The oral microbiome holds clues to not only dental health but also risk of Alzheimer’s disease, heart attack and even cancer. Let’s speak with an expert in that area who is helping us better understand and optimize this critically important region.

Danny Grannick is CEO & Co-Founder at Bristle Health. They use genomics to measure the bacteria in  saliva that are linked to periodontal disease and caries and also heart attack, Alzheimers, and cancer. They then offer evidence-based recommendations and treatments for helping to prevent them. 

He has a bachelors degree in biochemistry from UCSD and a masters in Biotechnology and Entrepreneurship from NYU. 

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Robert Lufkin  0:01  
Welcome back to the health longevity secrets show and I’m your host, Dr. Robert Lufkin. The oral microbiome holds clues to not only dental health, but also the risk of Alzheimer’s disease, heart disease, and even cancer.

Today, let’s speak with an expert in that area who is helping us better understand and optimize this critically important region. Danny Granick is CEO and co founder at bristle health. They use genomic to measure the bacteria in saliva, better link to periodontal disease and caries and also heart attack Alzheimer’s and cancer. They then offer evidence based recommendations of treatments for helping to prevent these diseases. Danny has a bachelor’s degree in biochemistry from UCSD and a master’s in biotechnology and entrepreneurship from NYU. And now, please enjoy this interview with Danny Granick. Hey Danny, welcome to the show.

Danny Grannick  1:09  
Hey, thanks for having me.

Robert Lufkin  1:11  
It’s so great to have you here. I can’t wait to hear about the the interesting work you guys are doing and gals are doing with gristle health and understanding the oral microbiome and the significance of that not only for not only for, you know, dental, dental caries and periodontal disease, but also as we’re going to find out about Alzheimer’s disease and, and heart attack and cancer and stroke and all sorts of chronic diseases that just a few years ago, nobody thought were associated with oral health. So this is gonna be great. But before we do that, maybe just take a moment and tell us how you got interested in this in this fascinating area.

Danny Grannick  2:06  
Yeah, it’s, um, it’s been in the works for a long time. I mean, I think, you know, my background was originally in biochemistry, more on the physical chemistry side, so a lot of time in the lab. And while I was in the lab doing some research, I started to notice that I was a lot more interested in the application of the research and kind of translating it into product than I was with doing the actual research itself. So that led me into a bit of a pivot, where I’d previously been looking at PhD programs into something more on the commercial side. And I was lucky enough to start my career in the genomics industry, which at the time was really, I would say, kind of crossing the chasm between this early adopter segment and becoming a really formalized technology clinical care. So I worked at Illumina and a leader in sequencing technologies, and they, for background, they make a genetic sequencing technology. So they literally make the machine that reads your genetic code and spits out all of the different nucleotides associated with it. And they, they basically sell that platform technology to researchers looking into genomics for companies like 23andme, or ancestry, along with the flurry of companies that have have emerged since then, investigating genomics and connecting it to health. So I got my start at Illumina and became exposed to all these different applications and genomics. We’ve seen huge applications and growth in areas like oncology, non invasive prenatal testing, obviously, the gut microbiome space has gotten a lot of traction over the last couple of years. And, you know, I think it’s, it was really reflective of what we’ve seen across all different kinds of health technologies. We’re using biometrics to collect data that previously wasn’t accessible. And we’re basically amassing this huge database, and we’re starting to be able to derive insights from it. So I was at Illumina for a couple of years, and had the opportunity to work with some amazing researchers and companies and was always looking for a new area that genomics could be applied. Basically, you know, what was an area in health that we had limited insights into that we could apply this increasingly democratized technology towards and kind of uncovered you insights related to health? The real story around Bristol kind of the specifics of that we were at a, a pitch competition and I think we had heard a few companies kind of present on the gut microbiome and we knew that this was a space getting A lot of attention, there was still a gap between the research that was being done and what we considered being clinically actionable results that you could provide to patients. And coincidentally, my then friend, and now co founder had a dental appointment the next day. And he is, like a lot of us the, your typical patient who is religious about oral hygiene and inevitably has cavities every time he goes to the dentist, so he was kind of lamenting about, you know, what he was expecting the next day. And, you know, it kind of hit us in the face that we had never heard of a company or a research group really leveraging sequencing and genomics to focus on oral health. And we started digging into it. And basically found, you know, that there was this massive gap in in our understanding of how oral diseases are manifested at the consumer and the patient level, what is implicated in as far as its connection to overall health and disease, and that a lot of these insights really reside in the oral microbiome and the data that we’re able to derive. So the specific makeup of bacteria, fungi and viruses that live inside of our, our mouths, are connected to a whole host of overall health factors. And we, we just saw this really exciting kind of space that we could we could define with bristle, and we saw a lot of utility that we could deliver to patients. And that was that was kind of the beginning of the company.

