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Jonathan Levine:
Welcome to Think Oral.

Mariya Filipova:
Where we connect the unconnected between oral and physical health.

Jonathan Levine:
I’m your host, Dr. Jonathan Levine.

Mariya Filipova:
And I’m your host, Mariya Filipova.

Jonathan Levine:
Let’s get at it.

Mariya Filipova:
Hi everyone. Mariya Filipova here and I am very excited to be joined by Jonathan Levine and we have a very special episode today for you. This episode is very special because of our guest, a close friend of mine, but also because of the topic. We are talking about innovation today, innovation at scale, innovation in health care and innovation in oral health. Fun fact, do you know when was the last large-scale innovation that was adopted in oral health? My personal answer to that question is that it has been 77 years since the last transformative innovation in oral health care. In 1945, fluoride was discovered and added to the drinking water in Michigan. Since then, it has had a profound impact on a large set of patients and communities, irrespective of their zip code, social status, education or medical background.

Jonathan Levine:
I love that analogy and it’s a really perfect one because it had such a huge impact on the decay rates for the children, and in fact it was a 65% decrease, which was quite incredible, keeping children in schools, keeping them out of pain and a huge impact. But it was the democratization of the impact, it wasn’t just for the few. The two percenters of the people that accessed to super high end technology. This was something that got into the drinking water and had a huge, profound effect in the United States. And this can be really, a very important question to ask our innovative colleagues, what they’re building. Can it flow to the greater mass of the people who do have the access to care, but also for people who there is a high level of inequality and don’t have access to care?

Mariya Filipova:
That’s right. I love this example as well, because it doesn’t require high tech. It’s not quantum computing and AI and neural nets solving a problem. It’s policy, clinical science coming together and doing something very foundational, yet highly impactful. And that really sets the tone and the ethos for the innovation that we want to uncover, validate and scale through our conversations. That’s truly the bar. How many people could we impact with the simplest, most elegant solution to improve, meaningfully improve access to care, improve equity and quality of care as well?

Jonathan Levine:
That’s exactly right. The word equality is so critical there because people who don’t have access to care think that walking around in pain is normal and losing teeth and extracting teeth is something normal. And it’s not until now that people can reach out, foundations reach out and start developing a leveled playing field to move these people more into an area where they do have access to care, do you see this incredible change, this transformational change for these people?

Mariya Filipova:
And with that in mind, I want to introduce our guest for today. I’m very excited that we are joined by the Stanford and Harvard-trained physician scientist, innovator and investor with over 25 years of clinical research, biotech and entrepreneurial experience. Dr. Daniel Kraft is joining us today from the West Coast. He serves as the chair of medicine in Singularity University. He’s also founder and chair of Exponential Medicine, now NextMed, we’ll speak to him about that and we’ll speak to him about his current entrepreneurial venture around digitizing medical solutions or digital tools, digital therapeutics for all kinds of clinical applications. And we’ll speak to him specifically about how the lessons learned from adopting innovation in medical community we can apply on the dental side. Daniel, welcome to the podcast. We’re very excited to have you. We are really looking forward to having a very pragmatic and real talk, if you will, about what we could do to identify impactful and scalable solutions in oral health. The reality is that over a third of the US population sees a single provider, one provider a year, either a dentist or a physician, but not both. And so if we have an opportunity to touch a patient once in a year, then to me it makes sense to make the most out of that visit and that touchpoint. And I share this openly that in, for me, the future of integrated health is when your primary care physician talks to you about periodontal health and your oral health, and your dentist talks to you about a-1c levels and managing your diabetes. So with that framing in mind, Daniel, what do you see as the most promising opportunities for that future? And do you think this is a reality to be a soon to be reality, or do you really think this is more of an aspiration?

Daniel Kraft:
The future is coming faster than we think, hopefully, and including in oral care and health care and public health, it’s more about getting to a world of integrated health, right? Where we’re not so siloed in body parts and where we connect our oral hygiene to our public health and our cardiovascular health and our brain health. I don’t think it’s very far off in some parts of the world are much more integrated in some systems, even in the US. So I think it’s a real time where we have the opportunity now to not think in such traditional silos, but recognize that, yes, while you’re in the dentist chair, you could have your blood pressure checked, or hemoglobin A1C and, while you’re at the primary care office, they could be doing some elements of oral care that tie to other health systems in the body and beyond. So I guess it’s a time to connect the dots and technology and new mindsets as we enter the era of 2023.

