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Halitosis is the medical term for chronic bad breath. Having halitosis is far different than having bad breath from eating too much garlic. Halitosis is a lingering bad breath and could be an indicator of something more serious going on with your health.

What Causes Halitosis?

What We Eat. What we consume at meals and snack time can definitely cause halitosis as mentioned previously. As we eat, the foods are absorbed into our blood stream and eventually out thru the lungs. These foods just need to be removed from the body for the halitosis to disappear. Brushing and flossing will only mask the odor for a short time before it returns. The most common foods of this type are:

Halitosis Marielaina Perrone DDS-Onions

-Garlic

-Cheese

-Pastrami

-Certain spices

-Orange juice or soda

-Alcohol

Many popular diets run into a problem with halitosis for these reasons. The large amounts of certain foods they choose to eat will linger in the body and cause chronic halitosis until they are removed.

-Xerostomia or Dry Mouth. Refers to a condition in which the salivary glands in your mouth do not produce enough saliva to keep your mouth wet. Our saliva acts as a helper to our dental health and this includes warding off halitosis as well. Our saliva has the ability to rinse our mouths when eating, help break down foods, and keep bacteria at bay to fight tooth decay. A lack of saliva would definitely lead to chronic halitosis. Saliva also enhances your ability to taste and makes it easier to chew and swallow. Dry mouth can be caused by many factors. These include:

Prescription And Over The Counter Medications. Countless medications produce dry mouth as a side effect. The most common dry mouth cuplrits include antihistamines, decongestants, and pain medications.

Medical Conditions. These include diabetes, stroke, yeast infection (also called thrush) in your mouth, Alzheimer’s disease, or autoimmune diseases (including AIDS/HIV).

Mouth Breathing And Snoring. These two acts while often inter related can also cause dry mouth.

Cancer Treatment. Chemotherapy drugs can alter your saliva and the amount your salivary glands produce. This could be a temporary situation, with normal salivary flow returning after cancer treatment is completed. Radiation treatments in the head and neck area can also lead to damage of salivary glands. This damage could cause a marked decrease in saliva production. This could be temporary or permanent.

Tobacco And Alcohol Use. Both are known to increase dry mouth symptoms.

Excessive Caffeine Consumption. Another known cause of dry mouth.

-Mouth, Nose and Throat Infections. Postnasal drip, due to head and neck infections may also contribute to bad breath. Bacteria feeds on mucus your body produces when it is battling something like a sinus infection.

Dental Health IssuesTooth decay and periodontal disease can lead to long term chronic halitosis if left untreated. The bacteria in the mouth will be out of control and difficult to bring under control unless seen by a dentist.

Preventing Halitosis

The following are simple dental health tips to ward off halitosis:

Watch What You Eat And Drink. Avoid foods and drinks that are known to cause bad breath. Choose more fruits and vegetables and drink more water to stay hydrated.

Choose Sugar Free Mints And Gum. Both of these will stimulate salivary production to help cleanse the mouth and help ward off tooth decay. They will also give you a temporary fresh smelling breath.

Avoid Tobacco Products.

Floss Daily. It is recommended to floss after every meal but 1x per day should keep breath smelling fresh.

Brush after every meal. Use an ADA approved fluoride toothpaste and brush at minimum 2x per day.

Use An Antiseptic Mouthwash. Listerine is a good example.

Be extra vigilant if you have orthodontic braces. Food and plaque can build up around brackets very easily.

What Is Halitosis? Conclusion

Halitosis is an embarassing problem to have but it can also be a sign that something more serious is happening in your body. If you have persistent halitosis, you should see your dentist and rule out the obvious causes. Your dentist will be able to diagnose the issue and get you back on track to fresher breath. With a professional cleaning and dental examination, your dentist can help rule out any dental health problems and educate you on at home dental hygiene. This will include what types of dental products to use or refer you to a physician for follow up.



Maintaining cleaner teeth at home can be a real challenge for many. A diligent dental hygiene program is necessary to maintain cleaner teeth at home between dental visits. So what steps are necessary to maintain cleaner teeth at home? Below you will find some helpful tips to maintain cleaner teeth at home and make each dental visit easier. Your dental visit will be quicker and less stressful knowing you are doing your best at home for cleaner teeth.

