Xylitol, erythritol as sucrose replacements: their effect on oral health - narrative review

Abstract

Background:Dental caries in one of the most common chronic diseases worldwide. Sucrose consumption is one of the main cause of dental caries due to biofilm acidification, microbial dysbiosis, and demineralization.Researchers have centered their attention on developing sucrose substitutes with special emphasis on polyols, which can reduce cariogenicity. Aim: This narrative review aims to integrate existing evidence with regard to the mechanism of action, clinical efficacy, and safety usage of xylitol, erythritol, in relation to preventing dental caries, maintaining periodontal and overall oral health. Methods: This narrative review was conducted through structured research of PubMed (2015-2025).Recent clinical trials, in vitro studies, systematic reviews were included. Results: Xylitol demonstrates consistent inhibition effects on S.mutans, reduced biofilm adhesive properties, lowered acid production leading to a gradual change in cariogenic oral microbiome. Erythritol is found with similar or better activity levels in most studies. Unlike sucrose, polyols lack the fermentable activity, preventing a lowered pH and subsequent enamel demineralization. Conclusions:Sucrose substitutes have emerged as potential efficacious and biologically credible additions to established prophylactic modalities. Their abilities, makes theme promising additions to caries prophylaxis and initial periodontal therapy itself. There is a need for further well-designed clinical studies to establish a precise dosage and efficacy of these substances.