Mariya Filipova:
But it’s easier said than done, and technology is unfortunately not the limiting factor here, right? So what are some of the real barriers to that future to making that happen? And I’ve got, we’ve got we’re privileged. We have a dentist, we have a physician here on the podcast today. So let’s put some of these barriers out on the table.

Daniel Kraft:
Well, number one, just to be clear, I did get my annual cleaning done about three weeks ago.

Mariya Filipova:
Hey, there you go one step at a time. That’s right.

Daniel Kraft:
And the oral hygienist was awesome. And of course, she guilted me a little bit about not flossing very often. So I just want to put that on the table. But I did also get now a new connected toothbrush with an app that gamifies it. So I’m doing a much better job at my brushing and my flossing, just put that out there. So some of the barriers are behavioral. Just I always remind my kids to brush their teeth in the morning and the afternoon. I was not always the best brusher. And in fact, some of the barriers are again are how we get integrated and thinking about oral care and our general health. And I think we’re entering an era now where folks are getting into this era of more self care, not just health care, where they’re more engaged with their own health. They can see some of their data, whether it’s from their wearables and other bulls, giving them insights about their sleep and their activity and their cardiovascular health and their mental health and potentially tie that to other elements. So some of the barriers are behavioral, some of them are societal, but a big one, of course, in quote-unquote health care are the culture of care. It might be the culture of a clinician, of any sort of physician, nurse, dentist, pharmacist, how they see their workflow and their incentive models. You can have the best tele-medical visit or tele-dental visit, … what’s paid for and the incentives are aligned, it may not happen. So a lot of it still, still derives from the incentive elements and how we get paid for care. It’s still a bit nutty that I have to get a separate health insurance plan and pick a dental plan that’s still optional, right There should be potentially integrated together. And of course, some of it is not just having the technology, but connecting the dots, whether it’s the data from my connected toothbrush or what is my dentist do with my oral microbiome, if they have access to that, or how could they use 3D printing in the clinic or AI to better read imaging exams that would improve their efficiencies but also improve their time face to face with their patients. So lots of barriers, lots of opportunities. And again, a lot of it, as you mentioned, isn’t about the technology.

Jonathan Levine:
That’s right. If you look at the facts, one out of two adult Americans have periodontal disease, that’s chronic inflammatory disease. And over the age of 65, 70% have chronic inflammatory disease. And there’s 58 systemic inflammatory disease that now connects to inflammation, chronic inflammation in the mouth. So when we think about these data points deeply and what we think about, in dentistry, is that the hygiene room, because of some new innovation that’s living in dentistry, becomes the innovation center, connecting the dots of dentistry and medicine through sensors, through genomics. There’s some very exciting young companies coming up that are using all of the health care innovation, research, and science and all of the great genomics that’s happening with our understanding and moving it into dentistry because we know how long adoption takes in medicine, right? Over 70 years, well, it’s worse than dentistry because it is still a fragmented industry. The DSOs are coming, organizing dentistry, but they’re still only about 18 to 20%, which is pretty good growth. But still we’re dealing with fragmented dental business models of the dentist being the leader, and it’s difficult for them to get out of their same old way and adopting these new innovations not dissimilar to the cardiologists in the United States that are still using the Framingham study as a basis for their knowledge of cardiology, right? So it’s these biases that everybody has, and we have to break down those walls between dentistry and medicine and start really shaking it up a little bit. And people like yourself, Daniel, please comment on that because that’s exactly what you folks are doing there at Exponential.

