Эритрит

What It Is

Erythritol is a four-carbon sugar alcohol (tetritol) with molecular formula C₄H₁₀O₄ and molecular weight 122.12 g/mol. It occurs naturally in mushrooms, algae, melon, pear, and grape, and in fermented foods such as miso, cheese and wine. Commercial production uses fermentation of glucose by yeasts including Moniliella pollinis or Yarrowia lipolytica.

As a sweetener, erythritol is approximately 60–70% as sweet as sucrose but nearly calorie-free (0.2 kcal/g vs 4 kcal/g for sugar). About 90% of an ingested dose is absorbed in the small intestine and excreted unchanged by the kidneys — it is not metabolized.

In dentistry, erythritol has been studied since the 1990s. Early interest centered on its non-fermentability by cariogenic bacteria. Subsequent research revealed a richer mechanism: erythritol actively disrupts biofilm architecture and shifts the oral microbial community.

---

How It Works

Non-Fermentability

The core mechanism: Streptococcus mutans and other cariogenic bacteria cannot ferment erythritol. They produce neither lactic acid nor acetic, propionic, or other organic acids from it. This means plaque pH does not drop to the critical threshold (<5.5) that triggers enamel demineralization — even in the presence of erythritol.

By comparison, xylitol is also non-fermentable by S. mutans specifically, but other streptococcal species can partially metabolize it. Erythritol is inert across a broader range of cariogenic organisms.

Biofilm Disruption

Erythritol's effect on biofilm goes well beyond passive neutrality. Loimaranta et al. (2020, PMID 32600259) showed that erythritol and xylitol both suppress real-time biofilm formation by S. mutans across nine clinical strains. Inhibition is strongest during early attachment phases.

The mechanism involves reduced extracellular polysaccharide (EPS) production — the structural component that gives biofilm its mechanical strength. Biofilm formed in the presence of erythritol is less adherent and more easily removed by rinsing. A 2025 molecular study (Microorganisms, DOI: 10.3390/microorganisms14040782) identified the celB gene in the phosphotransferase system (PTS) as the key target: erythritol downregulates celB and — downstream — the glucosyltransferases (gtfB, gtfC, gtfD) and fructosyltransferases that build the adhesive polysaccharide matrix.

In other words: erythritol switches off the bacterial program for biofilm assembly at the transcriptional level.

Microbiome Shift

Runnel et al. (2013, PMID 24095985) found that three years of erythritol consumption in schoolchildren produced significantly lower counts of mutans streptococci in both saliva and dental plaque — compared to xylitol and sorbitol groups. Plaque in the erythritol group also had lower concentrations of acetic and propionic acids, indicating reduced fermentative activity across the whole biofilm community, not just S. mutans.

---

Efficacy

Clinical Evidence

3-year RCT (Runnel et al., 2013 / Falony et al., 2016). 485 children aged 7–8 in Estonia were randomized to erythritol, xylitol, or sorbitol candies, given three times daily during each school year.

After 3 years:

• Only the erythritol group showed a statistically significant reduction in fresh dental plaque weight
• Significantly lower mutans streptococcal counts in saliva and plaque vs both comparators
• Fewer new carious surfaces vs the sorbitol group

Post-treatment survival analysis (Falony et al., 2016, PMID 27806364) followed children for 3 more years after the intervention ended. Time to enamel/dentin caries development, time to dentin caries, and time to dental intervention remained significantly longer in the erythritol group vs sorbitol. The protective microbiome shift outlasted the intervention itself.

Review by de Cock et al. (2016, PMID 27635141) concluded that erythritol outperforms xylitol and sorbitol across plaque weight reduction, streptococcal adhesion, caries prevention, and suitability for professional subgingival air-polishing.

Limitations

• Regular use required: minimum 3 applications per day for accumulated antibacterial effect
• Concentrations below 5% are understudied; therapeutic range is 5–20%
• Not a replacement for remineralizing agents: erythritol does not deposit minerals into enamel — nano-hydroxyapatite or fluoride fills this role
• One study (PMID 22193650) in a fluoridated region with low baseline caries found no significant inter-group differences at 48 months — underlining that population context (baseline caries risk, water fluoridation) affects measurable outcomes

---

Safety

Tolerability. Erythritol has an excellent tolerability profile. Unlike sorbitol and xylitol, which cause osmotic diarrhea above 20–30 g/day, erythritol is largely absorbed in the small intestine and excreted renally. Laxative effects occur only at very high doses (>50 g) in sensitive individuals.

Regulatory status.

• FDA: GRAS (Generally Recognized As Safe)
• EU: Approved food additive E968, no ADI limit set by EFSA
• No CIR concerns for oral care applications at concentrations used in toothpaste (5–15%)

No contraindications identified. Glycemic index = 0 (safe for diabetics). Safe for children. No known adverse interactions with standard toothpaste ingredients.

---

Comparison with Alternatives

| Parameter | Erythritol | Xylitol | Sorbitol | |---|---|---|---| | Carbon chain | C4 (tetritol) | C5 (pentitol) | C6 (hexitol) | | Fermented by S. mutans | No | No | Partially | | Plaque weight reduction | Significant (RCT) | Not significant | Not significant | | S. mutans suppression | Strongest | Strong | Weak | | Caries prevention vs sorbitol | Proven (RCT) | Equivocal | Baseline | | Laxative risk | Very low | >30 g/day | >20 g/day | | Evidence history | ~30 years | >50 years | >50 years |

---

Sources:

• de Cock P et al. (2016). Erythritol Is More Effective Than Xylitol and Sorbitol in Managing Oral Health Endpoints. Int J Dent. PMID: 27635141
• Falony G et al. (2016). Long-Term Effect of Erythritol on Dental Caries Development during Childhood: A Posttreatment Survival Analysis. Caries Res. PMID: 27806364
• Runnel R et al. (2013). Effect of three-year consumption of erythritol, xylitol and sorbitol candies on various plaque and salivary caries-related variables. J Dent. PMID: 24095985
• Loimaranta V et al. (2020). Xylitol and erythritol inhibit real-time biofilm formation of Streptococcus mutans. BMC Microbiology. PMID: 32600259
• Söderling E & Pienihäkkinen K (2022). Effects of xylitol and erythritol consumption on mutans streptococci: a systematic review. Acta Odontol Scand. PMID: 34647843