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Welcome to Fink Oral.
Speaker1:
Where we connect the unconnected between oral and physical health.
Speaker2:
I'm your host, Dr. Jonathan Levine.
Speaker1:
And I'm your host, Maria Filipova.
Speaker2:
Let's get at it. Welcome to the Think Oral podcast. Jonathan Levine here along with Maria Filipova. We are so excited to welcome Daniel Granick of a very exciting company called Bristle Health, Breaking New Barriers in Oral Health for Salivary Diagnostics. We are so excited to bring this to the listeners to hear what they're doing and to to really this new research and science that is emerging for the importance of understanding the microbiome of the mouth. Danny Granik, welcome to Think Oral. Thanks for having me, Danny. I'm excited.
Speaker1:
About today. Talk about the future of health and future of oral health. It doesn't get any more real than that. Yes. Let's get to it. Yeah.
Speaker2:
So let's talk about let's jump in, Danny, with the new research where the connection of inflammation in the mouth and the pathogens in the mouth, in the saliva can work its way through a thin, mucosal lining in inflammation and find its way throughout the body with 58 systemic inflammatory diseases now connected to inflammation in the mouth. Why do you and your colleagues who started this company think it's so relevant and so important for people to get ahead of this understanding of this connection and what can they do about it?
Speaker3:
Yeah, think that's a great question. When we talk about treating disease in the medical and in the dental space. Think for a long time it's largely been reactive, right? You wait until symptoms pop up and then you go and seek out treatment. And usually those first line treatments are kind of brute force therapeutic and procedures that are intended to remove disease tissue. Things like cavity fillings, root canals on the dental side. And then you've got maybe some more the more options on the systemic side. But think over the last 5 to 10 years, there's really been a big shift into more of a preventive model for health. And to do preventive health, you've got to get to the root cause of disease. So when we talk about the role of oral pathogens in systemic inflammation, we think about the mouth as a gateway to the body. And the best way to prevent oral pathogens from making their way to the body is to take care of them at the earliest stage in the oral cavity. So that's the goal around the company. And that's why we think that developing this next generation of tests and diagnostics is so critical. We want to be able to detect those pathogens and reduce or remove them entirely before they ever have a chance to migrate.
Speaker2:
Yeah.
Speaker1:
So can we maybe stay here because I'm in the privileged position to have both of you here today who very a handful of people in industry have actually been as close and kept as recent to all the clinical research and everything that's coming out. Could we just for the for our listeners who are decision makers or those of us who are just patients going to the dentist's office, what where given where the literature and science is today, today, what is actionable from what we know from literature and science and clinical trials, what could a dentist do differently today? What could a patient do differently today? Or is a business owner? How should I think about the the benefits that I offer my employees, knowing what the two of you in terms of what's possible and real from science.
Speaker2:
Great. That's Danny. Take that one first and I'll follow up.
Speaker3:
You know.
Speaker4:
That's right. I always leave the we always leave.
Speaker1:
The easy questions for our guests. Danny, you should know that.
Speaker4:
Yes.
Speaker3:
That is that's that's a good question. I think it's maybe we go backwards a little bit and provide some background to to anybody who's listening, because it's been a really interesting history and evolution in the space. The last like I said, the last five, ten, 15 years have seen a lot of advancement in terms of our understanding of the oral microbiome, but its origins and the understanding that the oral microbiome is this key biomarker and the foundation of oral health is a really old concept. So there was there was a guy, I'm going to have to look up his. Hold on. Got this somewhere. There was a scientist named and I'm going to butcher this but Antonie van Leeuwenhoek. Leeuwenhoek.
Speaker2:
Leeuwenhoek.
Speaker4:
Yeah, the. That's right. The father. The father of microbiology. Exactly.
Speaker3:
And he was one of the first, if not the first to characterize bacteria. And one of the first samples that he took was actually a scraping on a tooth. And I'm sure that you've probably talked about this in other episodes of the podcast, but the foundation of microbiology has been rooted in the oral cavity and oral health. And over time we've seen advancements. So we got a better understanding of the role of bacteria in periodontal disease. We started characterizing the role of bacteria in caries, and we've understood that there are specific microbes that are implicated in each of those conditions. I'm sure people are familiar with the concept of the retina orange complex of bacteria, cariogenic or acetogenic bacterial species, and it stayed there for a while. So there was always this known association of oral. Bacteria and oral health and oral disease. And it wasn't until the last couple of years that we really started expanding our understanding of the role that those bacteria play in overall health. Now, I do think it's important to note that, again, decades of clinical research and I call them clinical anecdotes, right, because you can talk to 100 dentists and 99 of them will talk about diabetic patients. Right. Having a higher, higher prevalence of periodontal disease or having more severe symptoms. And there have been a lot of studies that have shown correlations and associations between systemic disease and risk or presence of oral disease. But it's really been the advent of technologies like genomic sequencing that has allowed us to think, get to the why, right? Why are these conditions so correlated? Why do we see them occurring in the same patient populations? Why are these patients at higher risk in the first place? And we have this amazing opportunity to lever bridge the oral microbiome, oral, microbiome and oral health as this, I call it, the lowest hanging fruit in health care.
