We're the founders of an oral microbiome testing company, here to answer your questions on the oral microbiome, its role in oral and chronic disease, and anything oral health or microbiome. Ask us anything!

What else are you going to do with the data? Will it be made available to law enforcement? Other researchers? Commercial development? Insurance companies?

If you are in the US, what measures will you take to prevent this data from being used by insurance companies to restrict access to medical services (under the guise of "pre-existing conditions")?

(This is my best answer without getting our very expensive lawyer responding on Reddit)

Data privacy is a top priority for us. We give you choices to control how your personal information is used, stored, or shared. We will never share your data without your consent, and will only ever do so in the name of advancing oral health research or your request.

We will use the data to advance research on the oral microbiome and oral health. This includes measuring how different interventions (oral care products, diet, etc.) impact the oral microbiome at the species level, so we can give personalized insights into how to promote good bacteria while eliminating just the bad - and ultimately developing more targeted and effective therapies/treatments. We also use aggregate, de-ID'd data for uncovering new biomarkers from the oral microbiome, which turn into new features for our users.

You own your personal data and control access to your results, so we can't "sell it" to companies. Insurance companies don't reimburse for our test which means we have no conflicting duties to provide them with your data (and can't anyway without your consent). In the future, I can imagine insurance companies being interested in accessing your data for better ("You have great oral health! Here's a lower premium.") or for worse ("You haven't been taking care of your oral health, and your rates may increase."). Honestly, we've barely scratched the surface with insurance given how novel our test is and how overlooked oral health has been. Ultimately, there are laws protecting your genomic data from being used by insurers to change your rates and I would assume something similar for our test - so you would (ideally) only benefit by getting rewarded for improving.

You can learn more about the steps we take for ensuring your privacy on our site. Let us know if you have any questions!

- Danny

What affect does mouthwash have on the oral microbiome?

This really depends on the type of mouthwash. Many of them non-specifically kill microbes and reduce the overall microbial load in the mouth. This slash and burn approach that we’ve generally used for decades has a generally negative effect on the oral microbiome and came about before we had a better understanding of how the existing microbiome is important for preventing disease. In one example,a study showed that chlorhexidine mouthwash can result in relatively dramatic (and negative) shifts in the community. Depending on what is currently in your oral microbiome, the slash-and-burn approach might be beneficial for you, but possibly detrimental as well.

Thanks. Do you have any recommendations for fresh smelling breath that won't wreck our biome?

Studies have found tongue scraping and certain mouthwashes (those containing cetylpyridinium chloride, and sodium chlorite) may reduce the levels of these species without harming the beneficial microbes.

Shameless plug: Our test can give you a breakdown of the levels of sulfur compound-producing bacteria in your mouth to see if they are the cause of bad breath!

This is quite interesting, I had similar advice warning me to limit my use of chlorhexidine wash for a sweat issue I suspected was due to a bacterial overpopulation.

Their reasoning was similar - it would be impacting my entire microbial population, including the good bacteria which are meant/need to be there.

It's crazy how vital something so tiny can be to the homeostasis of the body.

Definitely! Really cool to think about how we co-evolved. Here's my favorite video on it.

That was awesome, thank you for sharing!

My favourite class in a recent course was literally microbiology. Even at such a basic level I found it gave me so much insight into the symbiotic relationships we have with bacteria, and even helped me understand a few areas of my own health that are out of balance and why/how I can fix it.

My dream goal is to get a career in a neuropathology lab because of exactly this. So much we don't know about yet, and so much that could change the world!

Glad you liked it! Definitely - so much more for us to learn and explore :) Best of luck with the neuropathology career, I have no doubts you'll get there.

How does kissing someone impact each other's oral microbiome?

Great question! Intimate kissing (unfortunately) has been shown to impact the oral microbiome. Partners have been found to have more similar oral microbiomes than non-relatives. In a study of 21 couples, an intimate kiss did not lead to a significant additional increase of the average similarity of the oral microbiota between partners. However, clear correlations were observed between the similarity indices of the salivary microbiota of couples and self-reported kiss frequencies, and the reported time passed after the latest kiss. Bacteria transferred include those that have been shown to cause cavities and gum disease - so make sure your partner is brushing and flossing 😊

Probably should have done this AMA before Valentine's Day... my bad.
Source: [https://microbiomejournal.biomedcentral.com/articles/10.1186/2049-2618-2-41\]([https://microbiomejournal.biomedcentral.com/articles/10.1186/2049-2618-2-41](https://microbiomejournal.biomedcentral.com/articles/10.1186/2049-2618-2-41))

- Danny

Might the similarity in couples' biomes be connected to the couples similar eating habits as in often eating the same food (especially the ones living together)?