Daniel Kraft:
Exponential Medicine, now, NextGen Health is a bit about reshaping our perspectives and looking at, with this age of exponential data, it might be data about your mouth and your microbiome to the size of your teeth to voice as a biomarker. But as you mentioned, the Framingham trial is a great example. It was, it’s still, it’s still an ongoing trial, but based on a mostly a Caucasian population in western Massachusetts, I think most of them were nurses at the start. That’s not representative of our population in the US or around the world. The National Institutes of Health and others are now run this, are ongoing with this all of us trial, which you can still join as a data donor that will help drive the insights, build different precision, personalized guidelines for you rather than the person who grew up in Framingham in a certain social and physical construct. I think going back to the oral health care space, not all malice and risk factors are the same. I’m lucky to have maybe had one carry in my entire life. It might have been help from my genetics with the fact that my mom tells me she took a fluoride tablet when I was in utero in London. So many factors involved and the rest of medicine and health care. It shouldn’t be one size fits all in terms of prevention, diagnostics and therapy.

Mariya Filipova:
Yeah, we like that example about the fluoride in the drinking water a lot because it’s a great way to show that you don’t need tech innovation to impact the lives of many.

Jonathan Levine:
Yeah, but, but also the concept of access to care that we were dancing around here because fluoride did have this huge impact on the general population. And I think some of the challenge that we have is how do we take some of this new innovation, new science, new research, whether it’s genomics, whether it’s airway and understanding deep sleep and sleep and the impact on our systemic health, how do we democratize that? How do we bring that out? And sleep is an airway is, is a huge issue, not issue, but a fantastic diagnostics that the dentists and the physicians have to work closely together to get the proper solutions past some of the new the existing solutions that aren’t, aren’t so wonderful being driven by insurance companies. These are the type of things that by working together, we can democratize what we do in health care because of the opportunity for people who go to the dentist more than they go to physicians. So the that hygiene room can become an innovation center that connects, that connects information and data and real usable data that’s being shown by sensors and trackers and going up to areas where we can communicate to the physicians and back to the dentists.

Mariya Filipova:
What do you think, Daniel?

Daniel Kraft:
Well, … data is great when this data age and data is the new oil, etcetera. But it’s not about more data. In fact, many clinicians don’t want the data or don’t want to log into your Ora ring or Fitbit or 23Andme data or EMR of different siloed segments. I think an opportunity for the, let’s say, the dentist chair, which some people try to avoid, is that could become a bit of a check in for all sorts of health. You may have heard of, in the African-American population, the Barbershop study where they used the barbershop where everyone goes every month or so for their haircut as a place to screen African American men for hypertension and identify folks early and then be preventative of heart attacks, strokes, renal disease. Why not use the dental chair as a similar check-in. Now that you can put on a maybe a fancy version of a wearable that can do a screen of everything from blood pressure to arrhythmias, maybe other point of care, lab elements could be done there, whether it’s hemoglobin, A1C, or cholesterol. And part of that may mean we’re going to move to this more. I think it’s called omnichannel care, right? Where your care is integrated with your pharmacist and your payer and your dentist and your primary care and your specialists so that the data can flow and be made actionable. And this idea of crowdsourcing that knowledge kind of building, I always call it the Google Maps or Waze of Health, where the information applied to you or your patient is really representative of where they are in their health care journey and not just built on the one size fits all guidelines of Framingham or others.

Jonathan Levine:
So our listeners, that is such an important point and we got to where we needed to get to, which is actionable data that the industries and it’s really transdisciplinary. It’s physician and dentists working together to improve the lives of people, whether it’s the microbiome of the mouth that’s causing inflammation and systemic inflammatory diseases, whether it’s the ability to get into deep sleep and airway and understanding those conversations and all of the new research that’s emerging, so that is a great point.

Daniel Kraft:
One point that connects the dots there, you mentioned the oral microbiome. I tried the bristle platform and my oral microbiome wasn’t great, I’ve done it once. I now see now that I’ve gotten my teeth cleaned and my better oral hygiene, whether that’s improved. But to make sure folks are aware, it’s also healthcare education that when you have inflammation in your mouth and gingival disease, etcetera, that gives you a significantly higher risk for cardiovascular disease, or now the connection between was it P gingival and Alzheimer, the neurologic issues. And maybe there’s even opportunities to making this up. Reboot the mouth microbiome we’ve had now in the era of fecal transplants for things like C difficile infections or potentially rebooting the gut microbiome for things like C diff and obesity. But could there be an oral microbiome, preventative or therapeutic platform to … Back to the earlier proviso, how do you align the incentives? Because most of medical care and dental care is driven by fee for service and doing more tooth extractions or procedures and you’re not being paid to keep people proactively healthy.

