Oral Microbiome Testing with Danny Grannick | Longevity Optimization Podcast

Today I'm speaking with Danny Grannick from Bristle Health on the Longevity Optimization Podcast. In this conversation, we delve into the significance of oral microbiome testing and its implications for dental health and overall well-being. Danny shares insights into the differences between good and bad bacteria, highlighting the connection between oral health and systemic diseases. We also discuss the barriers to mainstream acceptance of oral microbiome testing and the importance of raising awareness about its benefits.

Danny Grannick is a passionate advocate for oral health and the role of the microbiome in overall wellness. Throughout our discussion, we explore gender differences in oral microbiome health, the role of nitric oxide, and how these factors can influence health outcomes. The conversation emphasizes the need for a deeper understanding of the oral microbiome and its impact on systemic health, providing listeners with valuable insights into how oral health can affect their overall well-being..

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Timestamps

00:00 Introduction to Oral Microbiome Testing

03:05 The Importance of the Oral Microbiome

05:55 Understanding Good and Bad Bacteria

08:59 The Connection Between Oral Health and Systemic Diseases

11:53 Barriers to Mainstream Oral Microbiome Testing

15:10 Gender Differences in Oral Microbiome

17:56 Nitric Oxide and Oral Health

20:56 Probiotics and Oral Health

23:51 Oral Hygiene Practices and Recommendations

27:00 The Role of Mouthwash and Toothpaste

30:02 Conclusion and Future Directions

Transcript

[00:00:00.000] - KAYLA BARNES-LENTZ

Danny, it's a pleasure to have you here with me today.

[00:00:02.790] - DANNY GRANNICK

Yeah. Thanks for having us on.

[00:00:04.570] - KAYLA BARNES-LENTZ

Yeah, absolutely. Today, we're going to be talking about oral microbiome testing. But for all the listeners, will you walk us through your background and why you decided to develop an oral microbiome test?

[00:00:17.940] - DANNY GRANNICK

Yeah, that's a great question. My background, and most of the founding team's background, is actually in the genomics space. We come from a variety of areas within genetic sequencing. I come from the commercial side, worked for a company called Illumina. They make the hardware that other researchers and companies use for sequencing DNA, so worked side by side with a lot of companies that were implementing sequencing for non-invasive prenatal testing, liquid biopsy for cancer screening, obviously the gut microbiome space. I know you've had a couple of speakers on here speaking towards that. Bristle really Well, I think we were always looking for areas where sequencing could be introduced, new areas of health care that were largely operating in this reactive standard, where the whole basis of care is around treating the symptoms of disease. The idea behind technologies like sequencing is, can we shift that standard to be more proactive, preventive, precise, personalized? It was somewhat serendipitous. My colleague and now co founder had a dental appointment coming up, and I'm sure, like a lot of people listening to this podcast, he is a very cliché patient. Every time he went to the dentist, he would have cavities.

[00:01:44.630] - DANNY GRANNICK

No idea why. Always implemented good oral hygiene, and he was worried about his upcoming dental visit. And that really set us off to understand why dentistry felt so reactive. Why is that every time we see the dentists, they look for the symptoms of disease, and the first-line treatment is something like a cavity filling or a root canal or something more invasive, painful, expensive. One thing led to another, and we stumbled onto the oral microbiome. So that's the makeup of bacteria, funga, and viruses in the oral cavity. And the idea behind the technology was that by identifying and measuring these different bacteria and associating them with health and disease, we could really shift the standard of care into something a lot more proactive. We could focus on early detection and prevention and then use that information to guide people towards the right interventions. Cavities in gum disease are the most prevalent conditions on the planet. The affect more than half of the global population, and they are largely preventive when they're caught early. As we're probably going to touch on in this episode, there is a growing body of evidence and research that's connecting our oral and overall health.

[00:03:02.070] - DANNY GRANNICK

One of the missions of the company is to really help people address their oral health as this very critical component of improving their overall health as well.