It's a great point! Diet likely accounts for some degree of the similarity. In the referenced study, though "by far most pronounced similarity for communities associated with the tongue surface" - which for the purpose of the study likely was explained by kissing frequency.

How big of an impact do tonsils have on your oral microbiome? Do they help or hinder the development of healthy flora?

Similarly how dangerous are tonsil stones to your oral health?

Great question! A few studies have attempted to address this relationship. However, I believe the jury is still out on how tonsils affect the microbiome, and vice versa. There is certainly a relationship between tonsils and the microbiome, but what that is exactly is unclear. Sorry for the unsatisfactory response! Maybe we'll launch a study to investigate this more directly!

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5774679/

https://journals.asm.org/doi/10.1128/mSystems.01302-20

https://bmcoralhealth.biomedcentral.com/articles/10.1186/s12903-019-0956-5

https://www.nature.com/articles/s12276-020-00487-6

I get canker sores a lot. Less now that I'm an adult, but if I bite my cheek, it's pretty much a given. Any ideas why? There's not enough research on it and it drives me nuts.

Some studies have pointed to a correlation between specific oral pathogens and titers of HSV-1 (causative agent of cold sores). Any number of molecules (including those released via inflammation) may be involved in reactivation of latent viruses such as HSV-1, which can result in the presentation of a cold sore.

At Bristle we haven't specifically looked into changes in the oral microbiome prior to or during canker sores, but I believe it would reveal some interesting findings that may help reduce those triggers.

https://pubmed.ncbi.nlm.nih.gov/23611298/

https://pubmed.ncbi.nlm.nih.gov/17804655/

Doing some original research into canker (not cold) sores could be both intellectually and financially stimulating for Bristle - as the OP said, so little research into potential causative or exacerbating effects of canker sores is out there. Being able to advertise that you could help get to the bottom of canker sore sufferers' woes would be huge - you'd have me as a customer, for example! I think I speak for a lot of canker sore-ees when I say that we've tried a LOT of random folk remedies and over the counter relief methods (fellow sufferers, look up Kanka, a combo cyanoacrylate and benzocaine product - like a liquid bandage for the mouth!) and something with some real science behind it could be a god-send.

Definitely! Based on the feedback from this AMA we already have our R&D team looking into how we can make this possible. I'll hopefully have an update for you in the near future :)

You open the door to curing canker sores and I will bathe your feet with my tears and dry them with my hair.

Can't wait!

Is oral microbiome related to gut microbiome?

Are there ways to improve oral flora, similar to how eating fermented foods can help diversify gut flora?

Yes! The oral microbiome is closely linked to the gut microbiome. Some studies have shown associations between IBD, Crohn's disease, and even colorectal cancer with bacteria in the oral microbiome. Here are two recent reviews on the oral-gut axis.

https://pubmed.ncbi.nlm.nih.gov/33924899/

https://www.frontiersin.org/articles/10.3389/fimmu.2021.620124/full

And are there any “good” microbes in the oral micro biome like there is in the gut flora?

Yes, there are indeed "good" microbes in your oral microbiome that prevent pathogenic microbes from invading the space. Their abundance is strongly associated with good oral health and similar to gut microbes and gut health.

On OP’s point- is there a way to promote the good bacteria? And do traditional mouthwashes with alcohol/hydrogen peroxide hurt the good part of the microbiome?

Yes, indeed there are ways to promote the growth of good bacteria including changes to diet, lifestyle, and taking some products. Yes, traditional mouthwashes have been shown to indiscriminately kill "good" microbes and "bad" microbes alike. There are a few oral probiotics on the market that may have some clinical efficacy, but this depends on your existing oral microbiome, as more of a good thing doesn't necessarily make it better.

How does eating blue moldy cheese effects? Are these molds considered good?

Some molds can potentially be beneficial to the oral microbiome but like anything else, it depends on what kind of mold we're talking about. What you might be referring to is some research showing that eating cheese can reduce risk for cavities. Cheese includes a few proteins - namely casein - that help reduce enamel demineralization. It's also thought the increased salivary flow from eating cheese helps keep your teeth clean.

I'd stay away from old moldy cheese though tbh... or eat a bunch then take our test :)

- Danny

All I hear is I can eat more cheese, I am soooooo excited

Eat more cheese! Just exercise too

- Danny

How do things like teeth-whitening strips, charcoal toothpaste, and other whitening products have an effect on the oral microbiome?

Lots of products touted as "beneficial" aren't. We often mistake good oral health for being a bright smile, minty breath, and straight teeth. Many whitening products are great for aesthetics but wreak havoc on your oral microbiome and can cause a variety of oral conditions down the road.

- Danny

Do you provide actionable insights and make recommendations? What percentage of your findings end in “talk to your doctor?”

We do! Our recommendations include ingredients/products, diet, lifestyle, and hygiene recommendations to improve oral health.

