In Vitro Inhibition of Pathogens by Polyols: Optical Density-Based Screening and Implications for the Oral–Systemic Axis
Abstract
1. Introduction
2. Materials and Methods
2.1. Microorganisms and Culture Conditions
2.2. Polyols and Preparation
2.3. Optical Density Growth Assay
2.4. Data Processing and Normalization
2.5. Statistical Analysis
3. Results
3.1. Streptococcus mutans
3.2. Streptococcus anginosus
3.3. Candida albicans
3.4. Fusobacterium nucleatum
4. Discussion
4.1. Summary of Main Findings
4.2. Relationship to Prior Literature on Xylitol and Erythritol
4.3. Emerging Evidence for Allulose and D-Mannose in Oral Microbial Modulation
4.4. Implications for Oral Biofilms and Formulation Design
4.5. Strengthening the Oral–Systemic Discussion: Mechanistic Pathways and Organism-Specific Relevance
4.6. Safety Considerations for Swallow-Safe Oral Products
4.7. Limitations
4.8. Future Directions
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
References
- Centers for Disease Control and Prevention. 2024 Oral Health Surveillance Report: Selected Findings. Available online: https://www.cdc.gov/oral-health/php/2024-oral-health-surveillance-report/ (accessed on 11 February 2026).
- Eke, P.I.; Dye, B.A.; Wei, L.; Thornton-Evans, G.O.; Genco, R.J. Prevalence of Periodontitis in Adults in the United States: 2009 and 2010. J. Dent. Res. 2012, 91, 914–920. [Google Scholar] [CrossRef] [Scilit]
- Eke, P.I.; Wei, L.; Borgnakke, W.S.; Thornton-Evans, G.; Zhang, X.; Lu, H.; McGuire, L.C.; Genco, R.J. Periodontitis Prevalence in Adults ≥65 Years of Age, in the USA. Periodontol. 2000 2016, 72, 76–95. [Google Scholar] [CrossRef] [Scilit] [PubMed]
- Milgrom, P.; Ly, K.A.; Rothen, M. Xylitol and Its Vehicles for Public Health Needs. Adv. Dent. Res. 2009, 21, 44–47. [Google Scholar] [CrossRef] [Scilit] [PubMed]
- Burt, B.A. The Use of Sorbitol-and Xylitol-Sweetened Chewing Gum in Caries Control. J. Am. Dent. Assoc. 2006, 137, 190–196. [Google Scholar] [CrossRef] [Scilit] [PubMed]
- Janakiram, C.; Deepan Kumar, C.V.; Joseph, J. Xylitol in preventing dental caries: A systematic review and meta-analyses. J. Nat. Sci. Biol. Med. 2017, 8, 16–21. [Google Scholar] [CrossRef] [Scilit]
- Knuuttila, M.L.E.; Mäkinen, K.K. Effect of Xylitol on the Growth and Metabolism of Streptococcus mutans. Caries Res. 1975, 9, 177–189. [Google Scholar] [CrossRef] [Scilit]
- Söderling, E.M. Xylitol, Mutans Streptococci, and Dental Plaque. Adv. Dent. Res. 2009, 21, 74–78. [Google Scholar] [CrossRef] [Scilit]
- Loimaranta, V.; Mazurel, D.; Deng, D.; Söderling, E. Xylitol and Erythritol Inhibit Real-Time Biofilm Formation of Streptococcus mutans. BMC Microbiol. 2020, 20, 184. [Google Scholar] [CrossRef] [Scilit]