Jonathan Levine:
That’s exactly right. But the science and the research, now that we understand that the mouth actually seeds the gut and those microbiome, the organisms aren’t killed in the stomach and one out of three hit the gut. And there’s a connection between the inflammation and the mouth and leaky gut, finishing up a book on oral systemic medicine and it’s really this leaky mouth that imposes on these other areas started with 20 years ago with Moisi Devereaux studies on the carotid artery and p gingivalis to your point. But by working, by working together and actually, you may make such a great point as basic as a A1C for diabetes and hypertension and blood pressure, the dental office and the hygiene room starts connecting. And then it’s just technology that allows disconnected, disconnected information to be actionable to your point. If we started there and we can get more preventative, and can you just talk a little bit about the wellness model versus this reactive model of medicine that puts our health care at almost 20% of our GDP? Is there a way that we can be more efficient as a business model by working?

Daniel Kraft:
I think as we all know, our trajectory of health care spending in the US and most Western countries is getting unsustainable. We’re at 18-19 plus percent of GDP. Covid certainly impacted that. There’s lots of long Covid elements as well. But we know that if you spend more time and money on proactive prevention, that will abrogate heart attack, strokes, cancers, mental health elements, etcetera, oral disease. So I think there’s a picture opportunity with technology and beyond to look at the proactive preventative side or precision wellness in a sense. We’ll have it NextMed Health this march. Leroy Hood, Lee Hood is a real father of omics, but also this idea of precision wellness, another kind of like phenomics, right? There’s no one data feed, that’s the only important piece. Your genome or your labs or your blood pressure. It’s also your social constructs and your financial health and your sexual health and all these other pieces that are measurable or getting measurable. And then can we start to create the models often called a digital twin, to help optimize your health care journey, preventatively better diagnostics, and then tying the right therapy to the individual, whether that’s a digital therapeutic like an app or a gene therapy, or changing the microbiome of your mouth, or maybe picking the right toothbrush or platform to keep you on top and connecting the dots with all these new digital other platforms that can integrate care anytime, anywhere.

Jonathan Levine:
Exciting future.

Mariya Filipova:
And if we go back to the point around key to improving access to care is actually omnichannel care. And not only talking about the difference between the bedside or the website of care, but actually taking care outside a clinical setting, right, taking care into the barber shop or into the community or to the, to the schools. And, and in that sense, we have to think about that behavior change of care not necessarily something that you get done once a year when you go to your annual physical, but self care that you get done when you’re in school, when you’re shopping, because it starts with the food and the grocery bill that you get when you go grocery shopping, and it’s a lifestyle. And so when you think about that integrated view of health and self care rather than health care, then in that view, what is, maybe make this a little bit more pragmatic, right? Let’s make this very real. What would you like to see change from a patient side, right? What do we want to do differently in the next 1 or 2 years as patients that would add to that behavior change over the long period of time and what we might want to do differently if you are a PCP or if you’re a, if you’re a dentist or a hygienist or if you’re actually designing a health benefits plan for your employees as as an employer. So let’s go around a little bit the different stakeholders and try and make this real in what can we impact in a year or two?

