The Most Under-Diagnosed Organ in Longevity

It's not your gut. And the science just got hard to ignore.

I mapped out the market, so you don’t have to. Full list below.

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I have wholeheartedly hated the dentist my whole life.

I am, by most measures, pain-tolerant. But put me in a reclining chair under a fluorescent light with a stranger holding a vibrating tool an inch from my molars and I become a person I don’t recognize. The fear is older than I can trace. It has never softened.

So for most of my adult life, I sorted dentistry into a mental category I called classic healthcare — the kind of thing you do when something hurts. I treated my mouth the way most people treat an MRI: necessary occasionally, unpleasant always, and unrelated to the proactive work I actually invested in.

That assumption has, quietly, started to look very wrong.

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The science that changed how I think about my mouth

In 2019, a paper in Science Advances did something most dental research never does: it crossed disciplines. Researchers led by Stephen Dominy detected Porphyromonas gingivalis (a common gum-disease bacterium) in the brain tissue of Alzheimer’s patients. Not the saliva. The brain.

The implication was uncomfortable: an oral bacterium might not just correlate with neurodegeneration. It might cause it. The follow-up drug failed its trial in 2021 and the mechanism is still debated - but the underlying observation, that oral bacteria don’t stay in the mouth, has held up.

A few things to anchor on:

• 6.87x higher risk of Alzheimer’s dementia for severe periodontitis (2025 meta-analysis, Journal of Evidence-Based Dental Practice, 24 studies)

• Periodontitis is now an independent cardiovascular risk factor in multiple major reviews

• You swallow ~600 times a day. The oral microbiome is upstream of the gut — every swallow inoculates it

I didn’t arrive here through dentistry. I arrived through gut. When I was doing longevity reviews in Paris, the team at ZOEI walked me through research connecting oral microbiome composition to brain aging. In the practitioner circles I move in, this has crossed from “fringe” to “emerging biomarker” in the last 18 months.

Which raised the obvious question: If this matters, why is the consumer infrastructure so broken?

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The category is being built in fragments

I spent the last few weeks mapping who’s actually building here. The full map went up on LinkedIn (embedded below). The short version:

🏛 Longevity Dental Clinics: three credible US operators

• Smile House (Tribeca) - Dr. Jonathan Levine + sons. 250-biomarker saliva test, Mouth Mapping framework

• Rejuvenation Dentistry 0 Dr. Gerry Curatola, NYU professor, forty years deep

• SAMA Oral Health - Dr. Jaskaren Randhawa, membership model with microbiome testing built in

🛋 Modern Dental Experience: Tend, Quip. Got the front of house right. Didn’t go upstream into biology. A better waiting room isn’t a different paradigm.

🧬 Functional / Biological Dentists: Dr. Mark Burhenne, Dr. Steven Lin, Bruno Integrative. Right science, wrong brand register. Correct for a decade, still looking like alternative health from 2014. The category needs what Equinox did for the gym.

🔬 At-Home Microbiome Testing: Bristle (800+ species, mail-in), Oral Genome (chairside, 15 min), Viome, Oralis 1

🧴 Premium consumer brands are having their skincare-circa-2017 moment, making the daily stuff good enough to actually use. People will tell you the pretty tongue scrapers are just branding. I don’t buy it. A treadmill was a treadmill before Equinox put a brand and a room around it, and that is what got people on it five times a week. Design is not the opposite of substance. It is how substance gets used.

• Boka (nano-hydroxyapatite, 320% YoY growth), RiseWell, Davids, Twice, Lumineux, Agent Nateur, Marvis (the heritage benchmark)

• Ancient Practice, Modern Packaging: tongue scraping and oil pulling, 5,000-year-old Ayurvedic rituals now rebranded as “microbiome support.” Which is exactly what they always were: Cosmic Dealer, Surya, Terra & Co.

🧠 AI Diagnostics: Pearl, Overjet, VideaHealth. The radiograph-reading layer that makes the rest of the stack affordable at scale.

⚙️ Infrastructure: Torch Dental (the Boukadoum brothers), digitizing the $20B+ dental supply chain. The clinic of the future can’t exist on an analog back-end.

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What the comments surfaced

The map went up Tuesday and the comments did something better than agree - they extended it. Two sub-categories I’d underweighted, all shown to me by people building and practicing in the space:

Oral microbiome therapeutics: engineering the bacteria, not just testing or cleaning:

• Primal Health (Dr. Emily Stein): patented, NIH-funded science shifting bacteria from sugar- to protein-metabolizing

• Ostia Sciences (Dr. Michael Glogauer, UofT): a Phase 2 probiotic lozenge for gingivitis

• FoodBIOME (Guy Lopez): a functional-food platform engineered to feed beneficial bacteria

• MyFitStrip + Per Os Biosciences: a prebiotic gum shifting the mouth toward nitric-oxide-producing bacteria

Chairside biomarker testing: same-visit diagnostics between the mail-in test and the clinic:

• Drül: nucleic-acid saliva testing, results in ~30 minutes

• ARKRAY’s SillHa; seven biomarkers in five minutes, already in practices

The pattern underneath both: the consumer brands at the top of the stack are only as good as the therapeutics and diagnostics underneath them. The thesis applies a layer deeper than the original map gave it credit for.

And the most valuable part wasn’t the map - it was who it brought in. I had the pleasure of connecting with Dr. Megan Pugach-Gordon and Dr. Jill Sirko, both out of the ADA Forsyth Institute (formed when the Forsyth Institute joined the American Dental Association’s research arm). Megan’s work sits right at the enamel-microbiome-saliva interface, including using beneficial bacteria to prevent tooth decay. The two of them are building something together in this space - exactly the kind of science-first work the category needs more of.

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What’s actually missing

What no one has built - and what investors should be looking for - is the layer that integrates all of this into something a consumer can actually use.

The dream version is mundane, but:

• Your microbiome is sampled the same day your teeth are cleaned

• Your dentist functions as a longevity practitioner, reading saliva alongside blood

• Your daily products are calibrated to what your microbiome needs, not what a brand is selling

• The data goes somewhere useful

That workflow doesn’t exist yet. The data exists. The clinicians, the brands, the diagnostics, the infrastructure - all exist. What’s missing is the connective tissue that turns disconnected purchases into one coherent picture.

And the mouth is just one example of a pattern repeating across consumer longevity: a category emerges in fragments, the science outpaces the infrastructure, and consumers end up with another biomarker, another test, another product, and no way to integrate any of it.

We are not short on data. We are short on the layer that makes it usable. The next decade of longevity isn’t about generating more measurements. It’s about helping people navigate the ones they already have.

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What I’m actually doing

• 💧 Water flosser: won’t travel without it

• 🪥 Tongue scraper every morning (Cosmic Dealer; Surya is the accessible US option)

• 🌿 Oil pulling with Terra & Co., when I remember

• 🧪 Saliva microbiome test: results pending. I’ll write about what comes back.

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Next Thursday’s House Call goes deep with Cody Levine at Smile House — the closest thing I’ve found to the full-stack longevity dental practice this category needs. Subscribe if you want to read it.

Disclaimer: This is one person’s reading of an emerging and unsettled area, not medical advice. Talk to someone who knows your own history before changing anything.