- Bradshaw, D.J.; Marsh, P.D. Effect of sugar alcohols on the composition and metabolism of a mixed culture of oral bacteria grown in a chemostat. Caries Res. 1994, 28, 251–256. [Google Scholar] [CrossRef] [Scilit]
- Mäkinen, K.K.; Isotupa, K.P.; Kivilompolo, T.; Mäkinen, P.L.; Toivanen, J.; Söderling, E. Comparison of Erythritol and Xylitol Saliva Stimulants in the Control of Dental Plaque and Mutans Streptococci. Caries Res. 2001, 35, 129–135. [Google Scholar] [CrossRef] [Scilit]
- Mäkinen, K.K.; Saag, M.; Isotupa, K.P.; Olak, J.; Nõmmela, R.; Söderling, E.; Mäkinen, P.L. Similarity of the Effects of Erythritol and Xylitol on Some Risk Factors of Dental Caries. Caries Res. 2005, 39, 207–215. [Google Scholar] [CrossRef] [Scilit]
- Kõljalg, S.; Smidt, I.; Chakrabarti, A.; Bosscher, D.; Mändar, R. Exploration of Singular and Synergistic Effect of Xylitol and Erythritol on Causative Agents of Dental Caries. Sci. Rep. 2020, 10, 6297. [Google Scholar] [CrossRef] [Scilit]
- Salli, K.; Lehtinen, M.J.; Tiihonen, K.; Ouwehand, A.C. Xylitol’s Health Benefits beyond Dental Health: A Comprehensive Review. Nutrients 2019, 11, 1813. [Google Scholar] [CrossRef] [Scilit]
- Mäkinen, K.K.; Söderling, E. A quantitative study of mannitol, sorbitol, xylitol, and xylose in wild berries and commercial fruits. J. Food Sci. 1980, 45, 367–371, 374. [Google Scholar] [CrossRef] [Scilit]
- Han, S.; Rajitha, K.; Park, S.; Lim, J.; Jung, H.-Y.; Kim, J.; Kim, D. Unveiling the Impact of Allulose on Oral Microbiota and Biofilm Formation via a Cariogenic Potential Assessment Platform. Front. Cell. Infect. Microbiol. 2025, 15, 1670139. [Google Scholar] [CrossRef] [Scilit] [PubMed]
- Ruby, J.D.; Momeni, S.S.; Wu, H. The Effect of Allulose, Sucralose, and Xylitol on Streptococcus mutans Acid Production. JADA Foundat. Sci. 2025, 4, 100052. [Google Scholar] [CrossRef] [Scilit] [PubMed]
- Kranjčec, B.; Papeš, D.; Altarac, S. D-Mannose Powder for Prophylaxis of Recurrent Urinary Tract Infections in Women: A Randomized Clinical Trial. World J. Urol. 2014, 32, 79–84. [Google Scholar] [CrossRef] [Scilit]
- Hayward, G.; Mort, S.; Hay, A.D.; Moore, M.; Thomas, N.P.B.; Cook, J.; Robinson, J.; Williams, N.; Maeder, N.; Edeson, R.; et al. d-Mannose for Prevention of Recurrent Urinary Tract Infection among Women: A Randomized Clinical Trial. JAMA Intern. Med. 2024, 184, 619–628. [Google Scholar] [CrossRef] [Scilit]
- Rajasekaran, J.J.; Krishnamurthy, H.K.; Bosco, J.; Jayaraman, V.; Krishna, K.; Wang, T.; Bei, K. Oral Microbiome: A Review of Its Impact on Oral and Systemic Health. Microorganisms 2024, 12, 1797. [Google Scholar] [CrossRef] [Scilit]
- Kim, M.-Y.; Pang, E.-K. Relationship between Periodontitis and Systemic Health Conditions: A Narrative Review. Ewha Med. J. 2025, 48, e27. [Google Scholar] [CrossRef] [Scilit]