Jonathan Levine:
Well, part of it goes back to health education, particularly getting them while they’re young. I trained in pediatrics as well, and we know that the first few years of life, 0 to 3, and maybe when you have your first teeth and maybe your teenager plays such a role in, let’s say, your oral health, but also all these other elements may come back to education, whether you’re in the dental chair or your primary care doc or school education and getting folks more engaged. This idea of the new drug as the empowered, engaged patient who might be able to look at their base genome data and know their risk for certain diseases or be able to look at their inflammation markers, whether it’s C-reactive protein or others, or now use some of these digital tools to do their own oral screening or connect to dental care. So part of it is the education, but the empowerment and back to the data piece, being able to see that in an integrated way that matches you, this idea of precision engagement or precision digital health, where it speaks to you in your language based on your age, culture, maybe even religion, educational level or incentives. Some people are driven by social points or gamification badges, or they want to get a lower premium because they’ve been brushing flossing more regularly, so why should they pay the higher premium? So there are so many dots to connect, but it sometimes comes back to behavior and culture shifts within the individual and family unit, as well as in the clinical realm, where putting on my MD hat, we don’t get much education in the medical realm, I don’t recall. And why should that not be part of your more part of your physical exam or thinking about sleep apnea and the oral pathways where your dentist or an MD or a nurse practitioner or a pharmacist and then potentially thinking about these new digital layers to connect and improve care. I recently launched a platform called Digital.Health. It’s easy to remember Digital.Health, and I’m looking at the database now and there’s a whole bunch of dental related applications from Teledentistry to the mouthwash, intraoral cameras to AI platforms that will help the dentist look at your, and not miss a carie to health management platforms. Tons of stuff is coming to the space. The trick is finding them and as a clinician being able to even prescribe them to your patients. So if you’re a benefits manager, should you make some of these virtual care platforms, home dentistry kits, telehealth elements paid for, and again align the incentives for the care continuum.

Mariya Filipova:
I do want to make a, highlight what you just said, because there is a myth out there that in order for us to integrate care better, we need more data, we may need petabytes of data. And the reality is that more data is not always a good thing. It’s not always the answer. We need more contextualized data and context data that could be actioned into insights and data that could move forward the treatment or the access of the care. That’s the difference. And there is no shortage of data and no shortage of tools as digital health can summarize these. And you did, you did list quite a few of those vetted, validated technologies that are already being used in the dental space. So myth number one, let’s make sure we’re dispersing that there’s no shortage of tools. There’s no shortage of data. There is gap in the clinician, in the hygienist or the dentist’s ability and the hours of the day for them to stay on top of it and to be able to coordinate the workflows and the integration across different systems to talk to each other.

Daniel Kraft:
Yeah.

Jonathan Levine:
Mariya, let me jump in one thing, but one thing that I would add to what Daniel was talking about is the necessary roadways for communication. So if, if we’re really looking at actionable data, as Daniel was talking about, how do we take that data and then put it in a place like the cloud and share it with our medical colleagues? And just the most basic thing, whether it was inflammatory markers, C-reactive protein, interleukin, whichever ones that could preheat and say there’s potentially a cardiovascular event coming down the road. Just what’s happening with these other new technologies that’s looking at retinal scans and all these other data points that are coming in from our breakthrough technologies. Saliva, we believe, is really the new blood diagnostics. And we know it’s very well from Covid 19. We know that people with periodontal disease had three times greater chance of ending up on a ventilator. And because, of course, the cytokine storm. So the importance of what’s possible with some of this data, Mariya, to your point, and what are we doing with it? There’s a universal health record in medicine because of Apple watches and working with health care systems. Let’s bring the dental teams in on that.

Mariya Filipova:
Yeah. I wouldn’t go as far as we’ve achieved the universal health record in medicine just yet. I think there’s.

Jonathan Levine:
But it’s starting.

Mariya Filipova:
… There rather than the cottage industry of different electronic records and each in the dental space. Daniel, you just came back from Israel and you had a great visit with Clalit and Ron Balestier, the chief Innovation officer of Israel’s largest health care organization. Anything we could learn from other countries who have probably who are a little bit further advanced in integrated care and other systems? Obviously with the limitations and the differential, differences of incentive structures, right? If you have a national health system, be it the NHS or, …, lessons from other countries, what comes to mind?

Jonathan Levine:
I was visiting in Tel Aviv, Ron Balicer, who’s the head of innovation for Clalit, the largest health care system in Israel. And they have a tremendous amount of data and they were able to leverage that network, really importantly, to look at the rollout of the Pfizer mRNA vaccine and demonstrate its efficacy and safety and boosters. And that drove not just vaccines in Israel, but the evidence base to roll those out around the world. So sometimes having a nimble, data-rich platform with an engaged population is super powerful and something that often doesn’t happen in the US with many scattered, quote-unquote health care systems and data that’s siloed and very challenging to, to move around. So there’s just lessons to learn from Start-Up Nation and beyond. I think it is back to this idea of often the four P’s, proactive, preventative, participatory, what’s the other p.