Top Tips For Cleaner Teeth At Home

Brush With Proper Technique. The brushing technique used is just as important as the frequency of brushing to maintain cleaner teeth at home. If you are doing a weak job with technique it is almost as bad as not brushing your teeth at all. An important step for cleaner teeth at home.

Cleaner Teeth At Home Las Vegas Marielaina Perrone DDSProper Tooth Brushing Technique For Cleaner Teeth At Home Should Include:

Toothbrush should be angled at a 45 degree angle to your teeth and gum tissues.

-Brushing should be done with a gentle circular motion encompassing each individual tooth.

-Do not forget to brush all surfaces of your teeth. This includes the inside (also called lingual side), the outside (also called the Buccal side) and the tops of teeth (also called occlusal side).

-Tilt tooth brush vertically to reach the inside of your front teeth. Many people neglect this area and it is just as important as the back teeth.

-To clean the inside surfaces of the front teeth, tilt the brush vertically and make several up-and-down strokes.

Plaque that is not removed will harden over time, leading to calculus buildup and possible development of tooth decay and periodontal disease. Cleaner teeth at home should start with proper brushing.

Brush Your TongueThis is important for fresh breath as well. Plaque and bacteria can build up in the crevices of your tongue. The easy solution is to gently brush your tongue every time you brush your teeth. You can use your tooth brush or buy a separate tongue cleaner at the drug store. Ask your dentist how cleaning your tongue can lead to cleaner teeth at home.

-Bedtime Brushing. In an ideal world, we would brush after every meal and then again before bedtime. But for many of us this is not possible. Brushing at bedtime can be very important because generally we have more time to devote to doing it properly vs maybe in the rush of our mornings. Bedtime brushing will help remove build up of food and plaque that occurs throughout our day. Bedtime brushing will lead to cleaner teeth at home because your dental hygiene will be maintained thru the night.

-Choose A Fluoride Toothpaste. Fluoride is a staple of good dental hygiene. It helps defend against tooth decay by strengthening the outer layer (enamel) of our teeth giving us a protective barrier against bacteria. There have been reports of fluoride being harmful to our overall health but rest assured it is safe and effective in toothpaste for brushing to keep cleaner teeth at home.

-Incorporate Flossing Into Dental Hygiene Regimen. Less than 30% of all people floss daily. That is a very low number for an extremely beneficial part of dental hygiene. It is recommended to floss after every meal or at least once per day to get flossing benefits. Flossing will help stimulate periodontal tissues, show a reduction in plaque, and lower inflammation of gum tissues.

Proper Flossing Technique

Use index fingers to guide dental floss between the contacts of your teeth. “Gently” guide floss between the teeth by using a zig-zagging motion. Gently wrap the floss around the side of the tooth. Slide floss up and down against the tooth surface and under the gum line gently. Flossing too hard can cause trauma to tissues.

 -Use An Anti Bacterial MouthwashA good mouthwash like Listerine can help in many ways. They can act to reduce the amount of plaque in the mouth, act as an acid reducer, and destroy harmful bacteria growth in the mouth. It is important to ask your dentist for a recommendation as some are good for kids while others are good for sensitive teeth. A good mouth wash can lead to a cleaner mouth at home between dental visits.

-Stay Hydrated With Water. It is recommended to rinse your mouth with water after every meal. This will help remove food from the mouth but also lower the pH level in the mouth. Some foods can be very acidic. An acidic environment is ideal for development of tooth decay. Drinking water will lead to cleaner teeth at home by rinsing your mouth but also by limiting tooth decay development.

-No Tobacco Or SmokingTobacco and smoking has many negatives for our health but it also will cause staining of our teeth. Avoid smoking for cleaner teeth at home between dental visits.

-Limit Sugars. This is not only important for dental health but also for overall health. This has been proven time and again by scientific studies. Limiting sugars will also limit chance of tooth decay. The World Health Organization Guideline on intake of sugar for Adults and Children recommended to limit free sugars to no more than 5% energy intake to protect dental health over a lifetime. Cleaner teeth at home has a definite nutrition component.

