Danny Grannick of Bristle Health

Angel MD Pitch Club, with Dr. Ed Zuckerberg DDS
15 minutes

Episode Transcript

Dr. Ed Zuckerberg, DDS:

Okay. Hi, I'm Dr. Edward Zuckerberg, and I've got Danny Grannick of Bristle Health with me today. Bristle Health is in the salivary analytic space, and they've got an interesting product. I'll invite Danny to tell us a little more about what you guys are doing.


Danny Grannick:

All right, thank you, Dr. Zuckerberg. Yeah, so for a brief introduction to Bristle, so, at Bristle, we are developing a digital health platform for oral care by providing patients with at home oral health testing and ongoing care with providers. To do this we analyze the oral microbiome and patient saliva samples, and that allows us to detect the earliest signs of cavities and gum disease. And then we can provide personalized recommendations and treatments to prevent them.


Dr. Ed Zuckerberg, DDS:

Cool. So, yeah, and what kind of things, if somebody does your salivary analytic kit, would they get back from you in a data report?


Danny Grannick:

Yeah, so the users that sign on to Bristle, they'll receive the saliva kit. We'll give them a quick questionnaire to understand various risk factors for oral disease, so dental questions, a couple medical questions. And they'll submit the sample, we'll it through the lab, and basically what we return is risk scores in the most general sense related to somebody's likelihood or the presence or absence of what we believe is a cavity or existing gum disease. And then they'll receive a series of recommendations depending on where they fall. So you can imagine that we can stratify our patients into those that are largely healthy and have good oral health status, and they'll receive recommendations around the best over-the-counter products to use like toothpaste and mouthwash, some hygiene recommendations, some insights into their oral microbiome, and contributing risk factors like existing medical conditions.


Danny Grannick:

And then we'll get a middle bucket, which is the early onset of disease or early detection of those pathogenic bacteria, and we'll deliver everything I said before. And we'll also make recommendations around anything from prescription medications that really exist today, but are largely underutilized, and we'll enable that patient to get the prescription as well as the medication delivered to their house. And in more severe cases or more ambiguous results, we will facilitate referrals, whether it's over a teledental platform or an in-person consultation with a dentist for that patient.


Dr. Ed Zuckerberg, DDS:

So, in the case of someone who does doesn't have a dentist, do you have some referral network you're building with dentists who you would partner with and steer people to a dentist who's familiar with the Bristle product?


Danny Grannick:

Yeah. So, as a company, we're really focused on preventive and proactive care, and I think that this is largely recognized in the medical field. It's a bit earlier in the dental field and we're currently building out a network of dentists that are actively promoting preventive dental care. It's an unfortunate mixture of dental school debt, the debt of a private practice, and a fee for service care model that I think has slowed the progression of value-based care in oral health, but we're seeing accelerated efforts there. It's really exciting.


Dr. Ed Zuckerberg, DDS:

And, and how technical do these reports get that people get? Will they see the actual makeup of their oral microbiome with specific bugs listed? How much detail do you go into?


Danny Grannick:

Yeah, so, as a company, one of our principles is trying to democratize our access to care, and I think when we design products, one of the things that we thought about was how technical we wanted the results to be. We want to enable patients to really understand the drivers of their disease, but we don't want to overload them with information that they can't act on or can't interpret. And I think that has been something that a lot of other genomic tests have thrown at patients, and it limits a patient's ability to make treatment decisions. So, we are leading with a very distilled overview answering the question of, "Am I healthier? Am I not? And, if I'm not healthy, what can I do about it?" So, boiling down complex microbiome data into a simple risk score, and then we're providing avenues for patients to dive deeper into their microbiome and understand at an individual species or strain level, what is contributing to their disease and how those microbes are contributing.


Dr. Ed Zuckerberg, DDS:

Interesting. So, you mentioned that you actually can deliver some prescription antimicrobials to the patient. Is there a team on staff who will be ordering prescription drugs and verifying need and things like that without doing an exam on a patient?


Danny Grannick:

Yeah, so I think one of the other very important considerations in our workflow is we are looking to democratize a standard of care, and I think part of that is making sure that dentists and oral care providers play an integral role in our workflow and build relationships with our patients. So, we have dentists involved all the way from reviewing and approving the results on the tests that we provide back to the patient before the patient receives them to facilitating prescriptions and treatment planning with our patients, either asynchronously via email or messaging, or over synchronous communication, like a teledental video. Of course, a patient can choose to print out their report and bring it to their own provider and work on a more personalized treatment plan if they want.


Dr. Ed Zuckerberg, DDS:

So, obviously there are other companies that are dabbling in salivary analysis, so how is your solution... What features jump out that makes your solution a better solution than what else is out there on the market?


Danny Grannick:

Yeah, I think a lot of the existing solutions, I can start with maybe other salivary diagnostic tests applied to oral health. I think one of the biggest differences that we have is the idea of going direct to patient. A lot of other tests in other companies have really limited the use of their test to dental clinics, and I think that this has created a barrier for a lot of patients who don't have access to a provider to get answers about their oral health and actionable insights that they can take to improve health status. Over 80 million US adults, it's estimated, avoid dental care or checkups every year because of inconvenience and anxiety. So, the idea that these advanced technologies in this more proactive and preventive standard of care is only available through dental clinics is severely limiting to the patients that either physically or financially can't get access to those clinics or those that have access, but choose not to go because they find it uncomfortable or inconvenient.