Mariya Filipova:
Personalized.

Daniel Kraft:
Personalized, right, that is what Clalit and some other systems are trying to really bring to reality. And it ties often back to the word we’ve heard a couple of times here, which is workflow for many clinicians. We are still working with Epic fail, pun intended, EMR systems. I’m not sure about the dental EMR, but they don’t often seem that much more user friendly. Even when I had my oral hygiene cleaning a month ago in Silicon Valley, it was a mix of phone calls and finally they got on a tech system and actually this time it integrated in my Google calendar. I’m like, wow, this is much better than it used to be, playing voicemail tag. So I think there’s the potential to learn from other systems, particularly maybe the importance of in some socialized systems about rewarding and paying for oral care, which again downstream aligns the incentives in the US. Many health care plans don’t really care about how your health is 20 years later, so they’re not going to invest in it because they think you’re going to change insurance companies every 9 to 9 months to three years. So we need to realize that all boats float up and include oral care with our health care and connect some of those data dots and workflows so that when you show up in the primary care visit or your dental visit, maybe some of those dots connect between your medical record and your dental, that your clinician of any sort can cross, fertilize and coordinate on screening for sleep apnea or taking a look at the microbiome of your mouth or gut or putting those together as we build this era of the proactive, crowdsourced digital twin.

Jonathan Levine:
Mariya, you heard him say it. Mariya.

Mariya Filipova:
Yes.

Jonathan Levine:
… say it. Oral care is part of the solution and part of the health care solution. Daniel, I heard you say it, listeners, this guy just said it. The biggest thought leader. Amazing. And I’m just noting it with a couple of asterisks.

Mariya Filipova:
That’s right. I do want to connect what Jonathan, you were saying and Daniel, and answer the question I started with. If I’m a patient, what do we suggest a patient do differently? And I think what I, what we’re all saying is, next time, Daniel, you go to your dentist for your hygienist cleaning, ask them, talk to them about your sleep. Talk to them about your stress levels and your fatigue and how you’re feeling during the day and see what the dentist could do in diagnosing and treating obstructive sleep apnea. That’s the first piece, right? Engage in a conversation with your dentist that goes beyond how white your teeth are or your chipped tooth specifically. So think about your dentist differently. Think about them and the hygienist and the dental team as core part of your overall care team. And that’s self-care, not, not health care, to be clear. And I and on the other piece, what I’m hearing is I do want to underline this opportunity for benefit leaders, for those who are in decision-making roles, taking care of these or community of people. We need to understand that managing somebody’s health, their productivity, their well-being and wellness is requires thinking about their oral health and their overall clinical health, systemic health, as well as their financial well-being, as well as their safety, as well as social drivers of health. Health is a complex, interconnected system. So next, the next conversation about well-being and productivity of employees, ask the question of how oral health is contributing or distracting from the productivity and the well-being of your employees. And you might be surprised at the answer you’ll come out, come from that question.

Daniel Kraft:
I wonder how many quote-unquote sick days are when you need to have that root canal or have the not so pleasant dental visit or the downstream costs of cardiovascular events that could be tied to improving oral care. And that might mean maybe your payer is going to cover the medical selfie. Now, the camera, the exponential power of our cameras and our smart phones can help you do your analysis. Why not take a picture of your mouth and your teeth and your gums and give you, oh, it looks like you’re getting gingivitis. You might need this particular new rinse or new toothbrush or get scheduled for your visit. Maybe that comes through different interfaces like your Google Home or Amazon Alexa. Maybe we’re now in this world of gpt3 and generative AI. They can now write you notes that are going to talk to you, Mariya, in your native language of Bulgaria, and that will make you take action that would make me take action, and.