[00:03:11.240] - KAYLA BARNES-LENTZ

Well, thank you. I love that, and I think it's so important. I see a biological dentist who I will be having on the podcast soon, but that is something I most certainly did not know about until much later in life. It's also something that is oftentimes not covered by insurance, so it can be very expensive. The entire world of dentistry and oral health has been something I've really been diving into. Obviously, while putting together my protocol, it was super important to understand the oral microbiome as much as my gut microbiome and my blood biomarker. I love that you guys are doing this. I love that this is something that people can just purchase, and you guys do a good job of breaking down some of the good and bad bacterias in the mouth. Let's go over a few of them, and the names probably won't be as important. You can drop them here. But what are some of the bad bacterias in our oral microbiome, and what can they do, and what are some of the good bacterias, and what do they do for us?

[00:04:18.570] - DANNY GRANNICK

Yeah. I'll only mention a few of the most notorious harmful pathogens. But I guess to back things up, way in the past, we've known about the oral microbiome for a really long time. One of the first microbial discoveries actually came from a scraping of plaque off of a tooth. Since then, we have identified multiple kinds of bacteria that play direct roles in disease. A couple of the most notorious ones are Fusobacterium nucleateum and Porphyromotus gingivalis, P. Gingivalis, F nucleateum. I'll refer to them as Pg and Fn, just to keep things really short. But these two bacteria are part of a subgroup of oral microbes called the red and orange complex. All of these bacteria have been identified as playing major roles in the onset of inflammation in perios disease, so gum disease in the oral cavity. They've also been identified as playing major roles in systemic health conditions, so cardiovascular disease, Alzheimer's, diabetes. Just like we have certain kinds of bacteria that contribute to oral and systemic disease, we also have beneficial microbes. These are bacteria that help improve oral health. They compete with and sometimes eliminate pathogenic bacteria. They can perform systemic systemic functions playing roles in our ability to produce nitric oxide.

[00:05:48.890] - DANNY GRANNICK

Our test identifies and measures all of these bacteria, the good and the bad.

[00:05:55.320] - KAYLA BARNES-LENTZ

Yeah, and you guys make it. I've obviously done the test. I need to send in my repeat test. But you was They get really simple. It's just essentially, here are bad bacterias, here's what they're contributing to. But for people that... I feel like the cardiovascular link with oral health is pretty well known. I feel like it's mainstream. Maybe I'm wrong. I hang out with a lot of doctors and health people, so maybe just in my world. But I feel like the relationship to neurodegenerative diseases and brain health is a little bit newer. Can you explain just from a high level, how does having a bad bacteria or pathogenic bacteria in your mouth then potentially lead to cardiovascular disease or brain health issues?

[00:06:41.850] - DANNY GRANNICK

We can boil it down to similar mechanisms as cardiovascular disease. When we think about what harmful bacteria do in our mouths, they drive inflammation, they produce plaque. Obviously, a lot of those terms are the same ones that we use when we talk about things like cardiovascular disease as well as neurodegenerative conditions. The bacteria in our mouths, to really boil it down, can make their ways to other parts of our bodies. They can confer many of the same effects that they have in our mouths, but when they're in other parts of our bodies, those effects can be a lot more harmful and detrimental to overall health conditions. The connections between oral health as a general concept and and mental health or cognitive decline have been known for quite a while, actually. We have always had associations or known about associations between the onset of conditions like Alzheimer's and declining oral health. But because we have technology that can characterize and detect these microbes, we can actually characterize exactly, ideally, what that link is between those conditions. When we talk about something like P. Gingivalis, P. Gingivalis can essentially make its way into our bloodstream. If you're flossing and you see blood, you're opening up parts of your gums where those bacteria can be introduced, and sometimes they can make their way to cerebrospinal fluid, and basically through a cascade of interactions and reactions with other parts of our bodies.

[00:08:17.750] - DANNY GRANNICK

They can initiate immune responses, inflammatory responses. They can cause the production of certain kinds of toxins that can cross the blood-brain barrier and then contribute to the progression of disease like Alzheimer's.