Robert Lufkin  6:35  
Yeah, that’s a great story. I will, let’s let’s start off with the microbiome, the microbiome has exploded in the public consciousness, the word microbiome over the last over the last few years, and many people, when they hear microbiome, they equate it with the gut microbiome. But of course, actually, we’re now we now understand there are there are many micro biomes throughout the body, you know, the sino nasal microbiome, the vaginal microbiome, the dermal microbiome, even the brain microbiome. So, so tell us about what what about the oral microbiome?

Danny Grannick  7:21  
Yeah, I mean, I think you bring up a really interesting pattern that we’ve seen, which is, you know, for a lot of a lot of clinical history, we’ve really thought of ourselves as individual beings, first of all, and even within our individual beings being very compartmentalized. So we’ve always viewed our mouths as an individual, a component of our bodies, our guts as another individual component. And, again, I think with with a lot of the new technologies that have been surfacing, we have started to understand that, you know, one, we aren’t the individuals that we think we are, we’re actually a very symbiotic ecosystem of microbes that over, you know, hundreds of 1000s and millions of years have have adapted to, to basically use our bodies to survive in. And we’ve also uncovered a lot of relationships between the different parts of our bodies. So, you know, you mentioned the the gut microbiome is kind of being the the star and I think, you know, the gut microbiome was a really interesting space. And still is, it was, it was an unexplored area. But, you know, it took a while for research. And I think the public to become aware that just like there’s a gut microbiome, and your gut microbiome can be implicated in not only your gut health, but your overall health, we have similar micro biomes across all of our different bodies, because there’s all of these different environments that lend themselves to different species of bacteria and fungi and viruses to live on. And some of those bacteria are beneficial and they help protect us from disease, others are pathogenic and may cause harm to our bodies. So there’s this incredibly deep and complex layer, I think, to existing as a human being that we’re just starting to surface and the oral cavity is really interesting for us. You know, just like your skin, the the oral cavity is one of the most exposed components of the entire body. I mean, think about how many different things get introduced to your mouth from, you know, what you what you eat, what you drink, and what you breathe, and it’s directly connected to your digestive system to your gut. And, you know, it’s a pretty critical component. So So for us, the oral microbiome is a really key component of your overall health. And it’s been really exciting for us to explore not only the causal relationships between pathogenic bacteria and oral disease, but Patrick genic bacteria into overall disease or systemic conditions. It’s also really fascinating. I think, unlike the gut microbiome, the oral microbiome has kind of sub environments that we’re starting to investigate. So you can imagine that the kinds of bacteria that primarily live on your teeth that are maybe exposed to oxygen more frequently have a lot of movement going on, you know, have saliva kind of flowing over them are very different than the bacteria that live underneath your gum line closer to your bloodstream, or are different than the ones that live on your tongue. And each of those bacteria play a really important role in the makeup of those bacteria, those sub oral micro biomes are also very closely related to specific oral diseases and your risk for overall conditions.

Robert Lufkin  10:54  
Yeah, this, this is a fascinating area. So it’s almost like the, the all the all these micro biomes and mouth included, it’s like a sort of like a coral reef with all these different organisms and these different little relationships and niches and all I’m wondering of the, of the organisms that we’re going to begin to talk about in a bit are is it about the numbers of the organisms? Or are there any that are, you know, strictly pathogenic? In other words, if you if you detect this at all, it’s abnormal, or is it more? You Oh, you have too many have this amount or something like that?

