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 the study.
* 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 them from study completion or put them at increased risk such as :
* Hemodialysis dependent.
* Have a long-term intravascular catheter (e.g., for chemotherapy or parenteral nutrition).
* Active injection drug use (IDU).
* Clotting disorder such as, hemophilia.
* Have a solid organ transplant or hematopoietic stem cell transplant, or ongoing treatment for hematologic cancer.
* Currently incarcerated.
* Systemic antibiotic use within the past 2 weeks.
* Undergoing orthodontic treatment with fixed appliances (brackets and wires) or plans to do so during the study period.
* Taking or requiring antibiotic prophylaxis prior to dental procedures for other reasons, 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 and calibrated Oral Examiner's opinion, would require definitive dental care during the study period.