George K. Markle, DDS

Manual, Electric and Sonic Toothbrushes

'manual and electric toothbrush'With the many options of toothbrushes available today, we understand that choosing the right one for you can be overwhelming. If you are considering changing your brush style, read more information below about manual, electric and sonic toothbrushes.

Manual Toothbrushes

Manual toothbrushes are the most common type of toothbrushes, available at your local convenience store. Many people choose to opt for the manual toothbrush because it is a much cheaper option compared to the electric and sonic toothbrushes. Studies have shown that there is not a huge difference in using a manual toothbrush vs. an electric/sonic toothbrush, as manually brushing still cleans the surface of your teeth of food debris and plaque. However, manual toothbrushes clean your teeth at a rate of around 300 brush strokes per minute, while electric and sonic toothbrushes operate much faster (see below).

Electric Toothbrushes

Electric brushes operate at a much higher brush stroke rate than manual toothbrushes, with around 3,000 – 6,000 brush strokes per minute. A brush stroke from an electric toothbrush differs from that of a manual toothbrush because it moves much faster in a smaller surface area, using either oscillating or vibrating motions.

Sonic Toothbrushes

Sonic brushes differ from electric brushes slightly in that they vibrate at a much higher frequency, about 30,000 to 40,000 strokes per minute. Sonic toothbrushes have been found to have a slighter higher cleaning rate because they clean harder to reach areas, such as under the gums and in between the teeth. However, while this may be true – nothing compares to flossing in between the teeth. The ADA recommends for adults with arthritis or who have a hard time manually brushing to change to electric or sonic toothbrushes, which increases stability for your hand while brushing.

Whatever option you chose, as long as you are brushing for two minutes twice a day and flossing once, you will be able to effectively keep your teeth clean and healthy! If you have any further questions about the toothbrush for you, give us a call at San Francisco Office Phone Number 415-781-4725!

5 Reasons Why Your Teeth Are Changing Color

'woman brushing teeth'Brushing and flossing your teeth every day can keep your smile bright and white. However, you might have noticed that even though you take great care of your teeth, they look a little yellow and have lost their sparkle. This is completely normal. Here are 5 reasons why this could be happening to you.

  1. Food and Drinks: Coffee, tea and red wine play a major role in staining your teeth. They all have Chromogens, which are intense color pigments that attach to the white outer part of your tooth known as enamel.
    Tip: Drink with a straw, keeping those stain-causing dyes in the drink away from your teeth
  2. Tobacco Use: The two chemicals found in tobacco, tar and nicotine, create a tough stain. Tar is naturally dark. Nicotine is colorless, but when it’s mixed with oxygen, it creates a yellowish color. Both together create the stain.
  3. Age: Below the white shell of enamel on our teeth is a softer area called Dentin. Over the years, our outer enamel gets thinner from brushing and the yellowish dentin shows through.
  4. Trauma: If you have experienced an injury to the mouth, your tooth may change color. This is because your tooth reacts to the trauma by putting down more dentin, which is darker than the outer enamel on your teeth.
  5. Medications: Many different kind of medications come with the side effect of darkening your teeth. Also, children who are exposed to medication when their teeth are forming, either in the womb or as a baby, can experience discoloration of their adult teeth later in life.

Some of these reasons are preventable and some of these happen over the course of life. Try to avoid some of these things and continue to brush and floss your teeth every day. If you would like to discuss your teeth whitening options with us, please call our office at 415-781-4725 to schedule an appointment.

Tooth Extraction – Managing Pain

'man kicking away pain'The Procedure Itself

Thanks to a wide variety of anesthesia choices available to us these days, you should feel no pain during your extraction.

After the Surgery

  • Over-the-Counter Medicines: Generally speaking, over the counter non-steroidal anti-inflammatory medications such as Ibuprofen are all that you will need following your surgery.
  • Staying On Top of Pain: It is very important to stay on a strict schedule of medication the first few days following your surgery. Getting behind on medication will result in more pain and may even make it difficult to catch up with pain control again.
  • Ice for Swelling: We want you to ice your cheeks for the first 24 hours following surgery, twenty minutes on and twenty minutes off alternating. Managing swelling can help greatly with pain management, and the act of icing may even feel good on its own.
  • Rest: Your body was expertly designed with high-tech systems in place to heal – but you have to give it the space and conditions to do so. Rest is one of the most important things you can do to help your body heal faster.
  • Salt Rinse the DAY AFTER Surgery: The day after surgery, you should rinse your mouth very gently with a mixture of one cup of warm water and ½ teaspoon of salt. You may do so up to 4 times a day. Designed to gently clean the wound site (but NOT dislodge the blood clot), some patients also feel that the warm water helps with pain relief.
  • Prescriptions: Most often, our patients do not require prescription pain medication post-op. However, in the case that we feel your case calls for such, please keep the following in mind:
    • Antibiotics – If we have ordered antibiotics for you, you must take them on schedule and for as long as we prescribe – Never stop antibiotic treatment prematurely without our specific orders.
    • Pain-Killers – In the event that you require prescription pain killers, please note that we are required to prescribe these sparingly and in accordance with certain laws, due to rising rates of substance abuse. You can help keep these drugs off the street by taking only what you need, and taking unused pills to a pharmacy for safe disposal – never “keep them around” in your cabinet for future use.

For more information, please visit our surgical instructions page and feel free to call us at San Francisco Office Phone Number 415-781-4725

Autograft Vs. Allograft

'woman smiling after receiving bone graft'So, you were recently told by your doctor that you need a bone graft, but you aren’t quite sure what that means.