Danny Grannick  11:32  
Yeah, it’s that’s a really good question. Um, so one of the I think one of the statistics that you that we all see associated with the gut microbiome is something like a diversity score. And I believe that generally, the higher diversity you have the the healthier your gut microbiome tends to be. There’s there’s some interesting correlations there, we’re still uncovering how diversity and the oral microbiome is connected to disease. But broadly speaking, you you have an oral microbiome, and a subset of those microbes are going to be beneficial and help protect against disease, and you’ll have different abundances of different species that fall within that category. And then, on the other end of the spectrum, we’ll have pathogenic microbes, and those are the ones that confer damage to your mouth or can be implicated in systemic disease. And again, each of those species will have a relative abundance in terms of your whole oral microbiome. So there’s been a lot of research that has shown the ratio of you know, the total abundance of those pathogenic species versus the total abundance of the beneficial species does relate or correlate to oral health status, which totally makes sense. But then within those subsets of pathogenic bacteria, you have some that are related to the onset of something like periodontal disease, and others that are related to the onset of something like dental caries, or cavities. And the way that we present our results is we look at the comprehensive relative abundance of species that are associated with something like periodontal disease in relation to the entirety of your oral microbiome and that that score basically helps us derive relative risk for periodontal disease and same thing with caries and bad breath. Um, so you know, I think, today, the oral microbiome in relation to oral disease has been relatively well defined in terms of, you know, what species are pathogenic, and what a high abundance of those species means or why those thresholds are, we’ve had decades of research that have looked at, you know, 11, or 12, kind of Keystone pathogens that we know are causally related to those conditions. Interestingly, there are, you know, on average, I think over 200, unique species of bacteria and, and a user’s oral microbiome, at least from the data that we have so far. So looking at 11, or 12, gives you a, an idea of what’s going on, but there’s a heck of a lot more to investigate. And what we’ve started to find is that there are microbes that are beneficial and and are very common to find in the oral microbiome. But if those microbes appear in other parts of your body, they actually become pathogenic. A really good example is infected, infective endocarditis, which is a cardiovascular condition that it’s relatively common. And the theory behind that is that some of the beneficial microbes and a few of the pathogenic ones implicated in oral health can enter the bloodstream. They end up in your heart or in your arteries. cause plaque, because as we all know, especially pathogenic microbes in your mouth, love to produce plaque. And they can also be to inflammation and localized areas. So, you know, eventually that can lead to increased risk or the incidence of heart disease in the future. And it’s, it’s exciting and at the same time really frightening to think that something that’s beneficial in one part of your body all of a sudden becomes harmful if it’s introduced somewhere else. But you know, I think that that’s a really exciting thing, because by looking at the oral microbiome in understanding, you know, if you have pathogenic bacteria acts, it may be a low risk pathogenic bacteria in your oral cavity. But if that if that bacteria migrate somewhere else, it can cause really severe conditions, we can help triage patients to get the monitoring or get the the preventive care they need, ahead of time. So to answer your question, it’s a mixture of abundance and diversity, and then the the kinds of species that you have in your oral microbiome. But you know, even deeper down, those those individual species can confer varying degrees of risk in your mouth or in other parts of your body.

Robert Lufkin  16:22  
So so for the bacterial endocarditis, sort of the valvular disease, you mentioned from a septic Val. And you were saying that would be like a more common, like staph or strep sort of relatively benign oral oral bacteria. But then, for the, for the disease of the blood vessels in the plaques and heart heart disease are for ischemic heart disease, like a heart attack and narrowing the coronary arteries and inflammatory vessels disease, which organism is that? Or is which group of organisms?

Danny Grannick  17:04  
So there’s a yeah, there’s a few that are implicated. And I can actually send you a short list after after the call, I think, you know, the, the really interesting piece of it, to me, at least is that some of those organisms are pathogenic in our mouths, right. So they’re the same microbes that cause periodontal disease, which really is an inflammatory condition. And it makes sense that if those pathogenic microbes appear in other areas of their body, they’re, they’re still going to cause inflammation. And they’re really interesting pieces that some of them are actually beneficial in your mouth, but can cause problems and other parts of your body. So beneficial microbes in our mouth do produce, not necessarily Sara Lee a plaque as we traditionally look at it, but a biofilm that helps protect your teeth. But you can imagine that, that biofilm, and other parts of your body may cause issues, right, so narrowing of the valves or clogging the arteries, it can, those those beneficial microbes may be identified, but in other parts of your body as being pathogenic, where normally they would be identified as being beneficial in your mouth. So you’re getting inflammation associated with those, it’s, it’s really interesting, I think that there’s even a few beneficial microbes in the oral cavity that have been associated with colorectal cancer, because they’ve basically migrated through your body, particularly in immunocompromised patients and end up causing damage there.