[00:08:31.550] - KAYLA BARNES-LENTZ

Well, thank you for sharing that. I think that's really important because oftentimes people might think of the mouth as its own isolated, essentially system, when clearly it's incredibly intertwined And correct me if I'm wrong, but when you look at a picture of teeth connected to the brain, it's also directly connected. It's like a bi-directional relationship. They're almost, I mean, more so teeth going up to the brain, but it's connected by nerves, right? Exactly. Yeah.

[00:09:01.550] - DANNY GRANNICK

I mean, our mouths are evolutionarily one of the most important parts of our bodies. It allows us to breathe, to eat, to drink. And biologically, those connections between our mouths and our brain are on eat.

[00:09:15.390] - KAYLA BARNES-LENTZ

Yeah, absolutely. And this next question might not be your area of expertise, but I find it fascinating that mouth shapes, the shape of the head is actually changed quite significantly from our ancestors due due to breathing patterns. What's your thoughts on that?

[00:09:33.700] - DANNY GRANNICK

Yeah, I mean, I totally agree. And the shift to eating more processed soft foods has had noticeable effects on the shapes of our jaws. I'm not necessarily an expert in the morphology changes in the oral cavity, but what we do find is the oral microbiome is very niche-specific. When you have things like crevices, gaps, overlapping teeth, it does create very small specialized environments for pathogenic bacteria to thrive. Over time, as our mouths continue to change shape, as we introduce differences in what that environment looks like, we could be increasing the risk of those pathogenic bacteria taking hold and growing.

[00:10:20.150] - KAYLA BARNES-LENTZ

Yeah, that makes sense. I just find it fascinating that we have a whole set of teeth, supposedly called our wisdom teeth, that we now remove move. But to the best of my understanding, it's because we're removing them because our heads are getting smaller and our mouths are getting smaller. I mean, there was no wisdom teeth removal at our ancestors with our ancestors.

[00:10:44.770] - DANNY GRANNICK

Exactly.

[00:10:45.900] - KAYLA BARNES-LENTZ

Very fascinating. Okay, great. Well, thank you for sharing all those details. Why do you think that this is not being spoken about? Again, I'm blessed to see a biological dentist, so all of this is covered, but why do you think this is not in mainstream dentistry?

[00:11:01.730] - DANNY GRANNICK

Yeah, that's a great question. It's always going to be a complicated field, complicated industry. Biological dentistry as a practice is pretty specialized right now, and I think There's 2-3 reasons why oral microbiome testing and biological dentistry hasn't made it to the mainstream. The first really boils down to just foundational education. The oral microbiome is taught in dental schools. It's certainly not a focus. That's because for a long time, and my second reason is just there was a lack of tools and accessibility to that data. Nine out of 10 dentists or whatever that stat is will probably be familiar with the concept of the oral microbiome, they would agree with the fact that certain pathogenic bacteria drive the onset of disease. But until now, there hasn't really been an accessible tool that could be implemented in dental care to start to detect intervene based on what bacteria are present. Now that there's some actionability, I think that there's a lot more education and knowledge that's being shared across the community. We've gotten a lot more interest from dentists in the test now that the technology is available. I think the third reason is we live in a healthcare system that is largely fee for service.

[00:12:23.950] - DANNY GRANNICK

I think that dental care has an incredibly high proportion of providers that are also practice owners. Unfortunately, I think that they're put in a really difficult position where they have to wear two hats. They're entrepreneurs and they're care providers. At the end of the day, they are making revenue based on the procedures that get reimbursed by insurance providers, and the insurance providers aren't necessarily reimbursing for preventive care at rates that make sense to a dental office. When you have a combination of, I would say, surface-level education around the oral microbiome, a lack of accessible technology to detect it, and knowledge about what to do when you do get that data, and then a system that really incentivizes that reactive treatment-based care, you end up with dentists that are able to make that leap and start providing a more proactive, more preventive standard to their patients.

