Interpreting Bristle Test Results

Do not index

Text

Comprehensive guide on interpreting Bristle test results.

Parent item

Sub-item

👋

The Bristle Oral Health Test provides a complete picture of oral health from a single saliva sample by analyzing all of the beneficial and pathogenic (harmful) bacteria & fungi in the oral microbiome.

Each report contains 7 scores related to health and disease-related conditions. You can read more about what each score means here.

Beneficial Bacteria

Gum Inflammation

Tooth Decay

Halitosis

Gut Impact

Nitric Oxide

Diversity

Insights from Test Results

Oral Health Scores

Gum inflammation score: This score measures the level of inflammation in the gums. It indicates the severity of gum disease or periodontal disease. Certain bacteria are known to cause gum inflammation, and this score may help identify the presence and extent of such bacteria in the mouth.

Tooth decay score: This score measures the risk or progression of tooth decay. It takes into account the abundance of specific bacteria that are associated with tooth decay, such as Streptococcus mutans, Streptococcus sobrinus, Bifidobacterium dentium, Scardovia wiggsiae, and others. Higher scores may indicate a higher risk or presence of tooth decay-causing bacteria.

Beneficial score: The beneficial bacteria score evaluates the presence and abundance of bacteria that have a beneficial or symbiotic relationship with the host. These bacteria perform important functions, such as reducing nitrate into nitrite and nitric oxide. A higher commensal score indicates a healthier balance of beneficial bacteria in the oral microbiome.

Halitosis score: This score assesses the presence and severity of bad breath. It measures the abundance of specific bacteria that contribute to halitosis or bad breath. A higher score suggests a higher likelihood of having bad breath-causing bacteria in the mouth.

Oral-Systemic & Other Scores

Nitrate reduction score: This score evaluates the ability of bacteria in the mouth to convert nitrate into nitrite and nitric oxide. Nitric oxide is known to have important physiological functions in the body. This score reflects the potential nitrate reduction capacity of the oral microbiome.

Gut inflammation score: This score analyzes microbes that can cause significant gut disruption, either through initiating an inflammatory response or by displacing the normal gut microbes that are important for gut health. The abundance of these microbes are reflected in the gut inflammation score, where higher scores are higher risk for gut inflammation from oral microbiomes.

Diversity score: This score looks at the total microbial diversity of a patient’s sample, taking into account the total number of species in one’s microbiome, and the variance of their abundances. Both extremely low and extremely high diversity can indicate oral microbiome dysbiosis, and a healthy microbiome is somewhere in the middle, generally between 1.5 to 8.5. While diversity alone is not enough to determine the health of a microbiome, it can be an important contributing factor to risk of disease. In general, diversity scores can indicate the stability of a microbiome. Both very high and very low diversity scores are more unstable and likely to change.

Contributing Microbes

The Bristle Oral Health Test is the most comprehensive oral microbiome test available. You can read more about the test here.

Our test sequences the whole genome of all microbes in a sample. This method provides us with a few extra layers of information:

Broad microbial detection — we can detect bacteria & fungi with our test, instead of only detecting select bacteria.

Why does it matter? This is important because fungi and viruses also play a role in health and disease. Without knowing all of the microbes present, you are missing out on important information and an accurate picture of an individual’s oral health.

Higher resolution for identification at the species or strain level — most tests only identify bacteria at the genus-level.

Why does it matter? Two species or strains of bacteria can belong to the same genus but have vastly different effects on our health. For example, while most strains of E. coli are harmless, we are all familiar with the strain related to food poisoning. Without knowing which species or strain is present, you can get ambiguous results.

Understanding Test Results

Oral Health Report Card

The oral health report card provides a summary of the patient results. This allows you to easily identify areas for improvement. Each result provides a score from 1-10. Scores relate to the total abundance of bacteria detected related to each condition, with 0 being the lowest and 10 being the highest amount.

Health-related scores: a higher score is better

A score of “zero” for a health-related condition (such as commensal) indicates the patient has a very low abundance of bacteria that are associated with good oral health. In this case, one goal is to increase the abundance of health-related bacteria and thereby increase the score.

A score of “ten” indicates the patient has an extremely high abundance of health-related microbes. In this case, a goal would be maintaining the abundance of health-related bacteria.

Disease-related scores: a higher score is worse

A score of “zero” for a disease-related condition (such as tooth decay) indicates the patient has a very low abundance of bacteria that are associated with the condition.

A score of “ten” indicates the patient has an extremely high abundance of cariogenic microbes. In this case, one goal is to decrease the abundance of health-related bacteria and thereby decrease the overall score.