Robert Lufkin  18:46  
Yeah, yeah. And you hit on a key point here, that, that we’re that we’re all struggling with, is the fact that they’re associated with these diseases. In other words, the arrow of causality, so to speak, what’s causing it? In other words, whether the bacterium causes the the associated chronic disease or something else causes the bacterium to exist they’re in an opportunistic fashion sort of like if you have a leaky roof you have mold in your on the floor maybe but it’s not like the mold caused the roof to leak it’s just it grows there but maybe talk about I entered I pee change of Alice we hear a lot it’s gotten a lot of publicity as when one organism in the ranging all the way in the blood vessels of the coronary arteries to the brains of Alzheimer’s patients, this weird Association and then its presence in the mouth and and what other chronic diseases is it associated with? You mentioned cancer. So maybe pancreatic cancer also, I think,

Danny Grannick  20:03  
right? Yeah. P ginger valus has been associated with a variety of conditions. So I believe it’s been implicated in diabetes, rheumatoid arthritis. So again, looking at at kind of inflammation as maybe the underlying factor between all those infective endocarditis, I think that there’s been also some associations just with hypertension. And then obviously, Alzheimer’s has kind of come to the forefront, which happened rapidly as, as being one of the stronger associations between oral health status and mental health. You know, I think it’s, it’s also been interesting to see an evolution, you know, the, the relationship between oral health as kind of a, let’s call it like a phenotypic characterization. And overall health has been pretty recognized for decades. You know, it, I’m sure, if you ask a lot of the dentists that are probably listening to this, this conversation, you’ll find that there, there have been noticeable patterns and associations between patients that have been diagnosed with diabetes and higher prevalence of periodontal disease. And I think the really exciting thing is that we’re moving past these, these clinical findings into mechanistically. Understanding what the relationship is between the oral microbiome, which is a component of oral health status, and overall health or systemic disease, and we’re finding that the microbiome is really kind of that connecting a link between the two. So taking PGD balances as kind of the prime example, peaks and valleys has been, I think labeled a pathogen, meaning that it’s kind of the worst and the most common species for periodontal disease. And there have been noted associations between the emergence of periodontal disease and the worsening of the condition and cognitive decline. And kind of to your point around this chicken or the egg question. People have been wondering, you know, is it cognitive decline that happens first, and maybe patients get lowered here once with oral hygiene, which puts them at higher risk for periodontal disease? Is it that periodontal disease, you know, maybe, somehow it influences the onset of cognitive decline? And there are a lot of questions about, you know, which was coming first. And if they were, you know, truly kind of related at all. And there was a paper that came out, the one that I’m referring to is 2019, I’m sure that there were earlier studies that had looked at the brains of, of Alzheimer’s patients and the cerebrospinal fluid, and they actually identified via genomic sequencing the presence of peach and valus, in both the brains and CSF of of these patients in question. And in particular, they had identified a byproduct of peaks and valleys called Ginger pans, which is a protein that peach and develops, produces, and associated that with some Hallmark or biomarkers of Alzheimer’s. So the emergence of two proteins, in particular amyloid beta and tau. And a few more studies occurred that that basically was able to correlate, you know, that these patients that have peaks and valleys, the peaks and valleys, enters into the bloodstream enters into the body, and crossing the blood brain barrier, where it then produces ginger pains in the brain. And these ginger pains, are able to break down the connections between the neurons, and also cause some damage inside and that leads to increased abundances of these two kind of Hallmark biomarkers in Alzheimer’s patients amyloid beta and tau proteins, which I think is just a fantastic example of taking something that you observe in the clinic or or, you know, really in nature and bring it all the way through to identifying a mess mechanistic relationship, and we’ve started to see exciting results from that research, there have actually been two companies that that immediately come to mind that are developing therapeutics against peach and Debellis. For these for this reason, Cortex M is one. They released some really exciting data a few weeks ago and then the second one is a company called Keystone bio, which is really focused on on Pugin developers. itself.

Robert Lufkin  25:02  
Yeah. Are they are these two companies? Are they approaching targeting P ginger ballasts in the in the mouth? Or is it? Is it systemic delivery or what’s there? Can you talk about that a little bit? Yeah, yeah. So

Danny Grannick  25:16  
I believe both companies are delivered orally. My understanding is that cortex I’m designing their therapeutic to selectively target ginger pains so that that protein that’s by P ginger ballasts whereas Keystone bio is looking to target PG Debellis itself and kind of block the production of ginger panes downstream. Mm hmm.

Robert Lufkin  25:39  
Oh, interesting. Yeah. And the whole idea that you mentioned the whole association with P ginger valus and periodontal disease, not only with Alzheimer’s, but with all these other seemingly unrelated chronic diseases, but actually, of course, related at a fundamental metabolic inflammatory level, you know, hypertension, diabetes, stroke, heart attack and the cancers, they’re, they’re all really linked in and even so much so that periodontal disease is used as a now in some studies in in longevity research as an independent marker for aging as a as an independent biological clock. And, in fact, one of the, one of the priority targets for studying rapamycin, which is an mTOR inhibitor we talked about on the show before, but applying rapamycin in humans, one of the biomarkers they want to look at is periodontal disease and and actually rolling it rolling it back on that. I’m wondering, yeah, with with periodontal disease. Is there a, is there a reliable sort of consistent measure of periodontal disease? I think we’ve all had the experience of going into dentist’s office and they put the, you know, do manually probing and then writing down the scores. It seems like that that can be a little operator dependent, a little bit like that, but are you aware of biomarkers for periodontal disease that might be useful?