Mariya Filipova:
That would be my the Christmas gift for my parents the next year, if that really could make that happen. And more importantly, I want to take a medical selfie of my smile and then see the connection over in the next ten years. If I don’t take care of my gingivitis or my the inflammation in my mouth to see the implications of my cognitive health and the cognitive decline, because we know there are clinical studies that are connecting prevalence of Alzheimer’s and put me at a higher risk of Alzheimer’s if I have untreated periodontal disease. So these are the connections that we want to make sure that people are seeing. So we talk about digital twins and medical selfies. That’s what we want to see as patients making things real.

Daniel Kraft:
And I remember as a kid having those, the dentist try to scare you and show you pictures of what would happen to bad cases of people who hadn’t brushed their teeth for months or years. And you mentioned this idea of the medical selfie, but we can look in the mirror and see our you of today. But what if you could see you of tomorrow, whether that was your oral mouth situation or how that ties to cardiovascular or mental health or neurologic health. And now you can personalize that. You can have use the Snapchat version of a filter and make you older or healthier and dial this up, if you take care of X, Y, and Z, working out, eating better, oral care, you’ll look vibrant and X at age 60 or 70. Versus this might well look like if you are in your current trajectory. So I call that kind of you’re looking at your future self. And now augmented and virtual reality can play a role that even in the, as an aside in the dental chair, some people certainly don’t like to have procedures done. Now you can take a low cost Oculus Quest and put it on in the dental chair and be at the beach and some folks might relax and be more at more likely to go visit their dentist when they might have some aversions otherwise.

Jonathan Levine:
And also, when you think about where do you start, I can tell you myself I’m still a practicing, I’m a prosthodontist …. Dentist … a multi-specialty team. We establish in the hygiene room a healthy mouth baseline. So we really try to get everybody to get some basic microbiome testing, CBCT, we’re always looking at airway and we start asking proactive questions to see, are there sleep disorders? And just make this as an example that the dental profession needs to get elevated, the medical profession needs to get elevated and come together in kind of this good communication pathway to start. So we have a place to start.

Daniel Kraft:
I love the idea of having a sort of an oral health baseline because now there’s all these new forms of data but almost needs to be synthesized into a single score like we have a FICO score for our financial health. And I imagine not being a dental professional that there could be an integrative score around everything from your gums to the health of your enamel to your quality of your breath. There’s now obviously voice as a biomarker, but there’s also breath as a biomarker where you can look at the molecules in your breath. That might be something else, that could be screened in the dental office to look at signs that screen for lung cancer to metabolic disease. Again, other things that can be done from the oral cavity, including the respiratory pathway that can be integrated into that overall score. And when you have a score, you can gamify it and try and I’m going to get my toothbrushing score from an eight to a nine again, maybe that might align with certain incentives, financial or otherwise, depending on who your payer is and how it’s designed.

Jonathan Levine:
Yeah, because it drives behavior. Just like that Aura ring you’re wearing, I wear one also. And when I see that sleep score again, a little low, I go, oh boy. And it starts changing the behavior of when I’m going to sleep or all of the things that the, that we do to get a good sleep.

Daniel Kraft:
I just had this idea like the aura ring. When I wake up in the morning, I now, I look, I’m addicted to looking at my sleep score and my readiness score. Readiness score comes from a bunch of things, from your temperature to your resting heart rate to your sleep score to your exercise the day before. What if your readiness score was tied to your connected toothbrush and it could tell that you.

Mariya Filipova:
Right.

Daniel Kraft:
Brushed that morning and for how long? Let’s make that one up.

Jonathan Levine:
That’s good.

Daniel Kraft:
Why not integrate with HealthKit and these other platforms? There’s also on Android platforms, common health ways to again make this really actionable and again, not design it as one size fits all.