- Xi, M.; Ruan, Q.; Zhong, S.; Li, J.; Qi, W.; Xie, C.; Wang, X.; Abuduxiku, N.; Ni, J. Periodontal Bacteria Influence Systemic Diseases through the Gut Microbiota. Front. Cell. Infect. Microbiol. 2024, 14, 1478362. [Google Scholar] [CrossRef] [Scilit]
- Jiménez De Nunzio, S.; Portal-Núñez, S.; Arias Macías, C.M.; Del Cojo, M.B.; Adell-Pérez, C.; Molina, M.L.; Macías-González, M.; Adell-Pérez, A. Does a Dysbiotic Oral Microbiome Trigger the Risk of Chronic Inflammatory Disease? Curr. Treat. Options Allergy 2023, 10, 364–383. [Google Scholar] [CrossRef] [Scilit]
- Sahni, V.; Shankar, A. Oral Health and Its Expanding Role in Systemic Disease, Cancer Outcomes, and Public Health. Lancet Reg. Health Southeast Asia 2025, 43, 100627. [Google Scholar] [CrossRef] [Scilit] [PubMed]
- Murray, P.E.; Coffman, J.A.; Garcia-Godoy, F. Oral Pathogens’ Substantial Burden on Cancer, Cardiovascular Diseases, Alzheimer’s, Diabetes, and Other Systemic Diseases: A Public Health Crisis-A Comprehensive Review. Pathogens 2024, 13, 1084. [Google Scholar] [CrossRef] [Scilit] [PubMed]
- Hosoki, S.; Saito, S.; Tonomura, S.; Ishiyama, H.; Yoshimoto, T.; Ikeda, S.; Ikenouchi, H.; Yamamoto, Y.; Hattori, Y.; Miwa, K.; et al. Oral Carriage of Streptococcus mutans Harboring the cnm Gene Relates to an Increased Incidence of Cerebral Microbleeds. Stroke 2021, 52, 373–381. [Google Scholar] [CrossRef] [Scilit]
- Seo, H.; Hyun, J.; Kim, H.; Park, S.; Chung, H.; Bae, S.; Jung, J.; Kim, M.J.; Kim, S.-H.; Lee, S.-O.; et al. Risk and Outcome of Infective Endocarditis in Streptococcal Bloodstream Infections according to Streptococcal Species. Microbiol. Spectr. 2023, 11, e01049-23. [Google Scholar] [CrossRef] [Scilit]
- Pilarczyk-Zurek, M.; Sitkiewicz, I.; Koziel, J. The Clinical View on Streptococcus anginosus Group—Opportunistic Pathogens Coming Out of Hiding. Front. Microbiol. 2022, 13, 956677. [Google Scholar] [CrossRef] [Scilit]
- Signat, B.; Roques, C.; Poulet, P.; Duffaut, D. Role of Fusobacterium nucleatum in Periodontal Health and Disease. Curr. Issues Mol. Biol. 2011, 13, 25–36. [Google Scholar] [CrossRef]
- Chen, Y.; Shi, T.; Li, Y.; Huang, L.; Yin, D. Fusobacterium nucleatum: The Opportunistic Pathogen of Periodontal and Peri-Implant Diseases. Front. Microbiol. 2022, 13, 860149. [Google Scholar] [CrossRef] [Scilit]
- Abreu, M.T.; Peek, R.M., Jr. Gastrointestinal Malignancy and the Microbiome. Gastroenterology 2014, 146, 1534–1546.e3. [Google Scholar] [CrossRef] [Scilit]
- Zhou, J.; Ma, Q.; Liang, J.; Pan, Y.; Chen, Y.; Yu, S.; Liu, Y.; Zhang, Q.; Li, Y.; Zou, J. smu_1558c-mediated regulation of growth and biofilm formation in Streptococcus mutans. Front. Microbiol. 2025, 15, 1507928. [Google Scholar] [CrossRef] [Scilit] [PubMed]