[00:13:20.260] - KAYLA BARNES-LENTZ

Yeah, that makes a lot of sense. Except if you go full on biological dentistry, I think if you can build your practice, I mean, my dentist is super busy, and I think he has a great practice. Yeah.

[00:13:35.420] - DANNY GRANNICK

That's the exciting thing. I think that the dentists who are making that leap, who are really positioning themselves to provide that level of care, it works out for the patient, for the provider, for the insurer as well. It's just earlier. We're really seeing the most innovative early adopter forms of dentists that have built their practice from the ground up with that care in mind. It's super exciting to see.

[00:14:02.550] - KAYLA BARNES-LENTZ

Absolutely. When it comes to female and male oral microbiomes, what are some differences that you see, maybe some risk factors that you see for females, specifically?

[00:14:14.960] - DANNY GRANNICK

Hormones always play a major role in oral health and disease. Probably the most notable difference is during pregnancy. Pregnancy-induced gingivitis is a very widespread phenomenon. We know that the introduction of pathogenic bacteria at that stage of pregnancy can, again, lead to systemic inflammation, can have negative impacts on the fetus, the child. We see similarities between a mother's oral microbiome and their baby's oral microbiome before and after birth. So all in all, we do see higher rates of oral disease in pregnant women, especially. And a big part of the company is helping those women understand what their oral health status is, take the necessary steps to rebalance the oral microbiome, and hopefully take a risk factor off the table for their child.

[00:15:10.490] - KAYLA BARNES-LENTZ

Wonderful. Why is this? Why do you think that pregnant women are seeing more pathogenic bacteria in their mouths. Hi, guys. I'm going to interrupt this episode for a brief announcement. As you may or may not know, I started a community for females by females, and it's a female longevity optimization community. This is a place that you can connect with like-minded women. We are all here to support each other, and there's a variety of different benefits to being a member. You get a monthly Ask Me Anything, so submit your questions and I'll answer them directly. We also have an entire library of courses on all of the important components of longevity, such as labs, nutrition, exercise, sleep optimization, longevity optimization protocols that I'm doing, along along with real-time updates to my personal protocols. There are so many benefits of being a member of the community. We'll also be doing in-person live events here in California and virtual events for anyone that can't attend. But if you're interested in joining the community, I would absolutely love to see you there, and I will include a link in the show notes.

[00:16:19.810] - DANNY GRANNICK

There's a couple of theories about it. So I think that there are some cases where there's major dietary changes during pregnancy, and Sometimes those dietary changes can be, for lack of a better word, in the negative direction. People develop sweet teeth. They gravitate towards higher sugar, higher carbohydrate-based foods because they have a second person that they're trying to care for. Other reasons are just hormone changes that lead to inflammatory responses that can change the environment in the oral cavity that make it more predisposed to pathogenic bacteria growing. I think those are some of the two leading hypotheses, but I'm certain that there's other issues as well.

[00:17:07.700] - KAYLA BARNES-LENTZ

Interesting. Well, you guys and your team will have to get me updated as more information comes about regarding that because I'm super interested Understood.

[00:17:15.690] - DANNY GRANNICK

Yeah.

[00:17:17.610] - KAYLA BARNES-LENTZ

Okay. Nitric oxide and the oral microbiome or your oral health. What's the relationship there? What is nitric oxide, and why do we need it?

