IMPACT OF SUGAR ALCOHOLS ON ORAL HEALTH – A LITERATURE REVIEW
Abstract
Introduction and Purpose: Dental caries is one of the most common chronic diseases worldwide, with sucrose recognized as a key dietary factor in its development. As a result, sucrose substitutes have gained increasing attention as potential tools in caries prevention. Among them, xylitol, sorbitol, and erythritol are the most extensively studied. Xylitol is not fermented by Streptococcus mutans and may help reduce bacterial growth and adhesion. Sorbitol is less cariogenic than sucrose, but can still be slowly fermented by certain microorganisms. Erythritol is not fermented at all and may even help reduce plaque and improve the balance of the oral biofilm.
The aim of this study is to summarize what is currently known about sucrose substitutes in relation to oral health, with a particular focus on xylitol, sorbitol and erythritol.
Materials and Methods: The review is based on throughout analysis of the materials selected from PubMed, Cochrane and Google Scholar using the following keywords: xylitol, sorbitol, erythritol, sucrose substitutes, sugar alcohols, oral health.
Conclusions: The available evidence indicates that xylitol and erythritol are the most beneficial sucrose substitutes for oral health. Erythritol reduces plaque most effectively, inhibits Streptococcus mutans, and slows caries progression, while xylitol lowers bacterial levels with less consistent effects on plaque, and sorbitol is the least protective. To strengthen these findings and develop clear guidelines for polyol use in dentistry, further well-designed long-term trials are necessary.
References
Sheiham A. Sucrose and Dental Caries. Nutrition and Health. 1987;5(1-2):25-9.
Touger-Decker R, van Loveren C. Sugars and dental caries. Am J Clin Nutr. 2003;78(4):881s-92s.
Liang NL, Luo BW, Sun IG, Chu CH, Duangthip D. Clinical Effects of Sugar Substitutes on Cariogenic Bacteria: A Systematic Review and Meta-Analysis. International Dental Journal. 2024;74(5):987-98.
Luo BW, Liang NL, Townsend JA, Lo ECM, Chu CH, Duangthip D. Sugar substitutes on caries prevention in permanent teeth among children and adolescents: a systematic review and meta-analysis. Journal of Dentistry. 2024;146:105069.
Oza S, Patel K, Bhosale S, Mitra R, Gupta R, Choudhary D. To determine the effect of chewing gum containing xylitol and sorbitol on mutans streptococci and Lactobacilli count in saliva, plaque, and gingival health and to compare the efficacy of chewing gums. Journal of International Society of Preventive and Community Dentistry. 2018;8(4):354.
Matsukubo T, Takazoe I. Sucrose substitutes and their role in caries prevention. Int Dent J. 2006;56(3):119-30.
Mazi TA, Stanhope KL. Erythritol: An In-Depth Discussion of Its Potential to Be a Beneficial Dietary Component. Nutrients. 2023;15(1):204.
Chan A, Ellepola K, Truong T, Balan P, Koo H, Seneviratne CJ. Inhibitory effects of xylitol and sorbitol on Streptococcus mutans and Candida albicans biofilms are repressed by the presence of sucrose. Arch Oral Biol. 2020;119:104886.
Burt BA. The use of sorbitol- and xylitol-sweetened chewing gum in caries control. J Am Dent Assoc. 2006;137(2):190-6.
Drago L, Bortolin M, Taschieri S, De Vecchi E, Agrappi S, Del Fabbro M, et al. Erythritol/chlorhexidine combination reduces microbial biofilm and prevents its formation on titanium surfaces in vitro. Journal of Oral Pathology & Medicine. 2017;46(8):625-31.
de Cock P. Erythritol Functional Roles in Oral-Systemic Health. Adv Dent Res. 2018;29(1):104-9.
Tochio T, Makida R, Fujii T, Kadota Y, Takahashi M, Watanabe A, et al. The bacteriostatic effect of erythritol on canine periodontal disease–related bacteria. Polish Journal of Veterinary Sciences. 2022:75-82.
De Cock P, Mäkinen K, Honkala E, Saag M, Kennepohl E, Eapen A. Erythritol Is More Effective Than Xylitol and Sorbitol in Managing Oral Health Endpoints. International Journal of Dentistry. 2016;2016:1-15.
Štšepetova J, Truu J, Runnel R, Nõmmela R, Saag M, Olak J, et al. Impact of polyols on Oral microbiome of Estonian schoolchildren. BMC Oral Health. 2019;19(1).
Riley P, Moore D, Ahmed F, Sharif MO, Worthington HV. Xylitol-containing products for preventing dental caries in children and adults. Cochrane Database Syst Rev. 2015;2015(3):Cd010743.
Featherstone JD. Delivery Challenges for Fluoride, Chlorhexidine and Xylitol. BMC Oral Health. 2006;6(S1):S8.
Kitchens DH. Xylitol in the prevention of oral diseases. Spec Care Dentist. 2005;25(3):140-4.
Salli KM, Forssten SD, Lahtinen SJ, Ouwehand AC. Influence of sucrose and xylitol on an early Streptococcus mutans biofilm in a dental simulator. Arch Oral Biol. 2016;70:39-46.
Wölnerhanssen BK, Meyer-Gerspach AC, Beglinger C, Islam MS. Metabolic effects of the natural sweeteners xylitol and erythritol: A comprehensive review. Critical Reviews in Food Science and Nutrition. 2020;60(12):1986-98.
Breban-Schwarzkopf D, Chioibas R, Macasoi I, Bolintineanu S, Marcovici I, Draghici G, et al. Comprehensive in vitro and in ovo assessment of cytotoxicity: Unraveling the impact of sodium fluoride, xylitol, and their synergistic associations in dental products. Biomolecules and Biomedicine. 2024;24(4):923-38.
Gales MA, Nguyen T-M. Sorbitol Compared with Xylitol in Prevention of Dental Caries. Annals of Pharmacotherapy. 2000;34(1):98-100.
Svensäter G, Edwardsson S, Kalfas S. Purification and properties of sorbitol‐6‐phosphate dehydrogenase from oral streptococci. Oral Microbiology and Immunology. 1992;7(3):148-54.
Regnat K, Mach RL, Mach-Aigner AR. Erythritol as sweetener—wherefrom and whereto? Applied Microbiology and Biotechnology. 2018;102(2):587-95.
J AL, Bamashmous M. Meta-analysis on the Effectiveness of Xylitol in Caries Prevention. J Int Soc Prev Community Dent. 2022;12(2):133-8.
Salli KM, Gürsoy UK, Söderling EM, Ouwehand AC. Effects of Xylitol and Sucrose Mint Products on Streptococcus mutans Colonization in a Dental Simulator Model. Current Microbiology. 2017;74(10):1153-9.
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Copyright (c) 2025 Michalina Więckowska, Katarzyna Skorupa, Agnieszka Zakrzewska, Karolina Hetmanek, Edyta Szlęzak, Julia Mroczkiewicz, Aleksandra Szczepanik
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