Danny Grannick:

And then I think we can also look at other companies in the dental space. So, there's been a rise in companies that are using AI to analyze radiographs. This has been super exciting for us to see. I mean, I think it is really shifting the level of care that you can get in the clinics. Again, it's very limited to the dental clinic itself. And I think the other major difference is, with our tests, we're analyzing the microbial drivers of disease, and in many case says we can detect disease before symptoms like tooth decay or increased pocket depth have manifested. These AI companies looking at radiographs have optimized an existing technology, but the existing technology still looks for existing symptoms like tooth decay, so we're trying to get ahead of that.


Dr. Ed Zuckerberg, DDS:

Right. Cool. Okay. Is there specific data and research that supports your solution to this problem?


Danny Grannick:

Yeah. So, for us, it was really exciting to see the existing amount of studies and research that's been done on the connection between pathogenic bacteria and oral disease. One of the problems that we saw with the existing research and data was that it largely leveraged tools that are very narrow in scope. Things like qPCR in 16S that look at either a predetermined set of pathogenic bacterial drivers, or get a very narrow understanding of what bacteria makeup, a disease signature. So one of the first things that we optimized was our workflow which uses a method called shotgun metagenomics, and we sequence the entire genome of all of the microbes in a sample. And this gives us incredible resolution on the identity of the microbes that are contributing to disease all the way down to the strain level. And it also gives us a lot of contextual information and community level information on the functional drivers of disease, so we can understand oral disease at a deeper level than existing research, even though it gave us a really good foundation to build off of.


Danny Grannick:

The other thing that we did once we developed our assay was partner with a dental school in San Francisco, and we've been profiling nearly every patient that walks into the clinic, and we will match the oral microbiome profile that we generate with the patient's diagnosis in the clinic from that day. And we've also been assessing their electronic health records to look at things like medical risk factors, the existing dental history behind these patients, just to understand and optimize our assay accordingly.


Dr. Ed Zuckerberg, DDS:

Neat. That's neat. Yeah, data accumulation is great. So, obviously you've chosen the B2C solution to enable you to reach patients who might not have access to care, but is there also a component of Bristle now, or that you see in the future, where you would partner with dental offices who might institute a program whereby patients would take home a product or maybe just have the dentist directly refer them to Bristle Health? And do you see this as a service that patients would use repetitively or is it more of like a one shot deal?


Danny Grannick:

Yeah. So, on the B2B side, it's something that we are actively building into our product now and in one flavor, and I think that we're looking to expand in the future. The reason why we chose D2C, and I touched on this a bit earlier, but I think right now, there is a large amount of patients that either don't have access to a standard of care for oral health or choose not to opt into it because of the existing standard of care and the experience that those patients have when they do go. And our goal as a company was to make sure that people could get insights and actionable recommendations around our oral health without having to access the existing standard of care, which is what led us ultimately to going to go D2C initially.


Danny Grannick:

But we also don't want to get in the way of existing patient provider relationships. Our tools, I think, at the core are trying to enable a more personalized and preventive standard of dental care. And, for us, that not only means delivering a standard of care to patients that don't have one right now, but it also means that we can make our tools accessible to the existing standard of care so that providers can elevate the level of care they provide and deepen the relationship that they have with their patients. So, we're enabling patients to take their reports to their providers to work on personalized care plans, to share with providers. And we're also building in tools for providers to be able to order directly from Bristle and facilitate that testing through their clinics.


Danny Grannick:

In the future, we are certainly looking to expand. I think one of the exciting things about our company is that we are establishing and progressing a lot of associations between oral and systemic health. And we also see Bristle as an amazing tool that not only dental clinics can use, but also primary care or chronic disease clinics to provide another data point and another insight to get really a 360 degree view around their patients and progress this idea of integrating dental and medical care.


Dr. Ed Zuckerberg, DDS:

Great. So, I mean, there's definitely an exploding field.


Dr. Ed Zuckerberg, DDS:

Where are you at now in terms of product development? Bristle is ready for consumers to purchase now and have tests at home. Are you fully ramped up? Are you building out this slowly? Are there new products in the pipeline? How is this evolving?


Danny Grannick:

Yeah, so we are targeting a launch date from mid-August. We're heavy in product development right now, putting the final touches on the patient experience and the provider experience. But we expect to have an end to end solution on the market, at the latest, by the end of August. And that product will, again, really focus on oral health and risk for cavities and gum disease along with personalized recommendations and treatments to prevent them.


Danny Grannick:

That said, the oral microbiome is a relatively unexplored field, and we're building one of the most comprehensive databases in the world around it. There's going to be immense opportunity to expand the kinds of insights that we can deliver to patients and providers expanding, we think, beyond just oral health, starting to investigate how the oral microbiome and how oral health status reflects changes in overall health as well. So, we can expect new insights detailing anything from novel discoveries in the oral microbiome and the understanding kind of an entertainment level and the education level how it relates to your health status and risk for disease as well as more clinical insights relating to how oral health or oral disease may be a risk factor or an indication for something else that's going wrong in your body.


Dr. Ed Zuckerberg, DDS:

Great. Sounds really exciting. I'm looking forward to watching your progress. I guess people can find out more at bristlehealth.com. It's been great having you on today.


Danny Grannick:

Yeah. Thank you, Dr. Zuckerberg. I really appreciate it.