Danny Grannick  27:33  
Yeah, I mean, I think that, you know, you’re touching on a really exciting shift that we’re trying to progress with bristle. So, you know, now we’re kind of moving into oral health versus what we deem as dental care. And traditionally, just like you said, the way that we we characterize and diagnose dental disease has been largely observational, and based on the the presence and then the severity of physical characteristics. So for periodontal disease, we use things like probing where you measure the the pocket depth or the the space between your tooth and gum, as as an understanding and diagnosis of, you know, what level of periodontal disease you have. So the the deeper the pocket is, the worse the condition is. And that was basically, that has been the the standard for characterizing and diagnosing periodontal disease, you know, for the last ball forever. And, again, we’re, you know, what we’re trying to do with the oral microbiome is redefine what diagnosis and characterization of disease means moving away from using physical symptoms as as kind of this this marker of disease to the specific kinds of pathogenic bacteria, there are relative abundances that you have. And the advantage there is that, you know, if you’re just using physical symptoms, you already have progressed disease, you’re, you’re not going to be diagnosed until those symptoms have manifested and somebody can catch them. The advantage to using molecular methods for diagnosis and sequencing is we can detect those bacteria at the lowest abundances oftentimes before physical symptoms have emerged. And we can also get higher resolution on on what exactly is contributing to your disease. So it’s not going to be periodontal disease as a condition it would be, you know, P ginger ballast induced or driven periodontal disease. And I think that there’s going to be a really exciting shift in oral care in terms of you know, what your diagnosis looks like, the next time you go to a dentist. Yeah, it’s it’s been tough. I mean, I think it’s, it’s one of the bigger challenges that we have is actually Killing people around exactly what the results mean in the context of today’s care. But we’ve seen a similar shift with oncology, you know, moving from kind of location based characterization of tumors to mutation based. And I think that we’ll see a similar thing with with oral care.

Robert Lufkin  30:18  
It’s almost like you’re the and we’ll talk about bristle here in a moment. But but the the company produces, and this is a consumer facing product as well, but produces a report of the relative concentrations of the two groups of pathogenic bacteria that you’ve identified for periodontal disease and then for dental caries. And it’s really, it’s really beautiful, but that’s almost a it’s almost for a biological clock as well, for longevity research. It could be, you know, help people plan their, their longevity and, and how that’s looking as well.

Danny Grannick  30:53  
Yeah, and I think I mean, kind of, to your point around using periodontal disease as as a longevity marker, you know, it’s been a good start using traditional methods of characterization to make these correlations. But without the the depth and the resolution that you’re getting from having that molecular component, I think that there’s gonna be a lot of gaps. And again, understanding, is this a correlation? Or are they truly kind of mechanistically related to each other? Mm hm.

Robert Lufkin  31:24  
Maybe we can take a moment and dive into the weeds just a tiny bit. I we were talking earlier, I love the way you you describe the approach to genetic sequencing for the that you use at at Bristol health, specifically qPCR versus 16. S versus shotgun meta genomics. I think maybe you could just touch on those briefly. And it’ll help people understand the power that that will have with bristle health.