Speaker3:
Right? If we can really help people improve their oral health and get from 0 to 1, not only do we have a direct impact on somebody's risk for oral disease, so that means less cavity fillings, less root canals, less more invasive, more expensive dental procedures that end up coming out of the pockets of patients. But we also have this amazing opportunity to knock a pretty big risk factor off the table for systemic diseases like cardiovascular disease, like diabetes, like Alzheimer's. And I'm not going to sit here and say that solving for oral health and solving for oral disease will cure or rid the world of these systemic conditions, But it will certainly have an impact on patient outcomes. As a patient, I see the oral microbiome and improving my oral health as something that benefits me today because everybody likes to have a clean mouth. It benefits me in the future because I'm decreasing my risk for oral disease. It really benefits my future because I'm potentially decreasing my risk for systemic indications. And I think the other stakeholders in the industry, when we talk about providers, dentists and physicians, there is the same opportunity to improve patient outcomes. And I think that that's really at the core of what they want to do. And then other stakeholders like payers and employers have this opportunity to drive a shift in the way that we approach health, implement a more preventive model. And as bad as it sounds, I think save some money in the long run because their employees or their members are going to require less dental procedures and potentially will improve overall health outcomes and require less medical procedures as well.
Speaker2:
That's right. That's a great roundup because when we think about health care spending being 20% of GDP, and if we can think of the dental office potentially being the tip of the spear, as we like to say with diagnostics, because people go to their dental office much more frequently than they go to their physicians. We can lead the diagnostics very nicely with tests of, let's call it saliva that's looking the potential pathogens. And when there's inflammation in the mouth, if we say we believe that there is a connection now after 20 years of research to 58 systemic inflammatory diseases, there will be an impact as you just you so nicely stated about a wellness model versus a sick model where we can really drive where you got to in your conversation for the listeners, we can really drive efficiencies, save money on the health care. But the greatest thing is to create healthier population by getting to these problems and these root causes earlier than waiting for these diseases to happen and then spending crazy amounts of money trying to create health from that sickness model.
Speaker4:
All right.
Speaker2:
I'm bored looking at efficiency, so let's go flip over getting there.
Speaker1:
I get it. Okay. So as the designated skeptic in this group I'm tracking, I'm with you. There's the promise and the potential, and I understand the foundational science behind it. Now, what needs to happen in a very pragmatic, tactical way today for that promise to become true? Do we have the data integration? Just recently, just today, there was an article about the NIH director urging more progress in merging dental and medical records. Is that a prerequisite for that future that both of you are describing, future around systemic health now? What do we need to get done first to be able to act on that?
Speaker3:
Yeah, that's a great question. I think it depends. It depends on which perspective you're taking for dental payers. And again, I think we have to keep in mind that the models for dental insurance are completely different than medical insurance. And that's, I think, a large problem in and of itself. I would say.
Speaker4:
Are you talking.
Speaker1:
About. Aligning incentives or aligning business models because preventative care is an is a challenge for both the buying and connecting payments to outcomes is a challenge both on the medical and dental side. So what do we what do you need to see? Is it better integration between medical and dental insurance claims and teams? Is that where you're going with this?
Speaker4:
I think for.
Speaker3:
For medical payers, I think having better integration is going to lead to reimbursement for tests like the one that we're developing, right? So we need to be able to show that improving health outcomes has some qualitative and quantitative impact on overall health outcomes for dental payers. I don't think the gap is necessarily in the data or in showing improved outcomes. The gap really comes down to the misaligned incentives and the business models behind dental insurers. We know that behavioral change in patients, getting them the right products, making sure that they're adhering to the right hygiene practices, getting early intervention directly contributes to improved oral health outcomes, which should be a really attractive model for a dental insurer. I think I'm in the consumer health space, so I always look at insurance with a bit of skepticism. And I think that based on the dental insurance model right now, there isn't a huge economic incentive for dental payers to really drive preventive oral health. Now, I think that there are exceptions, right, in the Medicare and the Medicaid space. I think they're doing a lot of exciting things. But if we're talking about private insurers and the standard marketplace right now, I think that the motivation is a little bit less for the patients. I think there's the very real statistic that we spend $150 billion a year on dental care and 40% of that is out of pocket. That's, I think, four times higher than the average or the aggregate of all of our other health care expenditures. We as a country may not spend a lot on dental care, but we as patients definitely do. And if there are actions that I can take as an individual to prevent the onset of disease, to hedge my bets and ensure that ten years, 20 years from now, my oral health is going to be in a good place. I want to start that work as soon as possible. I don't want to be facing 20,000 and $30,000 expenditures and.