Not many of our findings end with "talk to a doctor." I think this has been a huge problem with at-home testing - not having an effective way to close the loop on behalf of the patient. While we encourage our users to share & discuss their results, our primary focus is providing insights and actionable recommendations to improve oral health directly to our users.

Some of our users have existing & severe oral disease, in which case they are already working with a provider (usually). There's clear value in understanding the oral microbiome and oral health status as a monitoring tool. Other users are fine and just want insights into their oral health, or have early symptoms and want to know what's going on. Our goal is to help people manage their oral health and prevent disease, so ending our report with "talk to a doctor" wouldn't be super impactful and I doubt people would act on it.

A couple of other pieces:

The oral microbiome is still in the earliest stages of being adopted to the standard of care, so it's likely that a provider wouldn't get much further than you (our results are easy to understand). Additionally, only 50% of US adults even see a dentist every year, so referring folks to a dentist as the only next step doesn't really help if they never go anyway.

Our focus is helping our users understand and improve their oral health on their terms - whether that's with or without a provider. Of course, we do encourage everyone see their dentist & physician regularly regardless :)

- Danny

Followup question: Do you make recommendations for prescription or OTC products, and if so, do you provide for this and manage medication interactions?

Most of our recommendations will be for OTC products. We do not sell any ourselves, but instead, link out to some products that contain the ingredients we recommend and come well recommended by the dental provider community. For medication interactions, we encourage users to consult with their physician to see if there are any concerns.

I'm a cancer patient on chemotherapy that tends to give me oral thrush for periods during my treatment. I have taken fluconozole for this, but I'm wondering if you have any suggestions on ways to keep infections like thrush down that aren't this one single medication. What foods or supplements do you recommend to maintain a healthy oral biome in this situation?

I'm sorry you have to deal with this issue. I'd recommend discussing this with your physician, but one resource is Side Effect Support, which was created by a hygienist (and great person) after watching her mom deal with the oral side effects of chemo. Wishing you all the best <3

-Brian

Microbiome testing companies have a shady past. What are you doing to ensure you're following the science and not the marketing and pop science?

A core value of ours is to let the science and literature be our guide. The oral care space (like much of healthcare) is filled with products claiming benefits but not being backed up by evidence. We created Bristle as a way to measure the impact of these products and other interventions (diet, lifestyle) so patients can make more informed decisions for their health. We believe transparency is one of the biggest ways we can help our users. We don’t have all of the answers, as the data is still sparse, but our goal is to equip users with information on what we do know so they can find what works best for them. I’m someone who has suffered from oral disease my whole life (too many cavities to count) and I’m determined to help build the future where others won’t have to.

-Brian

Hi! First time caller, long time listener. What that mouth do?

Test and find out ☺️

Take our test and find out ;)

What exactly causes halitosis? What creates the awful smell?

There are a few different categories of halitosis. However, 90% of halitosis cases come from intra-oral halitosis, which is caused by the production of volatile sulfur compounds (VSCs). VSCs are the same compounds released by rotten eggs that give them their distinct odor. Bacteria in your mouth are capable of producing VSCs. Bacteria that coat your tongue and reside at your gum line have been shown to produce VSCs.

You can use Bristle to find out which of these microbes is in your mouth and how you can address them.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7342603/

Halitosis is primarily driven by bacteria in your mouth that produce sulfur-containing compounds (VSCs) - which is the "stinky" part of bad breath. These bacteria feed off of a variety of foods and most are related to gum disease - so bad breath can be an early sign of gingivitis or worse.

- Danny

Are you guys doing 16s or shotgun? Technical bias could potentially be introduced just by having different library prep methods (ligation vs tagmentation have their own gc biases) or even different collection methods (swabs, saliva, etc). Do you guys observe that? Are you guys classifying to known bacteria or are you also going to try to look at unknown things?

Great questions, we use shotgun for improved resolution over 16s. We attempt to relieve some of the technical bias through automation. I won't go into details about our library prep method, but I can say we've done extensive testing to demonstrate consistent detection (of specific microbes) across samples (and time). We are focused on saliva for a number of reasons, one of them being consistency. We find it difficult to get a comprehensive view of an oral microbiome using a swab, which would rely on users swabbing an area and not contaminating it with skin or other microbiome.

The challenge of the unknown is that much of the nucleic acid in saliva has no matching reference genome, so its annotation is nearly impossible. However, we do work on the "known unknown" which is things that are mappable but also distinct from reference genomes, which gives Bristle a unique metagenomic database to work from.

Why do some people who take very poor care of their teeth have zero cavities, while others who are extremely vigilant have major problems? Is it genetics? Luck? Is it related to the microbiome?

