Table 1.

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

Study type	Substance tested	Subjects or strain	n	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.