Speaker1:
That value prop makes sense for a patient, right? Because this is we are ultimately it's in our best interests to stay healthy, at least in a in a logical world. That doesn't prevent me from eating those deep fried Oreos cookies that I might enjoy. But at least hypothetically, people, it's in their interest to stay healthy in the long term. The same argument holds true for self-insured employers, right? Or anybody who is in at risk contract. And so what you're saying is what I'm reading between the line is lines is some of those preventative health, systemic health type solutions that are coming down the innovation funnel are much better suited to be tested, validated and teed up to scale in those at risk contracts where the incentives are aligned for longer term outcomes because you're investing in the health of that patient member health plan member now to avoid longer term, more expensive procedures in the future.
Speaker3:
Yeah, I think for we've been forced into that kind of model, right? We have to work with people who are at highest risk because working with other stakeholders tends to be a longer cycle and it takes a lot more data to show. So we have to show that data somewhere to then approach other stakeholders and get them bought in. I would love I think you had mentioned what are the tactical approaches? I would love to do and this is for the audience, right? Like I would love to do a pilot study with a medical or dental payer looking at the impact of early detection of disease and behavioral change in improving oral health outcomes on the dental side, and then looking at an at risk population like a diabetic population and doing the same study except also looking at it through the lens of impacting overall health outcomes. And I think that we would see really exciting things. Unfortunately, those stakeholders just aren't self-motivated. So we have to generate a lot of that early data and think approach them and really make the case right.
Speaker1:
We'd love to talk to you about these validation points or proof points that we need to start creating so we generate the evidence that's needed for those health plans. Gotcha. Jonathan, where do you stand on that on that topic? You've been suspiciously.
Speaker4:
Quiet, shaking my.
Speaker2:
Head a little bit from a perspective of the fact that with such a growing body of evidence of connection of the pathogenic bacteria in the inflammatory, chronic inflammatory state in the mouth, and knowing where they end up, whether it's the carotid artery intima media of of cardiovascular patients or impacting diabetics, hypertension, pancreatic cancer, it's a long, long list. Everybody wins by taking. On this wellness model, the patient wins, the doctors win. The payers win. And the disconnection of medicine and dentistry, which is only going to get connected through innovation, whether it's universal health record, whether it's a company like Bristol Health, Salisbury Diagnostics or Sleep with dentists, understanding airway and impacting on the patient, all of these new innovations connect the dots of medicine and dentistry. The efficiency of the system starts to come in, not out. And we spend less money on this and we can reallocate dollars in other directions and we have greater wellness. So I shake my head only because what is it going to take for everyone to start collaborating together to improve that connection between medicine and dentistry? And and what I'd say to Danny is a company like his is the start of making that connection and creating a much more efficient model from diagnostics early to get these preventable diseases to this more efficient business model down in the chain.
Speaker4:
I totally agree. I think that.
Speaker2:
Was a statement, but I'm really tossing it over to you, Dan.
Speaker3:
But no, I think you hit the nail on the head, right? Like we somebody has to help eliminate barriers. It's not the wellness model is great. And and I think any person would sit here and say, of course I want preventive health. Of course I want to take better care of myself. I want to be proactive. I just think in today's world, like it's really hard to do. There's economic barriers, right? Because take our tent. I want to be preventive. I want to be proactive in oral health. Right now, our test isn't reimbursed. And I'm not kidding myself. The test is $149. That is not an accessible price point to everybody. And I think that if it was reimbursed, if we could lower the cost, get rid of that economic barrier, it there's no other reason why somebody wouldn't want to take that test and why they wouldn't want to drive behavioral change. Right now, the economic barrier is a major, major hurdle for people to get over it. And we still have people that are doing it because the economic costs down the road is so much higher than $149. You have physical barriers, right? Like literally my ability to get access to a dental office or to the same dental office for more than a couple of months. And that prevents people from being proactive about their oral health. And you've got mental barriers as well. I think the ADA did a study and I think they they showed that 30 million US adults get dental checkups every year and the top three reasons were cost, inconvenience and fear or anxiety of going to the dental office.
Speaker3:
And that anxiety is driven by the first two. Right. It's like really hard to get the care you need. It's really expensive to get the care you need. And when you do get the care under this reactive model, most of the time it's a pretty unpleasant procedure. So I would want to avoid that as well. Yeah, that's really exciting to see and think. It's crazy to me that the resources are so limited in dental care and just venture capital funding for the industry itself because referred to oral health as the lowest hanging fruit in all of health care. We're the and I'm not saying that it's a bad thing, right. But when we look at the amount of money that's going towards cardiovascular disease research and companies, metabolic health and diabetes, Alzheimer's and mental health, obviously exponentially more than anything going into dental but dental, it's a solvable problem. Cavities and gum disease are the most prevalent conditions on the planet, and they're largely preventable. They are rooted in the oral microbiome that technology exists today. If we're talking about an opportunity to completely change the way that we approach a facet of our health, dental is like on a silver platter. We just need the right partners and the right push to to drive mass adoption and shift.