Great question! This phenomenon was actually one of the reasons we created Bristle. I have too many cavities to count despite doing my best hygiene and was told I have "bad teeth", which was an insufficient explanation in my opinion. There are a number of factors that influence cavities, such as genetics (enamel strength, sugar metabolism), diet, dry mouth/mouth breathing at night, and teeth grinding - but the oral microbiome can play a major role. In testing mine, I found I have a higher abundance of cavity-causing bacteria, so I've started chewing xylitol gum and taking other steps to reduce them! We have more information in our blog here: Are some people more prone to cavities?

-Brian

YYAAAAAAYY! I started chewing xylitol gum for the same reasons! I'm sooooo happy that I'm not a quack for engaging in this for my oral health...

I try to chew 2-3 pieces a day, between meals.

So is it true that xylitol gum affects the bad microbes and leaves the good?

Not a quack, and great on you for taking action! That is what the preliminary research seems to indicate. My only word of caution would be not to overdo it on xylitol, as it can cause some GI distress.

-Brian

can you compare the gut microbiome to the oral? What is orals importance comparably?

The gut and oral microbiomes are linked. Bacteria in the mouth can influence your gut, and have a major impact on inflammation. I've added a few papers below discussing the oral-gut axis. Oral microbes related to gum disease are also implicated in gut disease.

https://www.frontiersin.org/articles/10.3389/fimmu.2021.620124/full

https://pubmed.ncbi.nlm.nih.gov/34710061/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8125773/

What current flaw in oral microbiome needs to be changed?

I think the biggest flaw is that the oral microbiome isn't addressed as a component of oral health/dental care! Decades of research have established causal links between bacteria in our mouths a some of the most prevalent oral diseases on the planet including cavities & gum disease. We have the tools to measure the oral microbiome but it hasn't been adopted as part of the standard of care.

There are some barriers here - misaligned incentives between stakeholders, education for providers & patients, etc. but they are all solvable problems that we're tackling at Bristle.

If we can get everyone leveraging the oral microbiome as a standard of care we will see improved outcomes - the lift is spreading awareness & education about the oral microbiome and creating a model that incentivizes using it.

Broadly wrt microbiome testing - companies tend to use outdated methods like qPCR or 16s that miss a lot of important information contained in your microbiome. More companies should invest in better technology for their tests!

- Danny

One more thing: Nearly half of US adults have a form of gum disease and over 90% have cavities, and both are largely driven by an imbalance of the oral microbiome. Additionally, research has been unveiling links between oral health and the risk or presence of systemic diseases, including diabetes, heart disease, and Alzheimer’s. One of the more exciting things we'll be able to do as we grow our database is looking for oral microbiome signatures related to other diseases, in hopes of discovering more effective therapies and interventions.

Can you talk about fluoride? Is it bad for our oral microbiome? What is a good alternative?

Research has found fluoride prevents and treats dental cavities by promoting favorable remineralization of the tooth enamel while concomitantly impairing bacterial metabolism. Research into the drawbacks of excessive fluoride is still ongoing, so we encourage users to decide what makes the most sense for them. A great alternative is nano-hydroxyapetite, which has shown similar benefits to fluoride. Another ingredient to consider is Xylitol, which has shown some promise in reducing the levels of cavity-causing species.

How much does your own genetics actually effect your propensity to develop mouth diseases like periodontal disease, tooth decay, bad mouth biome, etc?

Obviously you can help yourself by properly taking care of your mouth, but I have heard dentists, orthodontists, and oral surgeons say that genetics are more against you than most preventative measures, so how much of that is bunk?

Studies have found that genetics can play a role in the propensity to oral conditions, particularly in factors like your immune response to infection, sugar metabolism, and dental enamel. I was told I have genetically bad teeth, so I'm quite familiar :)

Our hope is that by better understanding the oral microbiome we can better understand these propensities, and develop more effective care plans based on each individual's oral microbiome/health.

We cover this a bit more in our blogs on Are some people more prone to cavities? and Is gum disease contagious?

Can bad oral health influence mental wellbeing?

The comments here sum it up - oral health can influence mental well-being on the psychological and physiological level.

We put way too much emphasis on white, straight teeth and not enough on good oral health. Unfortunately, lots of people become embarrassed by their mouths and lose the confidence to express themselves. It's tragic. Sometimes it's just bad breath, other times it's severe oral disease that goes untreated because people can't get the care they need.

There are also some interesting studies associating oral health with mental health - connections have been made between oral health & headaches + cognitive decline + depression.

- Danny

Absolutely! The oral microbiome (and oral disease) has been implicated in a number of neurological disorders. The most well known example of this is the relationship between periodontal disease and Alzheimer's disease. https://pubmed.ncbi.nlm.nih.gov/32280099/. Strikingly, antigens from periodontal pathogens can be found in the brains of patients with Alzheimer's disease. https://pubmed.ncbi.nlm.nih.gov/34720846/

Additionally, migraines are associated with the oral microbiome (which is in part responsible for nitrate reduction, an important regulator of vasodilation).