Mariya Filipova:
And I’m very excited for, not only for that segment of our listeners who are data geeks and get excited about data like Jonathan, your Daniel here. But for those of us who just like to feel good and feel better and like to connect the dots, and from that perspective, I think this, this part of the conversation that we are entering in and that will probably put a pin for the moment is the most exciting part, the ideation part, because once you open up your mind to think about the art of the possible and what if we didn’t think of our dentists in, in a silo talk to our PCP? What if we could connect digital and tools, digital tools to analog tools? And what if we could actually action some of the clinical connections that we know from literature that connect our, look at our health as a system of interconnections rather than siloed, siloed disciplines. And so with that perspective, maybe in less than an invitation, Daniel, first of all, we would love to have, to continue the conversation. And for those for our listeners who could join you at NextMed in March, I heard you say extend an invitation to all of those current and future dental oral health entrepreneurs that they’re welcome to the NextMed community and to NextMed in March 2023. Where else could what a great resources and what else should those entrepreneurs be looking at in terms of resources and friendly audiences where they could brainstorm some of those art of the possible ideas or get more insights into how innovation got scaled and adopted in medical?

Daniel Kraft:
I think the magic is and what we’ll be doing at NextMed health websites, NextMed.Health, come join us is that it’s the magic happens at the interface of fields right where you, where dentists runs into someone who does 3D printing or AI or VR or blockchain or nanotech or how Crispr might play a role, or someone who’s run a health care system in Nairobi that could apply to anywhere in the world, cross fertilization. And that opens up the realm of the art of the possible, as you mentioned, and also the realizing that, there’s this old quote shared at a prior NextMed by the head of innovation of NHS, that the challenges that often the new ideas but escaping from the old ones and a lot of folks I think in the dental world are still stuck in these old mindsets and practices and billing realms. So the idea is not when we talk about innovation and disruption, not to just digitize the fax machine, but maybe blend all these new worlds, not just with the technology of 2023, which is already pretty fantastic. But imagine what we’re going to have in 2033 and build and like Wayne Gretzky, skate to where the puck is going to be and always look for pain points and how to solve them. In fact, I have a patent and I would love some of your audience to join me to build this company. I was never a great tooth brusher, I didn’t admit that earlier. How often if you brush your teeth, even if you’re doing 3 minutes or 5 minutes, how much are you on any one tooth or area? So I designed and we build prototype a few years ago of a 3D printed sort of wash mouth washing machine that would match the dentist would scan your mouth with 3D print, the sort of structure that you bite into a mouth guard. It would be connected to almost like a water pick version and it would do your entire mouth cleaning with different rinse cycles depending on what you needed. I think I’ve seen other versions come out of that since there are.

Jonathan Levine:
There’s one came and went, one called AMA Brush. There’s a new one now that some technology people came together that’s just getting commercialized is exactly right. It’s a water pick but it’s a mouthpiece that the key is you got to get to the spaces between the not so much on the front back. Yeah.

Daniel Kraft:
So a good example. I had this great idea. We even prototyped it a few years ago at Singular University, but you got to execute on it. We’ll see if mine has some legs. But so for anybody out there, keep a little notebook. Whether you’re a dental student, a medical student, a patient of any sort, find a pain point. Think about how what’s not working today, right, okay. The toothpaste tube is a scroll, scrunch it up. Couldn’t that be designed in some new crazy new way? Could that be tied to gamification? Could there be a digital layer? Could you imagine an era of a making this up, a personalized toothpaste that has the right microbiome elements that matches your oral risk factors, and then dentists and dental components? Could you use a toothbrush as a diagnostic device because it be screening the microbiome of your mouth and looking at your saliva? All these ways to think about connecting the dots and solving for pain points happen at this interface of people, ideas, mindset and inspiration.

Mariya Filipova:
Very exciting. So excited about the future of care, self care and integrated oral and systemic health. Thank you, Daniel, for joining us. We’re right at time and we’ll look forward to continuing the conversation.

Daniel Kraft:
Great. Thanks for having me. Keep smiling. Check out the dental resources on DigitalHealth and come join us at NextMed.Health. See you.

Mariya Filipova:
Great. See you.

Jonathan Levine:
Looking forward to it. Thank you, Daniel. Thank you, Mariya. Always fun.

Jonathan Levine:
Thanks for listening to the Think Oral podcast.

Mariya Filipova:
For the show notes and resources from today’s podcast,

Jonathan Levine:
visit us at www.OutcomesRocket.Health/ThinkOral.

Mariya Filipova:
Or start a conversation with us on social media.

Jonathan Levine:
Until then, keep smiling.

Mariya Filipova:
And connecting care.

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