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Reduction of oral bacteraemia Patients at risk of endocarditis including those with valve replacement, acquired valvular heart disease with stenosis or regurgitation, structural congenital heart disease (including surgically corrected or palliated structural conditions, but excluding isolated atrial septal defect, fully repaired ventricular septal defect, fully repaired patent ductus arteriosus, and closure devices considered to be endothelialised), hypertrophic cardiomyopathy, or a previous episode of infective endocarditis, should be advised to maintain the highest possible standards of oral hygiene in order to reduce the:

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VGLUT1is significantly decreased, possibly resulting in poor clearance of glutamic acid in the synaptic cleft, leading to excitatory toxicity