I'm not a dentist but run an oral health/microbiome testing company, so I've been "in the industry" for some time as a non-incumbent and I've had the opportunity to connect with almost every stakeholder (patients, providers/dentists, hygienists, and payers) in dental care. My background is in genomics/sequencing so most of my experience pre-company was on the systemic health/medical side.
A lot of the problems are the result of misaligned incentives. While it's applicable to almost all of healthcare, it's especially prevalent in dental. Providing high-level what I've seen with the understanding that I am talking about the worst outcomes of our care model and certainly not hitting all of the problems. That said, I have met many more dentists who genuinely care about their patients than those who don't - and I truly believe that is the norm.
*Payers*
Dental insurance is glorified discounting. Medical insurance provides annual out-of-pocket maximums (deductibles) where anything you pay beyond that is covered by the insurer. Dental insurance is the opposite. There is an annual maximum the insurer will cover (usually ~$1500) and anything beyond that is covered by the patient. In both cases there are some covered services (medical: checkups, some tests, etc. dental: X-rays, cleanings, etc.) but the second you have something even marginally serious your insurance SHOULD kick in. The problem with dental is that it doesn't. I've spoken with people that had to defer necessary procedures for a year because insurance could only cover half - so 1/2 this year and 1/2 next year.
The problem with this model is that while medical insurance is (theoretically) more incentivized to keep costs low since they will have to pay for major care, dental insurance has a natural ceiling. Yes, if you need $5k of dental work the insurer "suffers" - but it's maxed out for whatever your coverage limit is. There's not a severe financial downside to extensive care.
*Providers*
Complimentary to the model of dental insurance is a fee-for-service (FFS) model for care. What this means is that providers are paid based on services. In other words, a provider makes more money doing a cavity filling than not having to do one because they kept you healthy.
The extreme opposite would be a model where a dentist was financially penalized every time you needed a filling - you can imagine how the relationship and role of the provider would change.
Something that gets overlooked, but is important to call out, is that the system for becoming a dentist doesn't help. There are 4 years of dental school. When you graduate, you're likely $XXX,XXX in debt. On top of that, private practice is still extremely prevalent in dental care - so add another $XXX,XXX in debt. Plus the cost of the equipment you need. This isn't an excuse, but its a reality for many dentists. When you combine massive debt and a care model that prioritizes paying for procedures the result is what we see today.
The other problem is that this misalignment means providers have to make personal/ethical choices around care. Sometimes those choices mean performing unnecessary procedures on patients. Sometimes it's the opposite, and the provider takes a personal hit on revenue. So you end up with 5 second-opinions, none of which line up to the others. A provider should not have to choose - or eve consider - ethical responsibility to patients vs. financial stability.
*Patients*
We - patients - get shafted in dental care. Our system is incentivized to reactively treat disease over maintaining good health. On average we pay [40% of dental expenditures out of pocket](https://www.carequest.org/system/files/CareQuest-Institute-B...). That's ~4x more than the average for all other healthcare services.
We're left to navigate oral care on our own. Of course you're skeptical when a dentist says you need 10 fillings - they're incentivized to perform the procedures. Would you be as skeptical if you knew the dentist was getting charged $50 for every filling they had to do? Do you think the care model would change if dental insurers suddenly had to pay for your $10k dental procedure instead of you?
Cavities and gum disease - largely preventable conditions - are the most prevalent diseases on the planet. And we're not talking about some complex, mysterious disease. These are microbial infections. We have tools to detect them early and interventions that work (at least work well enough to make a major dent). Misaligned incentives don't motivate anyone to adopt these technologies or encourage preventive care.
Anyway, that's my rant. There are lots of things I didn't cover but I have to get back to work. Linking [my company here](https://www.bristlehealth.com/) to minimize self-promoting but provide some more info.
Exciting to see more research around the role oral health might play in systemic disease. Given the prevalence of oral disease there's still a lot more to do on establishing a mechanistic relationship
We'll be continually updating your early access report with new discoveries we uncover along the way, but we may not be able to provide treatment recommendations from the early access test once we flip to clinical. Things like lifestyle, diet, hygiene can be provided. Regardless, I'd recommend retaking the test when we launch the clinical product since your oral microbiome may have changed since the time you took the early access test, so the recommendations between now and then might be different!
I’m sorry you feel that we were misleading you - that is not our intention. As I stated in my previous response: we are not a HIPAA covered entity but maintain HIPAA compliant protocols. We plan to include our data protection protocols on our site to make this information available and transparent for visitors and users. I appreciate you bringing this up!
David put it nicely (and more succinctly) in another reply: "In short, there is a network effect with our platform. Each sample we sequence contributes to a database of novel bacteria, viruses, and fungi that we can use to discover new microbes." I would just add that discoveries also apply to new associations that we can include in future reports.
A little bit of both actually - as our user base grows we create a network effect that will spur new statistical associations. We can apply those new findings to new and existing users by updating their report accordingly.
You can imagine that even if you took the test once and had (for the sake of simplicity) 1 insight being reported back, you could revisit your profile in 2 years when we have tested 10,000 users and may have 4 new insights that have been added to your report as a result of the new discoveries we've made!
TLDR; there are associations reported now, and new ones that will be reported as we grow our user base and data
Hi Astura, apologies for the delay. To answer your question: no, we are not a covered entity - but we still maintain HIPAA compliant protocols with your data:
We follow all HIPAA compliant protocols in handling your data. We have additionally taken a number of security precautions beyond HIPAA compliance that mitigate the possibility of a data breach.
I appreciate you bringing this up as it is an important distinction and a good opportunity to clarify. We are not a covered entity under HIPAA as we are not (1) a health plan, (2) a health care clearinghouse, or (3) a health care provider. The laws surrounding HIPAA were enacted before genomics and consumer health became prevalent. This means that most of the companies in our space (23&me, Ancestry, Everlywell, etc.) are also not covered entities but are working with PHI (protected health information).