Cleaner Teeth At Home Conclusion

Cleaner teeth at home is the foundation of a good dental hygiene program. This will also include regular dental visits for examinations and professional cleanings. Cleaner teeth at home will lead to a happier, healthier smile for a lifetime.


What causes periodontal disease? Periodontal disease comes in different stages. The earliest stage of periodontal disease is gingivitis. This stage is reversible with proper treatment. If caught and treated before progression there will be no long term affects. If it advances to the next stage, periodontitis, there will be long term effects to your smile. These effects can include gum tissue recession and bone loss surrounding your teeth. Below we will discuss what causes periodontal disease as well as how to bring it under control for good dental health.

What Causes Periodontal Disease?

What causes periodontal disease? Bacteria and Plaque. Periodontal disease is a chronic dental infection of the periodontal tissues surrounding our teeth. This disease can result in the breakdown of the tissue as well as the loss of bone that surrounds and supports our teeth. Periodontal disease begins when bacteria and plaque form a sticky film on your teeth. This film acts as an irritant to the  surrounding tissues and causes inflammation of the periodontal tissue.  Periodontal disease will continue and progress and become more advanced over time What Causes Periodontal Disease Las Vegas Marielaina Perrone DDSwithout dental intervention. Periodontal disease is the #1 cause of loss of teeth in adults. According to the Centers For Disease Control (CDC), it is estimated that 65 million American adults, have mild, moderate or severe periodontitis (advanced form of periodontal disease)In our senior population aged 65 and older, prevalence rates increase to over 70%.

Bacteria That Causes Periodontal Disease

Periodontal disease and tooth decay are triggered by different types of bacteria and are considered to be two separate and distinct disease conditions. However, they work hand in hand to break down our teeth and gum tissues if left unchecked. Swollen and receding gums allow the more vulnerable areas of the tooth (root areas) to be exposed to cause an increased incidence of tooth decay.  On the other side, patients with extensive tooth decay, the broken down teeth allow for food trap areas which keep periodontal tissue chronically inflamed.

Stages Of Periodontal Disease

-Gingivitis – This is the earliest stage of what causes periodontal disease. Ginigivitis is simply the inflammation of the periodontal tissues surrounding the teeth. Gingivitis is the mildest form of periodontal disease and is wholly reversible with professional care and a good at home dental hygiene regimen. Symptoms of Gingivitis Include red, swollen gum tissue with inflammation as well as gum tissues bleeding easily upon brushing, flossing, or even eating. Often these symptoms are unnoticed by patients. Bad breath may be another sign of advancing periodontal disease.

There are only a few signs at this stage and most are painless. This is what makes periodontal disease so common and so concerning. It is silent until it is not. Periodontal disease does not typically break its “silence” until the fourth and final stage. Beginning signs to watch out for include bad breath on occasion, swelling and redness of the gums, and bleeding when brushing or flossing. Good overall dental hygiene and regular professional examinations can treat and reverse gingivitis as well as stop it from progressing further.

This is a critical period for the patient, as gingivitis can be reversed (since the bone and connective tissue that hold the teeth in place have not yet been adversely affected) at this point if it is recognized, diagnosed, and properly treated by a dental professional. Gingivitis can commonly be seen during puberty, pregnancy (also called pregnancy gingivitis), times of high stress, and menopause. As for the rest of the population, poor dental hygiene is generally the most common cause, followed by medication and certain medical conditions (like diabetes).

-Periodontitis – If left untreated the next phase is early periodontitis. Once it enters this stage, the disease can be difficult to control. In this stage, the bone surrounding the teeth is now being affected. The bacteria will invade between the tooth and gums causing a separation of connective fibers. The result is what is called a periodontal pocket (normal pocket depth should be about 3mm without inflammation). These pockets will now approach 4-5mm in depth and can get filled with bacteria, plaque, and food. This will in turn begin to breakdown the bone below the gum line. Simple at home dental hygiene will not be the answer to bring back to a healthy state. Periodntitis signs include increased swelling or redness of the gums, increasingly bad breath, bleeding upon brushing or flossing, and pocket depths that are between four and five millimeters.