Danny Grannick  31:55  
Yeah, so let me I’ll start by setting the stage with what the oral microbiome looks like. So at the highest level, we’ve identified, the oral microbiome at the highest level is really made up of a wide variety of bacteria, fungi, and viruses, right. So there’s essentially three different buckets of microbes, that that all reside in there and interact with each other in various ways to drive health or disease outcomes. Specifically, looking at bacteria, to date, we have identified around 700 species, that that are part of the the oral microbiome, and obviously, the makeup of which species you have, and how much abundance varies from person to person. But, you know, if we’re looking kind of across the globe, there have been 700 ish species that we’ve found, on average, every person that we found in our data, and that research is kind of uncovered has usually between, you know, 250, unique species, that can be some makeup of beneficial pathogenic bacteria. And as I alluded to earlier, a lot of the early research and oral health than the microbiome had really centered around these 10 to 12 species of bacteria that have been causally related to oral disease. So you can imagine that there’s a set of bacteria that are causally related to periodontal disease, like peach and Debellis, there’s a set of bacteria that are causally related to dental caries. So when we look at the different methods for analyzing the oral microbiome, we’re gonna go in the opposite direction. But qPCR is one of the most common methods and that’s been the backbone of a lot of oral microbiome research over the last, you know, 20 or 30 years. And the way that qPCR works is you design primers that are specifically meant to or almost like, you know, fishing hooks that are designed for a specific kind of fish you’re trying to catch. So qPCR, you would design primers, and the primers are meant to detect the presence or absence and the relative abundance of predetermined bacterial species. So when we look at those 10 to 12, bacteria, a lot of those tests, were only testing for those bacteria. If there was there, it would be detected, and you would know, you know, around how much of it there was, if it wasn’t there, it wouldn’t be detected. And that’s great when you’re just focused on oral disease, but the problem is, is that you have 10 to 12 targets for what really is an environment that contains you know, 200 potential species of different bacteria. So there was this almost black box, right? You don’t know what you don’t know. So if you’re only looking for 10 or 12 species, and you find five of them, you’re completely overlooking the potentially, you know, 195 other species that are present in the sample. So that was kind of the first method. And then, with sequencing, there was another that was developed, and it’s called 16. S and 16. S is a genomic region in bacteria. And it’s a conserved region. So you can design primers that kind of stick to this gene. And then within that gene, there’s a huge amount of variability across species. So it’s almost like a fingerprint for bacteria. And the great thing about this method is that qPCR, you’re now able to detect all of the bacteria present. And you can identify them based on that 16 S sequence. So you’re going from 10 to 12, kind of predetermined targets, you’re missing the rest of the oral microbiome, or the microbiome in general. And now we’re getting all 200 bacteria, usually down to the species level, so you know, who’s there, you have an idea of what their relative abundances, it’s been a much more comprehensive method, and and again, has kind of become the most popular method when looking at the microbiome. The the shortcomings of that are that you’re only getting an eye, you’re only getting the idea of the bacteria that are in the sample, and really nothing else. So it’s hard to derive a lot of functional information and virulence factors, if you only know who’s there.

And then, over the last, you know, five or 10 years, there has been this other method that’s come up called shotgun, meta genomics. And that basically, is a completely hypothesis free approach to sequencing a sample, you’re doing whole genome sequencing across whatever is present. So we’re getting not only the human genomic data, but we’re getting bacteria or getting fungi or getting viruses. And we’re getting the whole genome of those micro organisms. The benefit there is, you know, I touched on being able to detect all 200 bacterial species using 60 minutes. Well, what about the fungi and viruses that we’ve been overlooking the entire time, I mean, they play a huge role in health and disease. We know HPV is a really important biomarker for a variety of conditions, and shotgun, metagenomics bridges that gap. So we’re getting all of the bacteria plus the fungi and viruses. And because we’re getting whole genome sequence information, we can characterize those micro organisms at at a deeper resolution. So moving from species level identification to strain level, and we’re also getting all of the functional information associated with those microbes. And we can start to understand how those different microbes are interacting with each other to drive disease. Because another really important component of oral diseases, it is not a one microbe to one indication relationship, a lot of these diseases are community driven, and we have the entire picture of what that community is to understand how they work together to drive disease. So that’s what we’ve built our assay off of. And it’s, it’s been really helpful because it produces a more accurate report as it relates to oral health and disease, but it also provides this foundation that we can start to innovate and derive new discoveries off of informing how oral health relates to overall health as well.

Robert Lufkin  38:51  
Wow, that’s so exciting, the ability to integrate all those different all those different genomic types beyond just the bacteria with 16 s in them or something but but viruses, like you say HPV for oral cancer and other risk factors. And in the fungi, we we talked a little bit before about mold when we were offline and and that would be such an exciting area and even I mean, like like you say even the human genetic information that’s in there for the individual. It’s it’s almost like this is an ideal deep learning application for AI where you have you know, massive amounts of the of the genetic information across, you know, three different organism types plus the the host and then putting it together and they’re, you know, there could be interactions in there that that that of course, are not one to one, like you say but rather complex ones across all of those that said, says such a great exciting possibility. these in the future. So for let’s talk about bristle health a little bit. The people can, consumers can do this themselves, right and send in their own samples, just saliva.