Detailed Results & Data for Each Score

You can click on an individual score in the report card or click the “Detailed Results” tab. The detailed results section will provide insight into the root-cause of an associated condition and score along with helpful content to interpret and explain the results.

Detected Microbes

Each score includes a list of detected microbes related to the associated condition.

Species name: Identified microbes include the species name.

Score: Each microbe will include a score from 0-10 indicating the percentile abundance of that microbe (see more detail here on percentile abundance).

Functional tags: Each microbe includes functional details to help guide personalized care decisions.

Definitions & How Bristle Calculates Scores

Relative Abundance

The relative abundance of a microbe defines how much of the oral microbiome is composed of the related species.

A relative abundance of 0.47 for a microbe indicates that 0.47% of the total oral microbiome is composed of that species. The sum of all relative abundances should equal 100.

Percentile Abundance

Relative abundance on its own does not indicate whether a microbe is high or low in relation to the norm. Percentile compares the relative abundance of a given microbe in an individual’s sample against all other samples in our database.

A percentile of 100% indicates that the given microbe is in the highest relative abundance we have detected, while the lowest would be 0%.

Clinical Benchmarks

We partnered with the University of Pacific Dental School to analyze patient oral microbiome samples in the context of physiological symptoms and clinical diagnoses. This provides a “clinical baseline” to understand oral microbiome results in the context of the presence, severity or risk for oral diseases.

Three scores contain comparisons to our clinical data set:

Commensal: this score includes a comparison of your patients’ commensal score to patients who were clinically diagnosed as healthy.

If your patient has a score equal to or higher than 6.6 it indicates they have a greater abundance of beneficial bacteria than patients diagnosed as healthy.

Gum inflammation: this score includes a comparison of your patients’ gum inflammation score to patients who were clinically diagnosed as healthy and patients clinically diagnosed with periodontal disease.

If your patient has a score equal to or higher than 6.6 it indicates they have a greater abundance of bacteria that drive gum inflammation than patients diagnosed with periodontal disease.

If your patient has a score equal to or less than than 3.3 it indicates they have a lower abundance of bacteria that drive gum inflammation than patients diagnosed as healthy.

Tooth decay: this score includes a comparison of your patients’ tooth decay score to patients who were clinically diagnosed as healthy and patients clinically diagnosed with caries.

If your patient has a score equal to or higher than 6.6 it indicates they have a greater abundance of cariogenic bacteria than patients clinically diagnosed with caries.

If your patient has a score equal to or less than than 3.3 it indicates they have a lower abundance of cariogenic bacteria than patients clinically diagnosed as healthy.

How to Interpret Each Score

Beneficial Bacteria

Commensal microbes, also known as beneficial microbes, are essential to a healthy oral microbiome. This score summarizes the abundance of commensal microbes in your oral microbiome. The oral commensal microbes are critically responsible for oral microbiome stability and homeostasis. People with a lower commensal scores may be more prone to changes in the oral microbiome, which can lead to dysbiosis. By contrast, people with high commensal scores may have more stable microbiomes, preventing new pathogenic microbes from invading the niches in the mouth and causing disease.

High commensal scores can help balance out other high scores. For example, the commensal species Streptococcus gordonii and sanguinis directly compete with the pathogen Streptoccocus mutans. A high commensal score, with high S. gordonii and S. sanguinis, might be critical to preventing the cariogenic activity of S. mutans. In this example, someone may present as a healthy mouth without tooth decay despite having a high tooth decay score.

Similarly, high levels of commensal bacteria can help dampen the immune response to periodontal pathogens. High commensal scores and moderate/high periodontal scores can exhibit without any symptoms. However, if the commensal score were to dip, the periodontal pathogens may be able to cause worse inflammation and disease.

Caveats to the commensal score:

Very low oral microbiome diversity (<1) with a high commensal score (>9.5) can be a sign of oral microbiome dysbiosis. Having these scores means your microbiome is likely dominated by a single commensal species and microbial imbalance.

Gum Inflammation

Specific species in the oral microbiome can serve as predictors of gum inflammation. These species contribute to the gum inflammation score. You can read more about this at our blog here. The microbes cause inflammation in a number of different ways. First, some microbes can cause damage to your gum and tooth tissues. Second, microbes can produce molecules, such as virulence factors, that promote inflammation. The gum inflammation score may be indicative of future outcomes. Some symptoms of gum inflammation may include red, sore, or bleeding gums.

