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.