Reducing Risk for Infective Endocarditis

Eligibility 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.
• * 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.