[00:17:27.340] - DANNY GRANNICK

Yeah. We touched on the relationship between cardiovascular disease and poor oral health. But we also see some beneficial relationships as well. To back up nitric oxide for the audience is a really important molecule in maintaining blood pressure, reducing risk of hypertension, and To produce nitric oxide, a lot of the... Well, I guess nitric oxide comes from another molecule called nitrate. And nitrate is found in leafy greens, beetroot juice is a great source of nitrate. Our Our bodies essentially convert nitrate into this end product nitric oxide. But our human cells are pretty inefficient at doing that conversion step. So we rely on, in a lot of cases, certain bacteria and certain enzymes to help us increase the efficiency of turning nitrate into nitric oxide. Specifically, what happens is we consume nitrate. That nitrate is into another form called nitrate, and then nitrate is eventually converted into nitric oxide. So the more efficient we are in doing those steps, the more nitric oxide we end up with, the more nitric oxide we have, the better our cardiovascular health is. And there are specific bacteria that are in our oral microbiomes that help convert nitrate into nitrate. So the more of these bacteria you have, the more abundant they are, the more efficient your body is in producing nitric oxide.

[00:19:01.810] - DANNY GRANNICK

And what our test does is we identify and measure all of those bacteria to give you an idea of how efficient your oral microbiome is in producing this really important molecule tied to cardiovascular health. So there were a few very interesting research studies that came out over the last couple of years, and they looked at the impact of alcohol-based mouth rins on these nitric oxide-producing bacteria for for lack of a better word. Alcohol-based mouth rinses. The kinds of things that you would find at the grocery store on the shelf, most people think that you should use it twice a day, every day, helps you maintain good breath, keeps your mouth clean. In reality, a lot of these mouth rinses can actually wipe out a lot of the beneficial and pathogenic bacteria resulting in oral microbiome dysbiosis. What these studies found were for people that consumed or frequently used alcohol-based mouth rinses, they had a much lower abundance of these nitric oxide-producing bacteria in their mouths, and they had higher blood pressure, higher risk for hypertension. A big piece of our report and our recommendations is helping people increase the abundance of those species to increase the amount of nitric oxide they can produce and mitigate those risk factors.

[00:20:24.830] - KAYLA BARNES-LENTZ

How do you increase those beneficial bacteria?

[00:20:27.690] - DANNY GRANNICK

There's a couple different ways. I mean, The three big ones are going to be dietary changes, so introducing more foods and supplements that are nitrate-rich. It's a great prebiotic to feed those bacteria and encourage development. Tonguescraping is another really effective method, particularly towards the front of the tongue, you're clearing out a lot of the pathogenic bacteria, and the back of your tongue actually harbors a lot of those nitrate-reducing species. Then the last piece, and this is early not only are in development, but oral probiotics. Can we introduce those nitrate-reducing species into the oral cavity, ideally seed them as part of the oral microbiome, and then use the two previous methods to keep them growing?

[00:21:12.510] - KAYLA BARNES-LENTZ

Great. Well, yeah, I would love to hear more as that develops. Do you guys have oral probiotics now or you're working on it?

[00:21:19.490] - DANNY GRANNICK

We do. We offer one oral probiotic. There's a couple other brands on the market. We developed ours because we... Well, We went through our data, and for background, a lot of our users come in, particularly to solve issues around halitosis or chronic bad breath and periodontal disease and gingivitis, so gum inflammation. As we were digging through the data, we started to notice a couple of patterns in terms of the pathogenic bacteria that were present, their abundances, and we couldn't find a probiotic that was already on the market that had all the strains that would address those imbalances, so we decided to make our own. For now, that's the only probiotic that we offer, but we do recommend other brands in the report as well. There's no financial relationships between our company and the third parties. We want to provide people with as many options as possible, and again, make the most targeted recommendations that we can.

[00:22:20.200] - KAYLA BARNES-LENTZ

If you have bad breath, if you have bad breath and you take your test, what is going to come back? I mean, is there always a relationship between harboring bad bacteria in the oral microbiome and bad breath?