Danny Grannick  40:17  
Exactly, yeah. So we have a direct to consumer saliva oral microbiome test, you can go online to Priscilla calm, and we’ve got a couple options, you know, users can sign up for a single test and really just get a snapshot of what’s going on, we’ve got subscription models, where we can send you a test every six months or every three months, so that you can track your improvement over time. And, you know, we’re always kind of updating our database and the results that we provide. So no matter which test you get, and what results you have, it will continue to be a living an evolving creature, kind of like our oral microbiome. But I mean, I think the really exciting thing, and what we really want to see our users do is use the test to drive behavioural and clinical actions and changes in their lives and really see the outcomes of those decisions and those changes in improving their oral health status and their oral microbiome.

Robert Lufkin  41:19  
And right now, it’s it’s surprisingly affordable, I don’t know, what’s the latest pricing on the on that and, yeah, it’s a one.

Danny Grannick  41:31  
Right now it’s $119 for a single test, and then it drops to $109 per test for a test every six months, and then it drops again, to $99. A test for a test every three months, we certainly hope to continue driving down the cost, I think, you know, making our test as successful as possible as a core value of the company. And I think the unfortunate reality is, is that just like chronic disease, a lot of certain socio economic groups are at much higher risk for oral disease and have a much higher restrictions on their ability to access consistent care. So we see this as a really good way to kind of shift where the majority of oral health and care is being done to into the consumer, the patient’s hands and in their house.

Robert Lufkin  42:22  
And I mean, ideally, in a perfect world at some point, it would be wonderful if this were included with the person’s dental or health insurance as part of their routine examination. And like you say, if some of these things that, you know, become possible that would that would, that would be huge. Aye. Aye. Heard you talk or I’ve seen you mention things about the value kind of your vision for Bristol, you talked about a little bit about also about the notion of decentralized testing and interventions. Is this in sort of the idea of D health is this like D health like defy for decentralized finance, which Yeah, I’m a big fan of cryptocurrency as well. But Dugger talk about what is decentralized testing and decentralized hell.

Danny Grannick  43:15  
Yeah, I mean, I think that there’s a lot of layers to decentralization, but, you know, the, the exciting thing for us is, I think, in medical and and dental care. But, you know, for the sake of relevance, we’ll focus on dental care, it has been a very siloed industry on a number of levels. You know, dental practices are completely different physical locations than where you go generally, to see your primary care physician. Dental insurance is a completely separate system than then medical insurance and operates almost an inverse way where you basically have a dental insurance plan that’s willing to pay, you know, up to a certain amount, and then everything afterwards is out of pocket. And, as kind of a an aside, we actually have the highest rate of out of pocket expenses and dental care in the entire health care system. So 40% of the 100 $50 billion a year we spent on dental care is coming directly from patients, versus what I think is around six or 8% for medical care. And then looking at the data, you know, especially as we start to uncover more associations between dental and an oral or oral health and overall health, there’s a huge gap and a huge barrier and being able to get your oral health data to medical care and vice versa, which creates a lot of discrepancies and discontinuities in the care that you can get. So what we find is You know, because dental care is so hard to access. I think around 50% of the public doesn’t see a dentist every year. And you can imagine that for a diabetic patient who may be at higher risk for oral disease and Cesar endocrinologist regularly, if that endocrinologist isn’t educated about oral health and oral microbiome, those symptoms can go on addressed, the patient can get, you know, doesn’t get the care that they need when they need it. And that can result in really severe and prevalent oral diseases, that eventually becomes an emergency that that patient then has to pay for. So it’s kind of this vicious cycle. And I think when we talk about decentralizing health, the first response is, you’re trying to drive patients away from engaging with their provider. And I think it’s completely the opposite. I think what we want to do is, make it easier for patients to understand and act on their health status, and also make it easier to share that kind of information with the providers that they engage with, we have to meet the patient where they are, instead of trying to get them to do things that right now is really hard for them to access. So we’re not trying to get patients to not see the dentist, it’s actually quite the opposite. We’re trying to go to the dentist, go to the patients who aren’t seeing dentist today, get them insights around our oral health, because they don’t have it right now. And help them act on it. But also facilitate a conversation with that oral health care professional to design personalized treatment plans or triage with their other care providers and kind of work our way towards this idea of 360 degree health, which is a really exciting notion. But you know, I think everybody has to remember that the patient is the one that’s at the center of that that circle.

Robert Lufkin  46:54  
Yeah, yeah. But as a as an expert in the oral microbiome. What What if you don’t mind sharing with us? Maybe what what are your personal strategies to optimize your own oral microbiome? You know, just even as simple stuff, as you know, brushing, flossing gargling, what, yeah, what do you do to improve that?