-Advanced Periodontitis – This is where the real destruction lies. At least 50 % of bone support is lost if not more. Teeth will begin to loosen and shift if they have not already. Deep periodontal cleanings and possibly surgical intervention are necessary to salvage teeth. This professional cleanings may occur using a periodontal microscope, (Perioscope), grafting of gum tissue or bone, placement of growth factors (Emdogain), periodontal antibiotic regimen (Periostat), placement of antibiotics directly into pockets, (Arestin), open periodontal flap surgery, and, possibly even removal of teeth.

How To Treat What Causes Periodontal Disease?

Luckily, the earliest stages of periodontal disease are easily treated. Following a good at home dental hygiene program (including brushing, flossing, and antibacterial mouthwash) along with regular visits to a dentist we can halt gingivitis in its tracks. Failing to to do the above steps will allow periodontal disease to advance unchecked leading to loss of teeth as well as systemic health issues.

Treatment For Periodontal Disease Can Include Any Of The Following:

Pocket Reduction SurgeryA surgical procedure to reduce the size of the periodontal pockets around your teeth. This will ensure the ability to keep the areas clean at home. The surgery is made up of tiny incisions in your gum tissues so that a section of gum tissue can be lifted back, exposing the roots for more effective teeth cleaning. Because periodontitis often causes bone loss, the supporting bone tissue may be recontoured before the gum tissue is sutured back in place. This surgery can take from 1-3 hours and is performed under local anesthesia.

-Periodontal Tissue Grafts. Periodontal or Gum tissue is often lost due to periodontal disease. When the gums recede your teeth will appear longer than normal as root surfaces are exposed. You may need to have damaged tissue replaced for cosmetic as well as functional reasons. It is important to note that root surfaces are not protected by enamel. This can cause extreme tooth sensitivity. This grafting procedure can help reduce further gum recession, cover exposed roots and give your teeth a more cosmetic lift.

Bone graft. The addition of the bone graft helps prevent tooth loss by increasing support structure around our teeth. It also serves as a building block for the regrowth of natural bone.

-Antibiotics and Antibacterial Medications – These medications will aid in healing and removal of bad bacteria from around our teeth. These include:

-Peridex – Prescription antibacterial rinse.

-Periostat – Oral antibiotic. Another type of antibiotic used is called minocycline.

Arestin – placed directly into the periodontal pocket to help aid in healing.

Chlorhexidine – A prescription anti bacterial mouthwash. This is used to control bacteria when treating periodontal disease and after surgery. Patients use it as they would a regular mouthwash.

-Guided Tissue Regeneration. This periodontal procedure helps to regrow destroyed bone. Your dentist or periodontist places a special piece of biocompatible fabric between existing bone and your tooth. The material prevents unwanted tissue from entering the healing area, allowing bone to grow back in a stable environment. The goal is to regenerate periodontal tissue and repair defects that have resulted from the development of periodontitis.

-Enamel Matrix Derivative Application. Another technique involves the application of a specialized gel to a diseased tooth root. This gel contains the same proteins found in developing tooth enamel and stimulates the growth of healthy bone and tissue. An example of this is the use of emdogain.

What Causes Periodontal Disease? Conclusion

Periodontal disease if left untreated can cause aggressive destruction of your smile. Regular dental visits can prevent periodontal disease from developing. A good way of looking at this is that it is far cheaper and less painful to go to your dentist every 6 months than it is to wait for periodontal disease to develop and chase after your health. Visit your dentist regularly for a happy, healthy smile.



Periodontal disease is a progressive disease of the structures (bone and gingival tissues) surrounding our teeth. It is believed that about 65 million americans have some form of periodontitis. Periodontitis is the advanced form of periodontal disease. Once the disease state reaches periodontitis it means there have been some form of permanent loss of bone or gingival tissues to the disease. In those 65 and over this number jumps to 70% of that population. These numbers are startling. Luckily, there has been extensive research into periodontal disease and new treatment modes have been developed. One such method is treating periodontal disease with Arestin.

What Is Arestin?