[00:22:34.470] - DANNY GRANNICK

Most of the time. There are, again, specific bacteria in the oral microbiome that are capable of producing volatile pulver compounds, VSCs. Those are the molecules in oral cavity originated bad breath that give it the smell. Our test can characterize those microbes, and we've actually identified six subtypes of keratosis that arise from the oral cavity. In some cases, it comes from the same bacteria that caused periodontal disease. It can be an early indicator of gum disease in the future. In other cases, it comes from Candida fungai that are tied to conditions like oral thrush. And there's multiple other buckets that we'll report on. So we'll tell you what subtype you fall into, and then there's some targeted recommendations for each type. But in other cases, there are digestive conditions that can cause bad breath that are unrelated to the oral microbiome. So in those cases, our test can almost be used as something like a differential diagnosis, where a negative result can actually tell you, okay, my bad breath isn't originating from something in my mouth, it must be coming from somewhere else like my gut.

[00:23:51.110] - KAYLA BARNES-LENTZ

Very interesting. Well, I hope anyone that has bad breath is listening and taking action on that because it sounds like it could potentially become pretty serious. Okay, when it comes to probiotic toothpaste or probiotic oral supplements, is it in the form of a toothpaste?

[00:24:08.930] - DANNY GRANNICK

Not yet. So most of them are in the form of something like a breath mint. It's pretty hard to actually integrate a probiotic into a liquid solution. That's why you find a lot of them to be in capsule form or pill form. So our probiotic comes in the form of a breath mint. There's a couple others that come in, powders, I believe, But you could always, if you wanted to implement it into a toothpaste, you can always crush it up and sprinkle it on your toothpaste. It's a great way to introduce it to the oral cavity.

[00:24:40.110] - KAYLA BARNES-LENTZ

Wonderful. Would you recommend that everybody just start using a probiotic, or do you want to really... Can taking an oral probiotic cause harm if you don't need it?

[00:24:52.270] - DANNY GRANNICK

No, I don't think it's ever harmful. I think it's especially beneficial for certain people that take the test. So if you have a deficiency of one of those probiotic strains, if you have an overabundance of certain pathogenic bacteria, then the strains that are in the probiotic can be particularly effective in rebalancing the oral microbiome, but there's no harm and taking it as a once daily addition to your typical hygiene routine.

[00:25:19.930] - KAYLA BARNES-LENTZ

Okay, great. All right, wonderful. Well, is there anything else more that you'd like to say on the test, specifically, before I ask you some general oral microbiome hygiene questions?

[00:25:32.150] - DANNY GRANNICK

No, let's dive in.

[00:25:33.970] - KAYLA BARNES-LENTZ

Okay, perfect. So you brought up mouthwash. Things like Listerine in my book are a hard no, but what about you?

[00:25:43.890] - DANNY GRANNICK

Yeah, so If we throw Listerine into a broader bucket of antimicrobial mouth rinses, our stance, and what the research shows, is that ongoing use of these rinses can do more harm than good. Again, you're introducing something that when you see in the grocery store that it kills 99. 9% of bacteria that cause gingivitis, it's not just bacteria that cause gingivitis, it's everything, including the beneficial microbes. So using mouth rinse once or twice a day for years can have really, really negative impacts on your oral microbiome. There are certain cases where if you have an overabundance of pathogenic bacteria, using mouth rinse can be an effective intervention in eradicating those microbes, but we only recommend that it's used in a very bounded period of time. In our care plan, we would have a recommendation that would say something like, use a mouth rinse with this antimicrobial ingredient based on the bacteria that we detected in your mouth twice per day for two weeks. You're only using it for a very temporary period of time with the goal of just trying to drive down the abundance of those pathogenic bacteria as much as possible. Then we would have somebody stop using the mouth rinse entirely and start introducing the probiotics to rebuild the commensals.

[00:27:14.500] - KAYLA BARNES-LENTZ

That makes a lot of sense. That's very similar to essentially what you would do with a gut microbiome test. First, it's like kill all the bad things and then manage the dysbiosis, and then you want to re populate with the good bacteria. So that makes a lot of sense. Exactly. Good. I use a mouthwash called Breo. It's essentially just like a saline solution, and I use it with a water pick. What are your thoughts on that?

