Launch HN: Bristle (YC W21) – At-home microbiome test to improve oral health
Hi Hacker News! We’re Danny, Shivam, David, and Brian from Bristle https://www.bristlehealth.com/. We’re developing an at-home saliva test to detect the earliest signs of cavities and gum disease - then provide evidence-based recommendations and treatments to help prevent them.

Cavities and gum disease are driven by infectious microbes, but today’s dental care only detects the damage they already caused. X-rays and observational screenings detect tooth decay and bleeding gums, which are symptoms, not causes. By the time they are detected, they’ve often become serious issues that require the invasive procedures we all dread - fillings and root canals. We end up spending billions of dollars reactively treating diseases that can largely be prevented with good oral health management.

About us:
Our backgrounds are on the research and commercial side of genomics. We have witnessed the rapid adoption and implementation of new technologies in healthcare enable remote monitoring of symptoms, early detection of disease, virtual care delivery, and new generations of therapeutics. Meanwhile, we have people like my co-founder Brian, who constantly face cavities despite great oral hygiene (good job, Brian) and get the same advice as everyone else.

Technologies like genomic sequencing and wearables are being applied to important areas in healthcare including oncology, rare disease, and NIPT - but aren't being used for the ones (literally) right beneath our nose. A lot of oral diseases start and progress from a build-up of specific acid-releasing or disease-causing bacteria. Working in genomics, we knew the technology existed to detect these pathogenic microbes at the earliest stages, when they were most treatable.

About our test:
Like other DNA tests (think Color Genomics, Ancestry, etc.), our test can be taken from home and only requires a saliva sample. Unlike most DNA tests that look at your personal genome (the collection of your genes), we analyze the oral microbiome: the community of microbes (bacteria, fungi, and viruses) living in your mouth. Imbalance between pathogenic and beneficial microbes can contribute to your risk of oral disease or signal systemic conditions. Decades of research have shown causal relationships between the oral microbiome and preventable gum disease.

Most microbiome companies use a method called 16s, which only provides the identification and relative abundance of bacteria at low resolution (often only genus-level). We use shotgun metagenomics to identify and quantify all of the microbes in your mouth including viruses, bacteria (over 150 on average), and fungi. Our test sequences the whole genome of the microbes providing information like functional profiling and higher resolution at the strain-level. This means higher sensitivity and specificity while providing the kind of data needed to develop better oral care products and therapeutics in the future.

Oral health tends to be overlooked, but is an important component of overall health with deep connections to the rest of the body. Research has been unveiling links between oral health and the risk or presence of systemic diseases, including diabetes, heart disease, and Alzheimer’s (I'll include some links about this below). One of the more exciting things we'll be able to do as we grow our database is look for oral microbiome signatures related to other diseases. Such analysis will only be done on de-identified data, and only go towards the goal of improving health.

Our assay will inevitably pick up some of your genome - it’s impossible to completely avoid. But our analysis only looks at the microbes from your sample and we filter out human genome data from downstream analysis. There are some interesting genomic markers we eventually would like to investigate (read about some here: https://www.ada.org/en/member-center/oral-health-topics/gene...) but for now we only look at microbial data and will obtain consent before analyzing anything else.

About our projects:
We are currently running a clinical research study with a leading dental school clinic, and will be bringing the test through clinical validation over the coming months. In the meantime, we’re offering a research version of our test to consumers through an early access program. This program provides an exploratory (non-diagnostic) lens into your oral microbiome, including information on your unique oral microbiome profile and how it relates to health conditions based on current research. The test is $50, but we won’t charge until you’re accepted off the waitlist and we are ready to send your kit. Right now we only ship in the US. If you’re outside of the US you can register at the bottom of our homepage to stay updated with our newsletter and be notified as we expand. https://www.bristlehealth.com/pages/early-access

Privacy is obviously a critical component of all this, and a top priority for us. We are determined to get it right from the ground up. Although we are not a HIPAA covered entity, we maintain a HIPAA compliant infrastructure. In the future, we believe that companies like ours may fall under a HIPAA designation. Operating that way today is our way of preparing for this. Most importantly, it protects your data. We will publish our data protection protocols on our website soon.

We believe we have a real opportunity to change the standard of care in oral health. We hope to expand access to patients and users, and give providers a new tool to help treat disease. We look forward to your feedback and questions - so please reach out or leave us a comment!

Thanks everyone,
Danny, Brian, Shivam & David