The gum inflammation score can indicate the severity of gum inflammation, and also how quickly it can progress. In general, healthy people have 4-6 unique gum inflammation species, while people with gum disease have more than 6. You can read more about the data behind this score at our blog here.

People will generally fall into one of four groups:

Moderate/High gum inflammation score + experiencing gum inflammation:

About 47% of all adults have some form of gum disease. Gum inflammation is usually accompanied by a high gum inflammation score, and high abundance of bacteria that cause gum inflammation. To better understand this score, look at the individual microbes that contribute to the score. A higher number of detected microbes is a sign of worse dysbiosis, and requires more involved intervention to fix. Additionally, some microbes that cause gum inflammation are more impactful than others, and typically the presence of rare microbes in this category is a sign of oral microbiome dysbiosis.

Moderate/High gum inflammation score + not experiencing gum inflammation:

A high gum inflammation score can inform about future outcomes of gum disease. In this case, commensal bacteria may help keep gum inflammation bacteria from causing worse disease. Additionally, gum inflammation is a chronic and often long process driven by oral microbes and your immune system. A high gum inflammation score can be a precursor to gum disease, and should be addressed before disease becomes irreversible.

This case may also occur when someone has an excellent oral hygiene routine, but is still at high risk for gum inflammation. Flossing more frequently can help to keep a score in the moderate range rather than extending into a higher risk score. This is because flossing frequency helps to maintain higher concentrations of oxygen at the gum line, which helps to weed out these anaerobic inflammatory species.

Using an analogy: a garden could be full of weeds, let’s say 200 weeds. Picking 100 weeds out on a regular schedule helps to keep them from taking over the whole garden and killing your other plants. Each time you pick 100 weeds, the other 100 also multiply, and create 100 more weeds. So if you pause your weeding routine even for a short moment, then the weeds multiply and grow beyond a manageable level, and returning to your previous weeding routine is no longer enough to keep them in check because they have now multiplied beyond the number of weeds you can pick.

Low gum inflammation score + experiencing gum inflammation:

In some cases, extremely low or high diversity can manifest in a low gum inflammation score despite symptoms of gum inflammation. Additionally, recent dental treatment or antibiotic therapy can also significantly affect this score, and artificially cause it to be lower than expected.

Low gum inflammation score + not experiencing gum inflammation:

This is the ideal situation, and very achievable. Maintaining a low gum inflammation score requires routines and maintenance, similar to keeping a garden healthy or a home clean.

Tooth Decay

The tooth decay score is calculated from the abundance of species in the oral microbiome that are known to be acid producers, or can influence the microbes that create acid. These bacteria ferment sugar (usually leftover from your diet), which results in acid production. The tooth decay score is an indicator of how quickly cavities can worsen if left alone.

For instance, an early stage cavity that has not penetrated beyond the enamel layer may be reversible through remineralization. However, once the cavity grows past the enamel into the dentin, it cannot be reversed and must be filled to prevent infection. Pathogenic cavity-causing bacteria can thrive in these early cavities. People with a high tooth decay score may progress to a severe cavity more quickly than those with a lower score.

People will generally fall into one of four groups:

Moderate/High tooth decay score + experiencing tooth decay symptoms:

People with a high tooth decay score may have caries that more quickly progress from incipient caries to irreversible decay that requires a filling to repair. People who experience tooth sensitivity and other symptoms of tooth decay with a high tooth decay score may benefit from the following:

using xylitol to prevent microbial fermentation

reducing sugar intake

addition of arginine in toothpaste or supplements

increasing other commensal species (such as S. gordonii and S. sanguinis)

Moderate/High tooth decay score + not experiencing tooth decay symptoms:

The tooth decay score does not always indicate existing decay, but describes the future risk of tooth decay. Commensal bacteria can play an important role in balancing out the species that cause tooth decay, helping neutralize any acid being produced and prevent those species from multiplying. However, if those commensal bacteria were to disappear, the acid producing species could cause more issues. Additionally, incipient lesions are often asymptomatic, and this score could indicate an incipient lesion.

Low tooth decay score + experiencing tooth decay symptoms:

Symptoms of tooth decay can manifest as sensitivity, or ache. Often in this case, commensal bacteria that help remineralize teeth may be lacking. Alternatively, vitamin and mineral deficiencies may also lead to tooth sensitivity without the presence of caries or cariogenic bacteria.

Low tooth decay score + not experiencing tooth decay symptoms:

Maintaining a low tooth decay score requires persistent routines and maintenance, similar to keeping a garden healthy or a home clean.

