Cavities and gum disease are driven by infectious microbes, but today’s dental care only detects the damage they already caused. X-rays and observational screenings detect tooth decay and bleeding gums, which are symptoms, not causes. By the time they are detected, they’ve often become serious issues that require the invasive procedures we all dread - fillings and root canals. We end up spending billions of dollars reactively treating diseases that can largely be prevented with good oral health management.
About us: Our backgrounds are on the research and commercial side of genomics. We have witnessed the rapid adoption and implementation of new technologies in healthcare enable remote monitoring of symptoms, early detection of disease, virtual care delivery, and new generations of therapeutics. Meanwhile, we have people like my co-founder Brian, who constantly face cavities despite great oral hygiene (good job, Brian) and get the same advice as everyone else.
Technologies like genomic sequencing and wearables are being applied to important areas in healthcare including oncology, rare disease, and NIPT - but aren't being used for the ones (literally) right beneath our nose. A lot of oral diseases start and progress from a build-up of specific acid-releasing or disease-causing bacteria. Working in genomics, we knew the technology existed to detect these pathogenic microbes at the earliest stages, when they were most treatable.
About our test: Like other DNA tests (think Color Genomics, Ancestry, etc.), our test can be taken from home and only requires a saliva sample. Unlike most DNA tests that look at your personal genome (the collection of your genes), we analyze the oral microbiome: the community of microbes (bacteria, fungi, and viruses) living in your mouth. Imbalance between pathogenic and beneficial microbes can contribute to your risk of oral disease or signal systemic conditions. Decades of research have shown causal relationships between the oral microbiome and preventable gum disease.
Most microbiome companies use a method called 16s, which only provides the identification and relative abundance of bacteria at low resolution (often only genus-level). We use shotgun metagenomics to identify and quantify all of the microbes in your mouth including viruses, bacteria (over 150 on average), and fungi. Our test sequences the whole genome of the microbes providing information like functional profiling and higher resolution at the strain-level. This means higher sensitivity and specificity while providing the kind of data needed to develop better oral care products and therapeutics in the future.
Oral health tends to be overlooked, but is an important component of overall health with deep connections to the rest of the body. Research has been unveiling links between oral health and the risk or presence of systemic diseases, including diabetes, heart disease, and Alzheimer’s (I'll include some links about this below). One of the more exciting things we'll be able to do as we grow our database is look for oral microbiome signatures related to other diseases. Such analysis will only be done on de-identified data, and only go towards the goal of improving health.
Our assay will inevitably pick up some of your genome - it’s impossible to completely avoid. But our analysis only looks at the microbes from your sample and we filter out human genome data from downstream analysis. There are some interesting genomic markers we eventually would like to investigate (read about some here: https://www.ada.org/en/member-center/oral-health-topics/gene...) but for now we only look at microbial data and will obtain consent before analyzing anything else.
About our projects: We are currently running a clinical research study with a leading dental school clinic, and will be bringing the test through clinical validation over the coming months. In the meantime, we’re offering a research version of our test to consumers through an early access program. This program provides an exploratory (non-diagnostic) lens into your oral microbiome, including information on your unique oral microbiome profile and how it relates to health conditions based on current research. The test is $50, but we won’t charge until you’re accepted off the waitlist and we are ready to send your kit. Right now we only ship in the US. If you’re outside of the US you can register at the bottom of our homepage to stay updated with our newsletter and be notified as we expand. https://www.bristlehealth.com/pages/early-access
Privacy is obviously a critical component of all this, and a top priority for us. We are determined to get it right from the ground up. Although we are not a HIPAA covered entity, we maintain a HIPAA compliant infrastructure. In the future, we believe that companies like ours may fall under a HIPAA designation. Operating that way today is our way of preparing for this. Most importantly, it protects your data. We will publish our data protection protocols on our website soon.
We believe we have a real opportunity to change the standard of care in oral health. We hope to expand access to patients and users, and give providers a new tool to help treat disease. We look forward to your feedback and questions - so please reach out or leave us a comment!
Thanks everyone, Danny, Brian, Shivam & David
The Economist, “Microbial ecosystems in the mouth and gut are linked to many ills”: https://www.economist.com/science-and-technology/2021/02/10/...
Personal health care expenditures, by source of funds and type of expenditure: United States, 2007–2017: https://www.cdc.gov/nchs/data/hus/2018/fig18.pdf US Dental care expenditures 2017: https://www.ada.org/~/media/ADA/Science%20and%20Research/HPI...
Healthcare expenditure trends in the US: https://www.cdc.gov/nchs/data/hus/2018/044.pdf
US Surgeon General Report on Oral Health (2000): https://www.nidcr.nih.gov/sites/default/files/2017-10/hck1oc...