While Bristle is not a covered entity, we can be HIPAA compliant by enforcing the same guidelines around your PHI as are used for covered entities. This is an optional, but in our opinion critical and non-negotiable, component of our infrastructure to maintain user privacy.
Thanks! We're continuing to develop and iterate the final product, and we hope that this program will provide some early user feedback. Current and new users will have their reports updated as we make changes and add new features.
Hi everyone - looking into shipping capabilities. CA should be doable but will have to look into Europe further and will follow up tomorrow! We really appreciate the widespread interest!
We follow all HIPAA requirements and de-identify our data accordingly. That said, as a company we are committed to patient privacy and I’m interested in hearing about the experiences you’ve had in the past with companies changing their minds. If you’re open to it, email us at [email protected] and I’ll follow up with you to discuss!
Regarding the "about" page - our website is brand new and we're building out more information to coincide with announcements over the coming weeks. One of those is around our advisory board and another is relevant to your comment on clinical trials. Our team has backgrounds in genomics on both the research and commercial side! I worked at Illumina and ONT myself - other co-founders come from companies including Genentech, Twist, etc.
Hi everyone! We’re planning to submit our formal launch on Hacker News in a few weeks, but given this post and all of the discussion around it I thought I would share a quick background now!
Bristle (bristlehealth.com) is leveraging the oral microbiome to pioneer oral health testing and care. We use metagenomic sequencing to analyze the oral microbiome from a saliva sample - looking at fungi, bacteria, and viruses - delivering evidence-based insights around oral health.
We are offering an early access program (https://www.bristlehealth.com/pages/early-access) providing oral microbiome testing and consumer research reports, with literature-backed insights accessed through an interactive web app. We’re charging users $50 and will only bill you when we ship your kit.
If you’re interested in learning more about your oral microbiome, please sign up! We literally launched yesterday and have gotten tons of interest based on exactly what’s being discussed here. We’re letting participants into the program in batches but will be turning kits around rapidly.
If anyone wants to chat more feel free to reach out to [email protected]. As I said, we will have a dedicated HN launch with lots more information in the coming weeks, but wanted to share given the interest and that we have this ready to go.
A lot of the problems are the result of misaligned incentives. While it's applicable to almost all of healthcare, it's especially prevalent in dental. Providing high-level what I've seen with the understanding that I am talking about the worst outcomes of our care model and certainly not hitting all of the problems. That said, I have met many more dentists who genuinely care about their patients than those who don't - and I truly believe that is the norm.
*Payers* Dental insurance is glorified discounting. Medical insurance provides annual out-of-pocket maximums (deductibles) where anything you pay beyond that is covered by the insurer. Dental insurance is the opposite. There is an annual maximum the insurer will cover (usually ~$1500) and anything beyond that is covered by the patient. In both cases there are some covered services (medical: checkups, some tests, etc. dental: X-rays, cleanings, etc.) but the second you have something even marginally serious your insurance SHOULD kick in. The problem with dental is that it doesn't. I've spoken with people that had to defer necessary procedures for a year because insurance could only cover half - so 1/2 this year and 1/2 next year.
The problem with this model is that while medical insurance is (theoretically) more incentivized to keep costs low since they will have to pay for major care, dental insurance has a natural ceiling. Yes, if you need $5k of dental work the insurer "suffers" - but it's maxed out for whatever your coverage limit is. There's not a severe financial downside to extensive care.
*Providers* Complimentary to the model of dental insurance is a fee-for-service (FFS) model for care. What this means is that providers are paid based on services. In other words, a provider makes more money doing a cavity filling than not having to do one because they kept you healthy.
The extreme opposite would be a model where a dentist was financially penalized every time you needed a filling - you can imagine how the relationship and role of the provider would change.
Something that gets overlooked, but is important to call out, is that the system for becoming a dentist doesn't help. There are 4 years of dental school. When you graduate, you're likely $XXX,XXX in debt. On top of that, private practice is still extremely prevalent in dental care - so add another $XXX,XXX in debt. Plus the cost of the equipment you need. This isn't an excuse, but its a reality for many dentists. When you combine massive debt and a care model that prioritizes paying for procedures the result is what we see today.
The other problem is that this misalignment means providers have to make personal/ethical choices around care. Sometimes those choices mean performing unnecessary procedures on patients. Sometimes it's the opposite, and the provider takes a personal hit on revenue. So you end up with 5 second-opinions, none of which line up to the others. A provider should not have to choose - or eve consider - ethical responsibility to patients vs. financial stability.
*Patients* We - patients - get shafted in dental care. Our system is incentivized to reactively treat disease over maintaining good health. On average we pay [40% of dental expenditures out of pocket](https://www.carequest.org/system/files/CareQuest-Institute-B...). That's ~4x more than the average for all other healthcare services.
We're left to navigate oral care on our own. Of course you're skeptical when a dentist says you need 10 fillings - they're incentivized to perform the procedures. Would you be as skeptical if you knew the dentist was getting charged $50 for every filling they had to do? Do you think the care model would change if dental insurers suddenly had to pay for your $10k dental procedure instead of you?
Cavities and gum disease - largely preventable conditions - are the most prevalent diseases on the planet. And we're not talking about some complex, mysterious disease. These are microbial infections. We have tools to detect them early and interventions that work (at least work well enough to make a major dent). Misaligned incentives don't motivate anyone to adopt these technologies or encourage preventive care.
Anyway, that's my rant. There are lots of things I didn't cover but I have to get back to work. Linking [my company here](https://www.bristlehealth.com/) to minimize self-promoting but provide some more info.