Reducing Risk for Infective Endocarditis

Inclusion Criteria:

• Age 18 years or older.

• Greater than 6 months since last dental hygiene prophylaxis (cleaning).

• 10 or more accessible teeth (including implants, with a minimum of 8 natural teeth).

• Willing and able to provide informed consent.

• Willing to comply with all study procedures and be available for the duration of thestudy.

• Willing to forgo routine professional dental cleanings while enrolled in the trial.

Exclusion Criteria:

• At high risk for IE, as defined by the 2007/2021 AHA Guidelines:

• Prosthetic cardiac valve or prosthetic material used for cardiac valve repair.

• Previous episode of IE.

• Cardiac transplantation recipient with cardiac valvulopathy.

• Specific congenital heart disease conditions.

• Pregnant, by self-report, or planning to become pregnant during the study period.

• Affected by a condition that, in the opinion of the investigator, may preclude themfrom study completion or put them at increased risk such as :

• Hemodialysis dependent.

• Have a long-term intravascular catheter (e.g., for chemotherapy or parenteralnutrition).

• Active injection drug use (IDU).

• Clotting disorder such as, hemophilia.

• Have a solid organ transplant or hematopoietic stem cell transplant, or ongoingtreatment for hematologic cancer.

• Currently incarcerated.

• Systemic antibiotic use within the past 2 weeks.

• Undergoing orthodontic treatment with fixed appliances (brackets and wires) or plansto do so during the study period.

• Taking or requiring antibiotic prophylaxis prior to dental procedures for otherreasons, e.g., to prevent prosthetic joint infection .

• Three or more teeth with moderate to severe gingival hyperplasia.

• Has clinically detectable emergent or urgent dental needs that, in the trained andcalibrated Oral Examiner's opinion, would require definitive dental care during thestudy period.