Erythritol-Mediated Modulation of the Oral Microbiome: Emerging Non-Antibiotic Approaches to Dental Caries Prevention

Contemporary concepts regarding the pathogenesis of dental caries consider this disease not as the result of the activity of individual cariogenic microorganisms, but rather as a consequence of ecological imbalance within the oral microbiome, characterized by alterations in its functional and metabolic activity [5,6]. Within this framework, dental caries is interpreted as a multifactorial process developing due to a shift in the oral microbial community toward the predominance of acidogenic and aciduric microorganisms, leading to a decrease in enamel surface pH and activation of demineralization processes. In the context of searching for effective, safe, and physiologically justified non-antibiotic approaches to caries prevention, considerable attention has been directed toward substances capable of modulating the oral microbiome without causing its complete suppression. One of the most promising compounds in this regard is erythritol, a next-generation polyol possessing pronounced anticariogenic and anti-biofilm properties, as confirmed by experimental and clinical investigations [7–9]. Unlike traditional antiseptic agents, the mechanism of action of erythritol is based not on direct bactericidal activity, but on the regulation of microbial metabolic activity and disruption of key stages of dental biofilm formation. The present review article summarizes and systematizes current evidence concerning the mechanisms through which erythritol influences the oral microbiome. Its effects on the formation and structural organization of dental biofilm, microbial metabolic activity, acid production processes, as well as on the remineralization potential of saliva and maintenance of acid–base balance in the oral cavity are discussed [2,8]. Particular attention is devoted to analysis of the role of erythritol in reducing the cariogenic potential of dental plaque and stabilizing microbial homeostasis.

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