[00:27:42.420] - DANNY GRANNICK

Love waterpicks. Super targeted way to introduce. So we actually have a lot of people that will also use dilute hydrogen peroxide in their water tray. Great targeted way to get at the gum line, introduce oxygen, which kills a lot of the anaerobic pathogenic bacteria that grow there. So I think that that is a fantastic at home oral hygiene routine.

[00:28:09.750] - KAYLA BARNES-LENTZ

Wonderful. I also do... So I was doing coconut oil pulling. Would love your opinion on that?

[00:28:16.040] - DANNY GRANNICK

We're looking into it. I think there's a lot of new products, a lot of new interventions that are coming to the market. A lot of these new treatments, a lot of these new hygiene routines have shown some promise at the clinical level. People will see reduced symptoms of disease. They'll see improvements in perceived oral health. We want to back up a lot of these interventions with oral microbiome data. It's too early to say whether oil pulling benefits certain bacteria, if it's better at eliminating certain pathogenic bacteria than others. But there doesn't seem to be any harm in doing it. I think that if people are seeing improved symptoms, then it's a great piece to implement. As we get more data, we characterize the efficacy of these, our goal is to share it across the community.

[00:29:12.440] - KAYLA BARNES-LENTZ

Good. I love that. Well, please let me know once you get some data to back up, coconut oil pulling. I mean, I've seen good results. The only downside is it takes so long. It's like 20 minutes of swishing around in your mouth. So that's annoying. I usually stack it with something else. I'm doing like breathwork or my red light panel, something of that nature. I most recently have actually been doing ozone oil pulling. That's probably even newer than coconut oil pulling. So if you guys ever want to do any data around that. But I mean, seems to be going well for me so far. Okay, so that's all the pulling things. We talked about tongue scraping. I found it interesting that you say, So the recommendation is not to scrape all the way. You want to not scrape so much in the back because that's where the beneficial bacteria are?

[00:30:02.890] - DANNY GRANNICK

Yeah, that tends to be where the nitric oxide or nitrate-reducing bacteria thrive.

[00:30:08.710] - KAYLA BARNES-LENTZ

Amazing. Obviously, so flossing twice a day is your guys' recommendation?

[00:30:14.880] - DANNY GRANNICK

Generally, which sounds... I mean, it sounds so cliché to say you should brush and floss twice per day, but it works. And I think one of the most interesting things since starting the company was there's all of these things that we're told, brush and floss twice per day. It wasn't until we published a blog article where we had dug into our data because we wanted to understand, do you actually have to floss every single day? Should you be flossing twice per day? Do you need to floss at all? We found that there was a positive correlation between increased frequency of flossing and beneficial microbes, as well as lower abundances of periodontal pathogens. So People who floss more often have more good bacteria, and they have less of the bacteria that cause gum disease than people who floss less frequently, which sounds obvious. But it wasn't until we published our blog article on it that I was trying to do a literature search to see what other research had been published. It was the first time in my life that I hadn't seen a study looking at the impact of flossing on the oral microbiome. To me, it was just this wake-up call that, in this case, our data and our research lined up with the typical advice that you would get.

[00:31:40.590] - DANNY GRANNICK

But it was this wake-up call that there's so many things in oral health, and even in general health, that we're told that haven't necessarily been characterized the way that I think we would assume they would be.

[00:31:55.060] - KAYLA BARNES-LENTZ

Yeah. No, I totally agree. I'm having a couple of people All my team, researchers on my team, pull all the female data right now and index it. There's so many things that we have no literature on. That's a big thing I'm going to be focusing on later this year, is actually to help fund female-specific human trials. That is very exciting.

[00:32:15.650] - DANNY GRANNICK

That's amazing.

[00:32:17.100] - KAYLA BARNES-LENTZ

Well, thank you. Okay, back to oral health. So we have, okay, is Waterpick sufficient or do you need to be flossing?