- Stevenson, K.; McVey, A.F.; Clark, I.B.N.; Swain, P.S.; Pilizota, T. General calibration of microbial growth in microplate readers. Sci. Rep. 2016, 6, 38828. [Google Scholar] [CrossRef] [Scilit] [PubMed]
- Mira, P.; Yeh, P.; Hall, B.G. Estimating microbial population data from optical density. PLoS ONE 2022, 17, e0276040. [Google Scholar] [CrossRef] [Scilit] [PubMed]
- Meng, C.; Bai, C.; Brown, T.D.; Hood, L.E.; Tian, Q. Human Gut Microbiota and Gastrointestinal Cancer. Genom. Proteom. Bioinform. 2018, 16, 33–49. [Google Scholar] [CrossRef] [Scilit]
- Castaño-Suárez, L.; Paternina-Mejía, G.Y.; Vásquez-Olmos, L.D.; Rodríguez-Medina, C.; Botero, J.E.; Olmos, V. Linking Periodontitis to Adverse Pregnancy Outcomes: A Comprehensive Review and Meta-analysis. Curr. Oral Health Rep. 2024, 11, 125–137. [Google Scholar] [CrossRef] [Scilit]
- Ryder, M.I. Porphyromonas gingivalis and Alzheimer’s Disease: Recent Findings and Potential Therapies. J. Periodontol. 2020, 91, S45–S49. [Google Scholar] [CrossRef] [Scilit]
- Dominy, S.S.; Lynch, C.; Ermini, F.; Benedyk, M.; Marczyk, A.; Konradi, A.; Nguyen, M.; Haditsch, U.; Raha, D.; Griffin, C.; et al. Porphyromonas gingivalis in Alzheimer’s disease brains: Evidence for disease causation and treatment with small-molecule inhibitors. Sci. Adv. 2019, 5, eaau3333. [Google Scholar] [CrossRef] [Scilit]
- Kuraji, R.; Sekino, S.; Kapila, Y.; Numabe, Y. Periodontal disease-related nonalcoholic fatty liver disease and nonalcoholic steatohepatitis: An emerging concept of oral-liver axis. Periodontol. 2000 2021, 87, 204–240. [Google Scholar] [CrossRef] [Scilit]
- Mäkinen, K.K. Gastrointestinal Disturbances Associated with the Consumption of Sugar Alcohols with Special Consideration of Xylitol: Scientific Review and Instructions for Dentists and Other Health-Care Professionals. Int. J. Dent. 2016, 2016, 5967907. [Google Scholar] [CrossRef] [Scilit]
- Bordier, V.; Teysseire, F.; Senner, F.; Schlotterbeck, G.; Drewe, J.; Beglinger, C.; Wölnerhanssen, B.K.; Meyer-Gerspach, A.C. Absorption and Metabolism of the Natural Sweeteners Erythritol and Xylitol in Humans: A Dose-Ranging Study. Int. J. Mol. Sci. 2022, 23, 9867. [Google Scholar] [CrossRef] [Scilit]
- Wölnerhanssen, B.K.; Meyer-Gerspach, A.C.; Beglinger, C.; Islam, M.S. Metabolic effects of the natural sweeteners xylitol and erythritol: A comprehensive review. Crit. Rev. Food Sci. Nutr. 2020, 60, 1986–1998. [Google Scholar] [CrossRef] [Scilit]
- U.S. Food and Drug Administration. GRAS Notice (GRN) No. 893: D-Allulose (Agency Response Letter), 2019. Available online: https://www.fda.gov/media/138901/download (accessed on 11 February 2026).