The oral microbiome (similar to the gut microbiome decades ago) likely plays a role beyond what we know so far, and can impact cognitive functions in ways we don't yet understand.

Is the oral microbiome similar to our sinus microbiome, as they're touching? Will you branch out if successful into testing sinus or gut microbiomes?

The oral microbiome is itself already incredibly diverse, with bacteria that colonize your tongue being different from those on the roof of your mouth or those on your gums. This means that each niche is unique by comparison to the sinus microbiome.

We are focused on the oral microbiome because it is accessible, can be modulated, and most importantly, changes to the oral microbiome may prevent the onset of irreversible disease. For example, for decades we've known about bacteria in the mouth that cause expensive and irreversible periodontal disease, and by addressing these microbes we can prevent disease from happening.

Is there any research into the effects on the oral microbiome from yeasty alcoholic drinks like beer vs spirits?

I'd guess that spirits kill large amounts of your microbiome whereas beer might add to it

We haven't compared the differences between alcoholic drinks, but a study from NYU found that "compared to nondrinkers, men and women who had one or more alcoholic drinks per day had an overabundance of oral bacteria linked to gum disease, some cancers, and heart disease. By contrast, drinkers had fewer bacteria known to check the growth of other, harmful germs."

Thank you for hosting this chat.

I have Sjogrens and am obviously concerned about how it affects my dental health, body, etc. Its not a well known disease, so there doesn't seem to be a lot of options for us. I have horrible dry mouth, lose my voice quite often and am basically told - drink plenty of water, take your MTX, HCQ and Pilocarpine when Flaring.

Will there be a time when oral biome research goes beyond just informing us we have a low level of microbiota as our dry mouth is inhospitable?

Thank you for your question and I’m sorry to hear about your issues with Sjogrens. We have a lot of users in the same boat and I agree that Sjorgen’s does not get the attention it needs.
In some ways, our test is already beyond just telling you that you have a “low level of bacteria.” We will report all of the species of bacteria in your oral microbiome and their relative abundance (the amount of each). Some of these bacteria are pathogenic and related to disease, while others are beneficial to oral health. In this sense, we can already provide insights beyond the bacterial levels - giving you the actual makeup of your oral microbiome and how those microbes are related to various conditions. Dry mouth is a common symptom of Sjorgens, but it's also relevant to know whether it is actually increasing the abundance of bacteria related to cavities. If it's not, then it's hopefully one less thing you have to worry about.
As we build our database, we will get to the point where we can measure how different interventions (oral care products, diet, etc.) impact the oral microbiome at the species level, so we can give personalized insights into how to promote good bacteria while eliminating just the bad.
Additionally, we hope to uncover new biomarkers in the oral microbiome related to conditions outside of the mouth. Our mouths are gateways to our bodies - letting in potentially pathogenic bacteria that cause other issues - and mirrors of our health - with oral microbiome shifts signaling other issues that may be happening in your body.

- Danny

In healthcare- had a patient with Sjogrens. I don't know about how it affects oral health but I'm curious as to your symptoms. My patient had the rarest form with lung and cardiovascular issues. Would you be willing to share?

Certainly and thank you for asking, we appreciate when healthcare professionals take an interest in our rare diseases. <3

I have the stereotypical chronic dry eye. Feels like debris stuck in my eyes. Chronic dry mouth - I wake up with my tongue stuck to my teeth, despite waking up during the night to drink water. Speaking of, I drink 6 to 8 liters of water a day, so a nephrologist keeps an annual check on my kidneys to ensure they are handling things okay. Swallowing pills can be a real problem. Swallowing food can be a problem, too!

And I get these horrible throat spasms that feel like my voice box is being ripped out - a twisting, ripping sensation. It stops my breath and can cause me to grab on to things as I struggle to breathe through it. I'm told my face goes grey-white, lips blue, etc. It happens more frequently when my throat is dry - like during exercise or activity. I always used to wonder why my throat burned during exercise. Well, post-dx I know why. If it happens when I'm swallowing, which thankfully is REALLY rare - it can cause me to choke horribly.

Crushing fatigue is really par for the course, think flu-level fatigue during Flares. Painsomnia is common.

I spend a few days a week with my voice giving out. Sounds like I have laryngitis, honestly. Very rough, low timber voice that sounds like I'm getting a cold but I'm not. I cough a lot - a dry, itchy, unproductive cough particularly when I'm talking as my mouth dries out. I HATE talking on the phone because of this.

Sore joints, achiness, etc. Swollen glands are so typical for us. My skin is insanely dry, so I use a yogurt-style lotion and strangely, I do not create callouses, which means - I cannot grip things so I drop things a lot. My hand skin is so soft, things just slip out of my fingers. I wear textured compression gloves often to help with this.