Halitosis

The Halitosis score measures the levels of oral bacteria that cause bad breath by producing foul smelling chemicals in the mouth. This score will also include a “Halitosis Type” which you can learn more about in our article, The 6 Types of Bad Breath.

People generally fall into one of four groups:

Moderate/High halitosis score + experiencing halitosis:

Unfortunately, this is the most common scenario. Fortunately, most cases can be improved through modulating the oral microbiome, adopting better oral hygiene routines and products, and improving diet.

Moderate/High halitosis score + not experiencing halitosis:

High scores may indicate a high risk of halitosis, but diet, environment, commensal bacteria all play an important role in reducing the symptoms of halitosis. For example, a high halitosis score for someone who has a healthy and diverse diet full of nitrates and a high commensal score is less likely to experience halitosis. Similarly, someone with a high halitosis score, low commensal score, and poor diet would be more likely to experience halitosis. Additionally, a high halitosis score can also be an early sign of gum disease.

Low halitosis score + experiencing halitosis:

Low halitosis scores may seem confusing for those experiencing chronic halitosis, but look closely at the microbes involved and you may be able to find a pattern. For example, sometimes a small pocket in the gums is enough to cause severe halitosis, but this pocket only makes up a small fraction of the total oral microbiome, resulting in a low halitosis score. Some species also have a higher “impact” on halitosis than other species. For instance, a low score with the presence of high Solobacterium moorei and present with much worse symptoms than someone with a low score without any Solobacterium moorei. Additionally, chronic halitosis can also be a result of low microbiome diversity, or low commensal species.

Low halitosis score + not experiencing halitosis:

A well balanced oral microbiome can help improve symptoms of halitosis, or even get rid of them altogether. Implementing and maintaining a proper personalized oral health routine is critical to reducing the risk of halitosis.

Gut Impact

The Gut Impact score measures the bacteria and fungi in the mouth that can cause issues in the gut. These microbes have been associated with conditions including IBS, IBD, Crohn’s, and colorectal cancer. You can learn more about the Oral-Gut Axis in our research article here.

Moderate/High gut impact score + experiencing gut issues:

The source of gut issues may be stemming from their oral microbiome. Improving the oral microbiome may help relieve their issue. These individuals may have tried to solve their gut health by using gut probiotics without success because oral microbes are the reservoir of their issue.

Moderate/High gut impact score + not experiencing gut issues:

Some people may have more resilient gut microbiomes that prevent the oral pathogens from invading the gut. However, if the gut were to become disrupted, this could allow oral microbes to cause issues.

Low gut impact score + experiencing gut issues:

The gut issues for these people likely do not originate in the mouth. I would point them toward their diet, genetics, their gut microbiome, or other systemic inflammatory diseases.

Low gut impact score + not experiencing gut issues:

A rare group indeed. With 40% of Americans having some kind of digestive trouble, it’s unfortunately rather rare to have both a healthy gut and healthy mouth.

Nitric Oxide

Certain species of oral bacteria help metabolize nitrate from our diets into nitric oxide, which is crucial for heart, brain, and immune health. You can learn more about the relationship of the oral microbiome to nitric oxide and cardiovascular health here.

Here is how you can interpret your nitric oxide score:

Low nitric oxide score:

Overuse of antimicrobials or antiseptic mouthwashes is associated with reduce nitric oxide levels. Additionally, insufficient nitrate in diet can lead to deficiencies in nitrate reducing species. Avoiding antiseptic products and increasing nitrate in your diet can improve this score, and both cardiovascular and cognitive health.

High nitric oxide score:

A high abundance of nitrate reducing species along with high levels of nitrate in diet can help reduce gum inflammatory and halitosis causing bacteria. Nitrate reduction can play an important role in limiting the effects of gum inflammation species. Maintaining a high nitric oxide score can help reduce your gum inflammation score.

Diversity

The Diversity score accounts for the total number of species and their abundance levels. If the Diversity score is “Within range” then no action is needed. You can learn more about Oral Microbiome diversity and its impact on our health through this link.

Caveats to the diversity score:

Extremely low diversity (<1) can have a major negative impact on the other scores. Usually, such low diversity is due to one species in the oral microbiome taking up too much of the space. This is an issue because one of the most well studied concepts in ecology is that diversity helps maintain homeostasis.

Extremely high diversity (>9.5) can indicate be a predictor of worse outcomes. Our hypothesis is that extremely high diversity is a signal that niches in the oral microbiome are expanding, potentially caused by microbes causing damage to your tissues.

Interpreting Bristle Test Results - Complete Guide