- Bloomer, R.J.; Pence, J.; Hellenbrand, J.; Davis, A.; Davis, S.; Stockton, M.; Martin, K.R. Randomized Trial to Assess the Safety and Tolerability of Daily Intake of an Allulose Amino Acid-Based Hydration Beverage in Men and Women. Nutrients 2024, 16, 1766. [Google Scholar] [CrossRef] [Scilit]
- Uhari, M.; Kontiokari, T.; Koskela, M.; Niemelä, M. Xylitol Chewing Gum in Prevention of Acute Otitis Media: Double Blind Randomised Trial. BMJ 1996, 313, 1180–1184. [Google Scholar] [CrossRef] [Scilit]
- Persaud, N.; Azarpazhooh, A.; Keown-Stoneman, C.; Birken, C.S.; Isaranuwatchai, W.; Maguire, J.L.; Mamdani, M.; Allen, C.; Mason, D.; Kowal, C.; et al. Xylitol for the prevention of acute otitis media episodes in children aged 1-5 years: A randomised controlled trial. Arch. Dis. Child. 2024, 109, 121–124. [Google Scholar] [CrossRef] [Scilit]
- Witkowski, M.; Nemet, I.; Li, X.S.; Wilcox, J.; Ferrell, M.; Alamri, H.; Gupta, N.; Wang, Z.; Tang, W.H.W.; Hazen, S.L. Xylitol Is Prothrombotic and Associated with Cardiovascular Risk. Eur. Heart J. 2024, 45, 2439–2452. [Google Scholar] [CrossRef] [Scilit] [PubMed]




| Systemic Condition/Pathway | Example Oral Microbial Connection (Selected Examples) |
|---|---|
| Cardiometabolic inflammation and atherosclerotic risk | Periodontal inflammation can increase systemic inflammatory mediators and endotoxemia; episodic bacteremia and oral–gut axis are proposed routes [20,21,22,23,24,25]. |
| Infective endocarditis | Oral streptococci are common etiologic agents; routine activities can seed transient bacteremia [27]. |
| Cerebrovascular disease | Cnm+ S. mutans strains have been associated with cerebrovascular pathology, including cerebral microbleeds [26]. |
| Diabetes and metabolic dysregulation | Bidirectional links between periodontal inflammation and glycemic control have been proposed; oral–gut axis and systemic cytokines are implicated [20,21,22,23,24,25]. |
| Adverse pregnancy outcomes | Periodontitis and oral dysbiosis have been associated with adverse outcomes in observational and meta-analytic studies [36] |
| Neurodegeneration | Oral pathogens and periodontal inflammation have been investigated in relation to Alzheimer’s disease; microbial and inflammatory mechanisms are discussed in translational work [37,38] |
| Non-alcoholic fatty liver disease | Oral dysbiosis may influence the gut–liver axis through swallowed microbes and immune modulation [39]. |
| Gastrointestinal disease and malignancy-associated microbiomes | F. nucleatum has been discussed in gastrointestinal disease contexts and cancer-associated microbiomes, motivating interest in oral reservoirs [29,30,31] |
| Opportunistic invasive infections | The Streptococcus anginosus group can participate in deep-seated abscess formation following translocation [27]. |
| Peri-implant and periodontal tissue destruction | F. nucleatum contributes to periodontal/peri-implant biofilms and can modulate host immune responses [29,30]. |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2026 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license.
Share and Cite
Cannon, M.; Stevenson, B.S. In Vitro Inhibition of Pathogens by Polyols: Optical Density-Based Screening and Implications for the Oral–Systemic Axis. Microorganisms 2026, 14, 884. https://doi.org/10.3390/microorganisms14040884
Cannon M, Stevenson BS. In Vitro Inhibition of Pathogens by Polyols: Optical Density-Based Screening and Implications for the Oral–Systemic Axis. Microorganisms. 2026; 14(4):884. https://doi.org/10.3390/microorganisms14040884
Chicago/Turabian StyleCannon, Mark, and Bradley S. Stevenson. 2026. "In Vitro Inhibition of Pathogens by Polyols: Optical Density-Based Screening and Implications for the Oral–Systemic Axis" Microorganisms 14, no. 4: 884. https://doi.org/10.3390/microorganisms14040884
APA StyleCannon, M., & Stevenson, B. S. (2026). In Vitro Inhibition of Pathogens by Polyols: Optical Density-Based Screening and Implications for the Oral–Systemic Axis. Microorganisms, 14(4), 884. https://doi.org/10.3390/microorganisms14040884