I go through chapped lip products like crazy. My lips dry out all the time. I sometimes get breathing issues if I don't drink enough - it's so incredibly important to stay hydrated.

Fwiw, I do sleep with a cool mist humidifier. And my doctor prescribed a bi-pap machine to try to push MORE humidity into my system while sleeping. It helps, somewhat. I certainly feel it when I don't use it.

Then there's the strange loss of appetite that occurs somewhat chronically. I've lost 35 pounds since late October. I pretty much have to force myself to eat so I can take meds at this point.

Sjogren's is so much more than "body is dry, needs water".

Admittedly, it's often hard to separate what is from primary RA and secondary Sjogren's. Honestly, I don't really try to prescribe symptoms to one or the other, but RA tends to be pretty damn specific.

Hope this helps.

Thanks so much for sharing your story. I'm sorry you have to deal with these issues, but people like you sharing their stories will help raise awareness of the importance of Sjogren's - which is sorely needed. Wishing you all the best and hoping we can help advance the research <3

How can I as a vegan best take care of my teeth? I know that long term carbohydrate consumption can damage them and I'd like to keep my chompers!

Great question! Proper oral hygiene will be the most effective thing you can do to keep your chompers healthy. On the diet side, you are correct that carbohydrate/sugar consumption can lead to a harmful oral microbiome (more acidic). We cover beneficial foods more in-depth in our blog here, but to summarize:

• Chewing sugar-free or xylitol based gum can help stimulate saliva production, which is our body's best natural defense against harmful bacteria and acidity
• Vegetables high in fiber have been shown to stimulate saliva production and neutralize acid, both of which protect teeth from decay. They also tend to be high in vitamins A and C, which aid in rebuilding tooth enamel and helping gums heal quickly from wounds, respectively.
• High pH, alkaline veggies. Cruciferous vegetables like broccoli and cabbage, kale and arugula are especially good and have many other health benefits. Green leafy vegetables, from spinach to lettuce are also good for your teeth. Substitute cucumber slices for lemon to jazz up your water.
• Foods high in arginine. Arginine is a chemical building block known as an “amino acid.” Multiple studies have looked into its apparent ability to destabilize the plaque build-up on our teeth that harmful bacteria can hide in. More clinical studies are needed to establish the efficacy of arginine in reducing plaque buildup, but early signs are promising. Foods high in arginine content include peanuts, chickpeas, lentils, soybeans, pumpkin seeds, and poultry.

Ultimately the best way is to stay on top of your oral health, which our test can help with (sorry for the shameless plug)!

I find it a little bizarre that neither your comment nor your blog post talk about the benefits of xylitol consumption. Yes, chewing gum stimulates saliva production which is massively important, but xylitol itself is incredible at fighting bacterial biofilms (plaque), altering the microbiome, etc.

That is to say that I think someone reading your comment or blog post would walk away with the impression that xylitol is just a way to sweeten your gum without it actually being sugar. But the xylitol itself is very important for fighting plaque, maintaining a healthy microbiome, and remineralization.

Is there a reason your blog post doesn't go into that? Xylitol's one of the most miraculous oral health compounds we have (and has some GI benefits too but I digress)

Thanks for pointing this out. Our blog on xylitol itself does go into detail about the antimicrobial benefits of xylitol and you're right that it is quite exciting. Some people experience GI disturbances from xylitol consumption, though, so we would want to caution not to overdo it at first.

Would it be (at least theorethically) possible to make (or modify) some sort of bacteria to "add" to your oral biome, to outcompete the bacteria causing bad things, and not be bad for us themselves? Like a cooperation where we would feed them (by feeding ourselves) and they in exchange would protect our mouths?

Yep! The two things you're describing are bucketed into "probiotics" and "prebiotics"

Probiotics are beneficial bacteria. The intent is to introduce them to your oral microbiome so they can outcompete pathogenic bacteria residing in your mouth. We include recommendations around these as part of our results.

Prebiotics include foods or supplements you take that "feed" the probiotic bacteria to increase their relative abundance and therefore their beneficial effects.

You can also make changes that reduce the abundance of pathogenic bacteria. An easy example is reducing sugar intake if you have a lot of cavities-causing bacteria. These bacteria feed on sugar and produce acid as a byproduct, which decays the enamel on your tooth and eventually the tooth itself. By reducing sugar intake you restrict the "fuel" these bacteria need and can lower their levels over time.

Our mouths are home to plenty of beneficial bacteria. It's the imbalance of beneficial to pathogenic bacteria that drives oral disease!

- Danny

Do you have any new research on what chewing tobacco/snus does for the oral microbiome? Alot of scandinavians use snus daily, and there have been inconclusive studies on its negative effects. The studies may slow an increase in oral and esophageal malignancies (among others), but I read a while ago it might be positive for the flora. Any thoughts on this? Thanks!

