol; the relative portion of S. mutans of total streptococci was significantly higher in the sorbitol group compared with the sorbitol-erythritol group	Mäkinen et al. (2002); [9]
Clinical study	Erythritol, xylitol, or sorbitol	Healthy teenagers	35-36	~17	7 g/day, 6x/day (tablets) plus 2x/day (toothpaste)	Significant reduction in the levels of S. mutans in dental plaque and saliva with erythritol or xylitol; only the erythritol group had significantly lower plaque weight compared to the control, sorbitol and xylitol groups	Mäkinen et al. (2005); [10]
In vitro growth inhibition	Erythritol, xylitol, or sorbitol	S. mutans	—	—	0.6 M for 5 hours	Erythritol inhibited growth “most effectively” compared with the other sugar alcohols	Mäkinen et al. (2005); [10]
In vitro glass adhesion and growth inhibition	Erythritol or xylitol	S. mutans, S. sanguinis, S. salivarius, and S. sobrinus	—	—	2 or 4%	Erythritol and xylitol, at 4%, significantly reduced the glass surface adhesion Growth inhibition was not associated with the magnitude of the decrease in adherence	Söderling and Hietala-Lenkkeri (2010); [11]
In vitro growth inhibition and acid production	Erythritol or xylitol	S. mutans	—	—	0.5–16%	Compared to xylitol, erythritol in low concentrations (0.5–2%) had a weaker effect on the bacterial growth and acid production of S. mutans, while having stronger effect at high concentrations (8–16%)	Yao et al. (2009); [12]
In vitro growth inhibition	Erythritol or xylitol	S. mutans and S. sobrinus	—	—	2.35–300 mg/mL	Erythritol (at 150 mg/mL) and xylitol (at 300 mg/mL) inhibited growth	White et al. (2015); [13]
In vitro polystyrene plate adhesion, biofilm formation,; and growth inhibition	Erythritol or xylitol	S. mutans, S. sanguinis, and S. sobrinus	—	—	2 or 4%	Erythritol more effective than xylitol in inhibiting growth, adherence, and biofilm formation	Ghezelbash et al. (2012); [14]
In vitro growth inhibition and reduction in biofilm formation	Erythritol	S. mutans	—	—	0.5–10%	Erythritol significantly inhibited growth (>78%) and biofilm formation (40.2%)	Saran et al. (2015); [15]
In vitro biofilm formation	Erythritol, xylitol, or sorbitol	Porphyromonas gingivalis and S. gordonii	—	—	0.8, 5, or 10%	Most effective reagent to reduce P. gingivalis accumulation onto S. gordonii substrata was erythritol when compared with xylitol and sorbitol; erythritol suppressed the endopeptidase, Rgp.	Hashino et al. (2013); [16]
In vitro growth inhibition mechanism by expression; of GTF and FTF genes	Erythritol, xylitol, sucrose, or sorbitol	S. mutans	—	—	10%	Erythritol and xylitol significantly inhibited growth at a similar level and decreased the expression of 3 GTF genes and 1 FTF gene compared to sucrose; the gene expression decreases seen with erythritol also were significantly decreased when compared with sorbitol and untreated control; adhesion values and the adhesion inhibition rate were significantly reduced with erythritol and xylitol when compared with sucrose, but not control (water) or sorbitol	Park et al. (2014); [17]

GTF: glucosyltransferase; FTF: fructosyltransferase.