Danny Grannick  47:20  
Well, I mean, I’m really glad that you you touched on like this, the simple stuff, I think, is the thing that stands out the most. And that’s what I think is one of the most compelling messages about bristle on. Oral health is is such an overlooked component in health care, and a lot of people don’t pay a lot of attention to what they do to maintain it. And there’s kind of this recurring patient experience of going to the dentist and being told to brush and floss more. But there’s not an explanation of why. Right? We know, okay, brushing, you know, helps make your teeth wider cleans somehow, but it’s hard to see the effect. And I think one of the the biggest impacts that we can make as a company is it’s not getting people from, you know, level eight to level 10. In terms of oral hygiene, I think it’s really getting most of the population from zero to one. And getting people from zero to one will have this monumental impact on oral health outcomes, because we know that doing simple things like brushing and flossing every day, have a quantitative and qualitative impact on your oral microbiome and your oral health status. We’re going to be publishing some some early data from our consumers. And what we’ve shown is I can’t remember the exact number but the difference between people who floss you know, daily or even every other day and people who never floss, I think it was something like a four 4x reduction in the abundance of periodontal disease causing bacteria. And we all know that we should floss. But I think until you see those numbers, and you really understand at a specific and quantitative level, how that’s improving your oral health. It’s something that we don’t pay much attention to. So, you know, personally for, for me, I got a lot better about my oral hygiene. And I think as a company like we would love nothing more than to see our users just adopt simple oral care habits that can dramatically improve their oral health. And then obviously, over time, we’ll work on making specific changes to your diet, you know, addressing different medications that you’re taking that may be contributing to risk. But for 90% of the population and a lot of our users, it’s really educating them on that zero to one shift.

Robert Lufkin  49:56  
Yeah, and and just to be clear, I think I think correct me if I’m wrong, but with dental health, unlike unlike maybe medical health where you you may not see your doctor like every year for a checkup with dental health, what you’re recommending with the flossing and brushing and, you know, the oral microbiome and all that. It’s still not a substitute for having your teeth cleaned and visiting a dentist, is that correct?

Danny Grannick  50:32  
In some ways, yeah. I mean, I think that, you know, there, I think that we have this idea of cosmetic dentistry. And it’s hard because a lot of people equate dental care or cosmetic dentistry with good oral health, but they’re not necessarily related. Right. So getting a lot of dental care doesn’t necessarily mean that you have good oral health all the time. Whereas having good oral health almost certainly means that you’re going to be able to reduce the amount of dental care that you need. So I think our goal, you know, it’s, it’s not it’s not so much telling people not to go see the dentist, but it’s shifting the conversation when they do go to Bing, okay, well, you have a really bad cavity, you need this expensive and invasive procedure to more of a consultative model where they’re working together to improve oral health status. There was a you know, and then there’s also some things with with dental cleanings that we found, there was a really interesting trial, the interval trial done by the NHS. And they had shown that when you stratify the population for risk for oral disease, and you look at that low risk population, as long as they maintain good oral health and hygiene habits, there is no, there was no noticeable difference in oral health outcomes for people that got dental cleanings every six months versus people that got dental cleanings every two years. So there is this really interesting idea of proactively managing your health and needing to reduce kind of the need for those in person appointments. I have not recommending that anybody stop saving their dentist every six months. But I do think that we’ll find, again, that by improving and maintaining good oral health, the population definitely will reduce the need for traditional dental care and procedures.

Robert Lufkin  52:23  
Yeah, there’s so much so much where we need to learn and we’re learning and tools like like you’re developing at Bristol health will certainly play a play a valuable role in understanding this and having more markers for assessing the the things that we do. Can you tell the our listeners how they can follow you on social social media or get in touch with bristle health? We’ll put it in the show notes as well. But

Danny Grannick  52:51  
yeah, yeah, no, no, it’s all the same. You know, Twitter, LinkedIn, Facebook, it’s all bristle health. So just the Add sign and bristle health, you’ll be able to find us. We post new research and content all the time, I’d encourage, at the very least going to our website and becoming a subscriber. We’ve got blog articles that we’re constantly posting, we’ve got newsletters that we do every month, that include the latest research in oral health and the microbiome. And then obviously, getting the test gives you access to all that kind of information at a much more personal level.

Robert Lufkin  53:27  
Thanks. Thanks so much, Danny for being part of the program. And I’m going to be thinking of you later today when I when I floss my teeth. And thanks so much for the great work you’re doing and spending an hour with us today on this program and sharing your knowledge.

Danny Grannick  53:43  
Of course really appreciate it.

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