Thanks for your question! We write about the effects of nicotine pouches here in our blog, here's an excerpt:

Some studies indicate that users of nicotine pouches have a noticeably increased gingival index, whereas other studies do not indicate any relationship between snuff use and gingivitis or gingival bleeding. What we do know, however, is that nicotine lowers blood flow and oxygen levels, which prevents the gums from healing and repairing themselves, ultimately ending in cell death. The nicotine contained in pouches will have this same effect on your gum health, even if it is delivered in a smokeless fashion.

We haven't researched snus specifically, but I hope this information is helpful!

Do you see a future where microbiome be used as a unique identifier of persons?

If so, how long can a sample be viable for and what methods could be used to preserve a record?

I personally don't see a situation where the microbiome is used for ID purposes - at least in the near term. The oral microbiome is a pretty dynamic environment to the point where it would be difficult to pair a profile with an individual, unlike something static like your DNA. There are so many things that can affect your oral microbiome profile - products, diet, hygiene, etc. It would be pretty easy to cause a shift in what your oral microbiome looks like.

That said, there have been some studies showing similarities in oral microbiome profiles between partners and parents/children - so it's possible to have something like a "familial" oral microbiome profile, but not to the extent you're describing.

- Danny

So when I take certain antibiotics, I get bad breath and general unfavorable mouth conditions. After dealing with that for a month, I realized my microbiome is all fuckered up, and decided I needed to borrow someone elses.

One wild night with a drunken makeout session later and my breath and mouth conditions are back to normal.

Did I wipe out my biome with the antibiotics and then rebuild it from someone else?

I've repeated this several times over the years. Is this...a thing?

It's possible! There are some studies showing that saliva swapping can induce oral microbiome changes between partners. Many commensal bacteria are opportunistic, so if you wiped out your oral microbiome and introduced beneficial ones it's plausible there would be a shift. You would just want to be careful not to get the wrong critters re-introduced!

Why are your hands so big?

You can ask my lawyer

- Danny

Does probiotic mouthwash and toothpaste help with bad breath? I've had issues with gut health that has affected my breath. Probiotics help (fermented foods and pills), so I'm wondering if probiotic oral products do too.

Studies have found tongue scraping and certain mouthwashes (those containing cetylpyridinium chloride, and sodium chlorite) may reduce the levels of these species without harming the beneficial microbes. We're still looking into probiotics, but Streptococcus salivarius strain K12 (usually just called K12) has some data supporting its use.

Glad to hear probiotics have worked for you!

Shameless plug: Our test can give you a breakdown of the levels of sulfur compound-producing bacteria in your mouth to see if they are the cause of bad breath!

What are some inexpensive solutions a person could use to mitigate the negative impacts of a high carb diet on their microbiome?

One inexpensive solution is to start chewing sugar-free or xylitol gum after you eat. This will help stimulate saliva production which can neutralize the pH in your mouth and wash away excess sugars. Xylitol has additional benefits of reducing cavity-causing bacteria.

Does Xylitol gum or toothpaste help improve the oral microbiome?

Copying an answer from above!

Xylitol works to kill cavity-causing bacteria by interfering with their energy production. It also promotes re-mineralization of teeth by increasing the flow of saliva when used as a sweetener in chewing gum.

https://pubmed.ncbi.nlm.nih.gov/10200706/

Your website states that only 50% of Americans regularly go to the dentist for check-ups. Are you trying to target that market or the market for those that don’t attend regular check-ups? If people already aren’t going for reactionary care, why would they purchase preventative care?

The top three reasons cited for not getting dental care are cost, inconvenience, and anxiety! People don't go because they don't care, they don't go because there are financial, physical, and mental barriers based on the (reactionary) standard of care today. Unfortunately, this avoidance results in the high prevalence of oral disease we see today, which end up becoming emergencies that require extremely invasive & expensive procedures. Most people are avoiding consistent care and end up needing emergency care. Bristle helps solve those three problems 1) preventing disease is less expensive than treating it, 2) we ship our kit directly to users and they access results/recs online, 3) it's just a saliva sample :) no needles or drills required - and hopefully never will be.

All that said, we are not a replacement for dental care. More dental care doesn't necessarily mean better oral health, but maintaining good oral health almost certainly means less dental care.

- Danny

Great question! For people who aren't going to the dentist, there may be a few reasons (anxiety, lack of time, etc.), so those individuals can use our test to monitor their health and see when they need to go to the dentist (though we encourage everyone to maintain regular visits). Most of our users do see a dentist regularly and use our test to stay on top of their health between visits and optimize their oral health.

What is contained in a healthy oral microbiome?