[00:32:26.080] - DANNY GRANNICK

Waterpick seems to be sufficient. It does a really good job. I think it's all about the frequency that you do it. So as long as you're making sure that you're doing it every day, you're targeting your teeth well or the gum line really well, then it should be effective. Obviously, I think flossing works if you have trouble with any of that, right? You don't want to forego certain parts of your gums or only do it every other day or something like that. But it is great. And I think that for people that have trouble with floss, you would be astonished how many people stop flossing purely because it's a pain getting the string everywhere. Switching to a waterpick gets people flossing every day, and it's such a beneficial intervention for your oral health. It really is night and day. I'll send you the blog article that we published with some of the data that we have, but substantial differences in the oral microbiome between people who floss every day and people who floss once a week.

[00:33:27.070] - KAYLA BARNES-LENTZ

Yeah, absolutely. Waterpick just makes it so much easier It's super simple, not messy. I love it. And yeah, you're right. You can basically add other solutions into the reservoir, which is really nice. So if you want to do that. Okay, so toothpaste. On the scale of Prest to David's, what have you guys seen? I mean, does toothpaste make an impact in the more oral microbiome?

[00:33:55.730] - DANNY GRANNICK

Yeah, in more ways than a lot of people think. So We're still doing some digging into the differences between the main active ingredients and their concentrations. Obviously, there's a lot of discussion around fluoride and its implementation in toothpaste, but there are alternatives. So nanohydroxyapetite is a relatively new ingredient in toothpaste. It is shown to be as effective, if not more effective than fluoride. But everything from the harshness of the paste itself, so the abrasiveness, we find that toothpaste that are more abrasive, so you can imagine like sandpaper. The more abrasive it is, the more rough the toothpaste is, it can It can disrupt your gums. It can lead to inflammation, it can obviously introduce cuts at the gum line. We do find that a lot of your traditional toothpaste tend to have higher abrasion because they're more focused on giving people that curly white smile. You're literally just standing down your teeth when you use the toothpaste. Then there's obviously less abrasive toothpaste with more of these novel ingredients. We're finding that those are really effective in driving the beneficial oral health outcomes that we're really looking for. Mitigating our risk for caries, not harming our gums, obviously walking away with fresh breath.

[00:35:27.480] - DANNY GRANNICK

There's still more research, but what has been introduced has been super exciting to see. And in terms of the spectrum, I would definitely go towards Dave's.

[00:35:36.390] - KAYLA BARNES-LENTZ

Yeah, I agree. That's what I use as David's. What type of toothpaste do you use?

[00:35:42.740] - DANNY GRANNICK

So I have been testing out a toothpaste, actually. It's called FIG. It was produced by Dr. Mark Burhena. He's a key opinion leader in functional oral health and care. Fig is short for feed your good guys. So obviously, a lot of thought went into in terms of its interaction with the oral microbiome, and it's been great so far. The team put a ton of work into trying to mimic a lot of the characteristics of saliva actually in the toothpaste. So it's not this traditional I don't even know if toothpaste is the right word for it. It's almost more of like a gel. But top quality ingredients, they use nanohydroxyapetite specifically, and it's been fantastic. I've also used biocydin, and that's been great. So I've been fortunate to get to work my way through a bunch of different toothpaste, but those are the two that I've been using the latest.

[00:36:42.830] - KAYLA BARNES-LENTZ

Yeah, I've used the biocydin one before, too. I mean, biocidin is something that we use very commonly in our practice, the drops for managing gut dysbiosis. So I was really excited when I saw that they had a toothpaste, so definitely had to experiment with that. Well, this has been amazing, and I really appreciate your time. I'll make sure to include a link to the Bristle test. I think you guys are going to get me a code, and I'll include all that in the show notes.

[00:37:12.240] - DANNY GRANNICK

Sounds good. I'll send over a couple of the blog articles that we discussed in the podcast. Perfect.

[00:37:19.020] - KAYLA BARNES-LENTZ

That sounds amazing. Well, thanks so much for being here.

[00:37:21.990] - DANNY GRANNICK

Yeah, thanks for having us.

[00:37:23.660] - KAYLA BARNES-LENTZ

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