The human oral microbiome in health and disease: from sequences to ecosystems: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7074908/
Oral microbiota of periodontal health and disease and their changes after nonsurgical periodontal therapy: https://www.nature.com/articles/s41396-017-0037-1
ADA Periodontitis stats: https://www.ada.org/en/publications/ada-news/2018-archive/ju...
The “Gum–Gut” Axis in Inflammatory Bowel Diseases: A Hypothesis-Driven Review of Associations and Advances: https://www.frontiersin.org/articles/10.3389/fimmu.2021.6201...
I'm that vein: Is this really a medical test, or is it just recreational?
What preventative treatment is this? If it isn't just "brush & floss", then what is it? If it's so great, why not just tell everyone about it now - why do you need a microbiome test?
I have a lot of dentist family and friends. Anything that isn't "drill and fill" is controversial to them. :)
Dental school these days seems to really stress that everything must be treated with intervention by a dentist that happens to bring money to their practice.
They are also super frightened of new technology. There was a technology that was like a new kind of mouthpiece with microbrushes that could brush your entire mouth in a few seconds. The dentists I know would barely even look at the picture before dismissing it.
I don't know why this is, but I'm pretty sure it has to do with the way their schooling works.
I’ve noticed some people just have good teeth, and others are not so lucky.
I’ve been down on my luck for years now. Close to being homeless. I haven’t been to a dentist in over two decades. I still have my all my teeth, except wisdom which I had pulled proactively when I had insurance.
Why do I still have my teeth, and my gums don’t bleed, or are recessed?
1. I feel it’s because I developed a neurotic compulsion to pick my teeth with those disgusting disposable tooth picks, with the floss. (I say disgusting because I see them discarded everywhere, and I worked for the inventor of the product. (Actually his wealthy father invented them, and fully funded his sailboating brat of a son a son to peddle them. He is now a 1 percenter, and yes—I’m jealous.
2. I’ve tried to use an ultrasonic toothbrush once a day.
3. I don’t eat much sugar, but I eat a lot of carbs?
4. Buy a few dental cleaning picks/tools, and learn how to scale your teeth yourself. If you’re gentile, and use common sense, you can get most of the gunk off. Below the gum line is another story though?
Take what I said with a grain of salt. A dentist told me 20 years ago, “you have great teeth, but let’s wait for the X-ray, and look at the bone. He said I got lucky.
I hope my next exam goes the same way?
I don't know anyone who gets more cavities than me and my mom. Seriously every time we go to the dentist we're either getting a new filling or replacing an old one.
I even spent 3 years (for non-dental reasons) eating no sweets and not much changed. We just have "weak teeth". I could maybe take better care of mine but my mom is an obsessive brusher/flosser and it hasn't helped her much.
We're working on building a knowledge base, as there are several pseudoscience wellness recommendations that have no clinical validity, and will share these on our blog that you can find on our website. A Bristle mission is to also develop more effective personalized therapeutics and oral care products that effectively treat microbiome dysbiosis to prevent disease prior to the onset of symptoms and irreversible disease.
> Your privacy is a top priority for us. Our test will pick up some of your DNA - it’s impossible to completely avoid - but we only look at the microbes from your saliva and we take steps in our workflow to throw out human data during analysis.
Can you do better than this? What exactly do you do with the data? What do you store? How do you store it? What do you throw away? When do you throw it away?
Your de-identfiied data (metadata and microbiome data) may be used in aggregate analysis to mine for novel biomarkers of disease, and to develop novel therapeutics targeting the oral microbiome for the treatment of disease.
Would our microbiome data be a sort of fingerprint?
For a good introduction I suggest the paper "Oral microbiome: Unveiling the fundamentals" at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6503789/
For the range of bacteria you can identify, what are some common treatments / behavioral that finding them might indicate? Or is it more information at this point?
At the moment, we cannot make any health recommendations, but in the next few months we plan to expand our product to include recommendations and fulfillment of prescription toothpastes, mouthwashes, and other preventive tools that we know are effective in improving oral health.
Additionally, we learn more from each user that takes our test, and can expand guidance around other indications where the oral microbiome is implicated to play a role, such as diabetes, cardiovascular disease, and possibly even neurodegenerative disorders. Eventually, the data we gather will also be used to develop personalized therapeutics tailored to treat specific microbial profiles in the oral microbiome.
Regarding pipelines: we use a custom pipeline that is similar in principle to available pipelines you mentioned (part of our secret sauce). We are actively working on functional analysis, as we hope to eventually develop targeted therapeutics that exploit microbial pathways to prevent disease.