Speaker2:
Yeah, that was the question I wanted to pose to you, Maria. Because of Quest Innovations, what is it going to take? What is it going to take for a company like Bristol Health to build that awareness, to excite other innovators, to join the join that conversation and really bring innovation to the forefront, understanding these pain points to create this more efficient model, to create a better wellness approach. What's it going to take for someone like innovators and companies like that to make a difference?
Speaker1:
I love that question. I wake up with that question, go to bed with that question every day. So I'm I'm glad that in the next two minutes I'll be able to give a comprehensive answer. Yeah, but it just it really starts with conversations like this and shining the light on the fact that we spend up to over 4% of total health care spending on dental care. It's over $160 billion in 2021. That dental care was as part of total spending. And yet. Investments in dental care. Oral health innovation is about 1% of total VC investment in health care. Number one, let's start with the facts that let's shine the light on on that discrepancy. Then let's keep shining the light on. Discrepancies around access and different communities are disproportionately impacted by lack of access and lack of care. And the barriers that Danny just described, although they're applied to everybody, we know, the different communities experience them more severely than others. So let's start with that common understanding of where we are. And then the next step for me is to propose an alternative that is validated and easy to act on. Our health plans today are not set up to process out-of-network claims from dentists.
Speaker1:
It's as simple as that. And even if they conceptually and as a vision and mission get it the need for whole person health. The wheels need to turn a little bit slower to make that happen. So making it easy to take those proof points and operationalize them in today's system is what I spend a lot of our time on and invite. And maybe the third thing is invite others. Part of the success metric for us is how many new Brussels new startups are we generating activity into the space? How many new investors who weren't looking in dental are looking in dental now and allowing to de-risk a little bit of the opportunity in dental because not again then your point is spot on. Dental is a great low hanging fruit, but not many people understand it. It's a different area altogether. And so I want to lend our expertise and resources for all of those investors who want to take a look to to understand the risk and when possible, to de-risk those companies so they could be accessible for other investors.
Speaker4:
That's my Maria, Can.
Speaker2:
We add one more.
Speaker4:
Piece to.
Speaker2:
What you were describing, which is fantastic, but could there be a pilot study that connects the payer? So a company that has both dental and medical reimbursement to run a pilot study that really shows what happens when you have early diagnostics on on the microbiome of the mouth when people understand it. Because what we're able to do in the dental practice is we can test at the beginning of our therapeutics. So we diagnose, we test, we run our therapeutics, whether it's chronic inflammation with decreasing periodontal disease. And then we're showing again what is the microbiome change. But then at the same time, what are the inflammatory biomarker change? What is the potential hypertension change? What are these medical medical indices of health or sickness and drive that? And I think that's going to come out of just what, to your point, is shining the light, having this conversation and bringing those stakeholders to the table to to get after it.
Speaker1:
Yeah. Love it. It's not only oral oral biomarkers or oral microbiome, it's also early stage oral cancer diagnostics. We diagnose in the dental office we treat in the medical setting. It's also sleep apnea. We diagnose in the medical setting and we treat on the dental setting with options, with oral appliance therapy. So to me, I love this conversation because again, we're giving our listeners another area that they could look into where not only do we have validation and clinical research to support the opportunity, but there are some real solutions that they could support and take on to their practice or to their employees if they're running our businesses or if they want to be part of that movement. Very excited.
Speaker2:
This is exactly why we started the Think Oral podcast by bringing the CEO of Bristol Health and talking about the the breakthrough innovations through their shotgun shotgun metagenomics, what they're doing there. And truly their price point actually is much lower than what's in the marketplace. And as that price comes down and if we can get all of the stakeholders working together, the reason you and I started this think oral podcast to connect the dots between medicine and dentistry, to drive these new innovations into people's awareness and drive adoption and make these changes, we might have done something good.
Speaker1:
That's right. We're so grateful for joining us today. Danny. More to come. We're looking forward to the future conversations, Danny, and hearing more from you.
Speaker3:
Me too. Thanks for having me on.
Speaker2:
Thanks for listening to the Think Oral podcast.
Speaker1:
Or the show notes and resources from today's podcast.
Speaker2:
Visit us at Dot Outcomes Rocket dot Health Slash think oral.
Speaker1:
Or start a conversation with us on social media.
Speaker2:
Until then, keep smiling.
Speaker1:
And connecting care.
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