Arestin (minocycline hydrochloride) is an antibiotic that comes in the form of micrspheres. These microspheres are placed locally into areas of concern. Periodontal disease generally hits certain areas over others initially. This gives us a chance to localize treatment of periodontal disease with arestin.

Treating Periodontal Disease With Arestin

Periodontal disease if left untreated will develop deeper and deeper “periodontal pockets” around out teeth. The normal space between our teeth, gums and bone is approximately 3 mm. When periodontal disease begins to damage these areas these pockets can widen and deepen as bone is lost and gum tissues lose their connections to our teeth. As the periodontal disease develops and progresses it is not unheard of to have periodontal pocketing in the 6-8 mm range. That is a doubling over normal pocket size. This allows food and bacteria to penetrate these areas and create even more damage to gingival tissues and bone. Once these support structures become damage they can cause our teeth to become loose and eventually lost them.

The standard course of treatment for periodontitis is scaling and root planing (S&RP). This treatment is highly effective for treatment of periodontal disease.

-Periodontal scaling of teeth with instruments involves manually removing all the plaque, tartar, and food from on and around our teeth.

-Periodontal planing can smooth out rough areas on our teeth’s roots where bacteria and plaque can attach.

Scaling and root planing has been our #1 treatment for periodontal disease for decades. Where does treating periodontal disease with Arestin come in? Combining the use of Arestin with the traditional scaling and root planing gives dentists and periodontists a real chance to reduce the periodontal pocketing around our teeth. In routine scaling and root planing, depending on depth of pockets, it may be difficult to reach to the entire depths of those pockets. Everyone’s anatomy is different so some areas are easy to reach while others might be more difficult based on root structures and how the periodontal pockets form. None are uniform. Using microspheres of Arestin allows your dentist to reach the bottom of those pockets and destroy harmful bacteria before further destruction of tissues can occur.

Treating Periodontal Disease With Arestin Procedure

The following is what to expect if you are undergoing treatment of periodontal disease with Arestin.

Diagnosis of Periodontal Disease. In its earliest form (Gingivitis) there is no damage to bone or gingival tissues and can be reversed thru professional cleaning and increased at home dental hygiene care. In periodontitis, destruction has begun. A simple professional cleaning is no longer as effective. Diagnosis of periodontal disease is achieved thru x-rays and use of a periodontal probe. This dental instrument allows your dentist or hygienist to measure around the teeth and see what areas might be affected by periodontal disease. A normal reading of 3 mm means tissues are healthy. Anything over that raises a red flag and leads to a diagnosis of periodontal disease.

-Treatment Plan To Fight Periodontal Disease. Your dentist will explain these results to you and discuss treatment necessary. The first line of defense is always a scaling and root planing (also called a deep cleaning). Your dentist may now offer Arestin in conjunction with this type of cleaning to give you a better chance of stopping this problem from developing further and also repairing tissues around our teeth.

-Treatment With Scaling And Root Planing.

-Arestin Application Following Scaling And Root Planing. The arestin is in the form of a microsphere. This allows the arestin to release the antibiotic gradually over time to fight the bacteria in the deepest depths of those periodontal pockets. It is able to target areas scaling and root planing instruments just cannot reach.

Is Arestin Effective?

Yes! Studies have shown that is more effective in treating pocket reduction when paired with Scaling and Root Planing Vs S&RP alone. In fact clinical trials have shown significant pocket reductions in as little as 1-3 months and maintenance for at least 9 months. It has also shown significant reductions in our more difficult to treat patients. Those include the smoker’s, ones with a history of heart disease, and those over age 50. The chart below shows those statistics.

Periodontal Disease With Arestin Marielaina Perrone DDS

Is Arestin A Miracle Drug? Conclusion

Arestin is not a miracle drug. But it will help controlling a very difficult progressive disease. Periodontal disease is difficult to control because it relies on many factors. The biggest one is at home dental hygiene. Patients need to understand their dental care does not begin and end inside the walls of their dental office. Fighting periodontal disease is a daily battle. Periodontal disease treatment with Arestin can help reverse some of those issues but it will not be a cure for it.