Abundance of bacteria such as Streptococcus salivarius and Haemophilus parainfluenzae (and dozens of others) are associated with health rather than disease. Bristle has put together data on hundreds of species, and strains to date.

However, a lot is still unknown about the oral microbiome, which Bristle is helping to uncover with help from our users!

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7074908/

Is there a way to kill Streptococcus mutans without damaging other normal flora of the mouth? Is strep mutans something we should get rid of or could live without?

There are products (beyond the traditional fluoride) that have been shown to limit the abundance and effects of S. mutans and other acidogenic species, such as xylitol and arginine bicarbonate that both suppress S. mutans growth and prevent enamel erosion.

Source: https://www.nature.com/articles/s41598-017-07042-w

I was pretty young when I first heard that cavities were caused by bacteria, and I realized quickly that people aren’t born with those bacteria. I would hear stories from people about how they didn’t get their first cavities until the same time period where they started dating, and kissing. So I’ve always believed that we all live in a global pandemic of oral diseases. I don’t think people really care, though.

Am I right? And, could this pandemic be stopped? Could drugs exist that target the bacteria that cause oral diseases? Could viruses be developed to eliminate these bacteria? Are these bacteria that cause oral diseases necessary to our health?

Completely agree! We refer to it as the oral health crisis. Cavities and gum disease are the most prevalent conditions on the planet - and largely preventable. Lots of factors contribute to this unfortunate reality - oral health is societally overlooked in the context of our health, we have a reactive and inaccessible standard of care that makes it nearly impossible to access consultative, preventive care, etc.

That's not even counting the fact that oral & overall health are intrinsically linked. We believe that oral health is a critical component of overall health and that by solving the oral health crisis we'll also see massive improvements to population health.

We need better tools to understand oral health (that's us), better education and awareness around it (also us), and better treatments for it (will be us)!

- Danny

What should we be eating more and less of to promote good oral health?

Answered above here: https://www.reddit.com/r/IAmA/comments/sutduc/comment/hxcxodo/?utm\_source=share&utm\_medium=web2x&context=3

What effect, if any, does longer term mouthwash use have on the type of micobiome? Do different types of mouthwash have different effects?

Answered above, but there are a variety of mouthwash types, with different known effects on the oral microbiome. We have a breakdown of the different types here in our blog, but to summarize:

• Alcohol based washes indiscriminately kills bacteria in your mouth. Which is good for eliminating bad, but also kills the beneficial bacteria in our mouths that help strengthen your tooth enamel, prevent tooth decay, and aid in saliva production. These can also lead to dry mouth.
• Mouthwashes with fluoride may help to strengthen tooth enamel and fight tooth decay.
• Cetylpyridinium chloride is an ingredient that targets the bacteria that cause bad breath.
• Potassium nitrate can reduce tooth sensitivity to cold.
• Carbamide peroxide or hydrogen peroxide can help whiten teeth over time for a more movie-star smile. But may negatively impact the oral microbiome.

The best way to find out what works for you, though, is to try them and test your oral microbiome (sorry for shameless plug ☺️)

What does a rinse like Chlorohexadine Gluconate do to your biome? Any thing one should do after using this rinse to restore healthy oral biome?

A few studies have indicated that Chlorhexidine gluconate can negatively impact the oral microbiome by dramatically shifting the community. https://www.nature.com/articles/s41598-020-61912-4

this study demonstrates that mouthwash containing CHX is associated with a major shift in the salivary microbiome, leading to more acidic conditions and lower nitrite availability in healthy individuals.

In summary, we don't advocate for a slash-and-burn approach of antibiotics because repopulating the slash-and-burned microbiome is challenging, similar to in the gut microbiome. A few oral probiotics exist that can assist in oral microbiome reconstitution, but they may not always be effective.

Hi! I've been to a few doctors and dentists and asked about canker sores, none giving me the same answer. What can I do to help reduce canker sores and how do I get rid of them quickly?

Answered earlier:

Some studies have pointed to a correlation between specific oral pathogens and titers of HSV-1 (causative agent of cold sores). Any number of molecules (including those released via inflammation) may be involved in reactivation of latent viruses such as HSV-1, which can result in the presentation of a cold sore.
At Bristle we haven't specifically looked into changes in the oral microbiome prior to or during canker sores, but I believe it would reveal some interesting findings that may help reduce those triggers.
https://pubmed.ncbi.nlm.nih.gov/23611298/
https://pubmed.ncbi.nlm.nih.gov/17804655/

What do you think about Xylitol for improving the oral microbiome?

Hello!
Xylitol works to kill cavity-causing bacteria by interfering with their energy production. It also promotes re-mineralization of teeth by increasing the flow of saliva when used as a sweetener in chewing gum.

https://pubmed.ncbi.nlm.nih.gov/10200706/