A bone graft is a surgical procedure that is used to fix bones or joints that were damaged by trauma, and it is also used to replace bone that is missing to provide structural stability around the body, including the jawbone. There are many types of bone grafts we can use to grow bone – the two most common are autografts and allografts.

An autograft is a bone or tissue that is transferred from one spot to another on the patient’s body. It is often thought of as the “gold standard” in bone grafting because of its reliability. Its high success rate is due to the fact that it is living tissue and thus its cells are kept intact.

An allograft is a bone or tissue that is transplanted from one person to another. They typically come from a donor, or cadaver bone. The allograft is safe, ready to use and available in large amounts. The main advantage of an allograft is that it requires one less procedure than the autograft, which must first be taken from the patient. Surgical time is minimized and the recovery can be quicker. The allograft comes from a reputable and reliable tissue bank.

Knowing which bone-grafting option you will need can be confusing, but we are here to answer any questions you may have. Please schedule a bone grafting consultation with us by calling San Francisco Office Phone Number 415-781-4725. We will perform a thorough evaluation of your oral health. After our evaluation, we will recommend what bone graft is best for you. We are happy to discuss your options and answer any questions you may have. We want you feeling confident with our choice and worry free.

Oral Cancer Among Men to Increase in 2017

'man thinking about oral cancer'A recent study by the American Cancer Society reports that oral cancer cases in men is expected to increase in 2017 by 4%, while the rate of new cases among women stays the same year over year. “Oral Cancer”, which is a common way to refer to all head and neck cancers, involves cancer of the oral cavity, lips, tongue, pharynx and esophagus.

Unfortunately, oral cancers often go undetected until their later stages when they are more difficult to treat, giving them an even worse reputation than many other cancers.

Oral cancer is more likely in those who:

  • Drink Alcohol Excessively (more than 2 drinks a day for men and more than 1 drink a day for women)
  • Smoke or Chew Tobacco
  • Have HPV (certain strains of the HPV virus are known to cause oral and other cancers)

HPV and Oral Cancer

Along with the rise of HPV among men has come the rise of oral cancers as well. Unfortunately, it has now been estimated that half of U.S. men are infected with HPV. While most of these will not go on to develop cancer, certainly, these increases may continue to create a rise in head and neck cancers until the disease is brought under control.

What You Can Do

Prevention and detection are the most important things when it comes to the fight against oral cancer. With early detection, we can do better for survival rates and, as we have seen with general cancer cases, prevention in the form of abstaining from tobacco and drinking in moderation can reduce the number of cases over time. In order to protect yourself and your family and help us with survival rates, we urge you to see us for an oral cancer screening. It only takes a few minutes for us to examine you – and it could save your life.

For more information on oral cancer, call us at San Francisco Office Phone Number 415-781-4725 or visit


What? There are 3 different types of cleanings?
No, not really. 
There are actually 3 different procedures based on the health of your teeth and gums. The way we determine this includes:
   1. Measuring the space in between the gum and the tooth, as well as any recession around the tooth (you know- when we call out those numbers)
   2. Taking X-rays to see your bone levels
   3. Assessing the amount of bleeding present when we touch your gums 
Here’s the distinction between the 3 procedures and how we determine which which one is best for you.  
   In this category less that 30% of the mouth shows bleeding, and periodontal measurements are usually no greater than 3mm. Since there is no disease present, this procedure removes plaque, calculus and stain ABOVE the gum line. This appointment supports health–healthy gum tissue, healthy bone, and healthy teeth themselves. 
   Although the most common frequency recommended for this type of cleaning is every 6 months, there are some situations in which we may recommend a 3 or 4 month recall. 
   When bleeding and inflammation are present on the surface of the gums (gingivitis) for long enough, this bacterial infection can spread past the tissue and begin to destroy the bone that supports the teeth. This is now considered periodontal disease and the pocket measurements will read 4mm or deeper. We may also be able to see bone loss on your x-rays. 
   Once bone loss is present, the method required to remove the buildup and bacteria from UNDER the gums (and from root surfaces) is called Scaling and Root Planing. 
   So, rather than a “cleaning”, this is actually therapy to treat periodontal disease.
   Since periodontal disease can fluctuate from being stable to active again (depending on a number of factors) we will consistently clean any deeper areas that may recur, working BELOW the gum line to help support and maintain the stability of the treatment. The frequency of this procedure is usually recommended every 3 to 4 months.
So I guess you could say:
   1. Regular cleaning=above the gum line
   2. Scaling and Root Planing=therapeutic treatment to remove disease below the gum line 
   3. Periodontal Maintenance Cleaning=supportive cleaning above and below the gum line to maintain periodontal treatment
Feel free to ask us any questions you have and see you next time!
Lorna Smith, RDH


It’s time for your cleaning! Yes! Why am I so excited? I guess it’s because we accomplish so much in this short time together, it’s nothing short of a miracle. Ok, maybe not a miracle but definitely pretty great. 

So I thought you might like to know what’s behind the curtain, so to speak, when you come in for your hygiene appointment, and share some ideas with you that can help to ensure that your visit unfolds exactly as you like. 

So, you may think you are here for “just a cleaning” but it’s not just a cleaning to us. Here’s what really happens in that 50 min supercharged appointment!

-Review medical history, recording and discussing any changes, including doctor visits, medications, etc. 

-Discuss anything that might be bothering you in your mouth and do any diagnostic tests to gather information for Dr. Markle

-update any periodic and recommended x-rays

-perform an oral cancer screening and soft tissue examination

-check the condition of all teeth, existing fillings and crowns and take any intra oral photos or additional x-rays for Dr. Markle to view

-assess teeth alignment and bite in relationship to overall oral health

-record periodontal probing to aid in the diagnosis of gingivitis or periodontal disease and explain findings related to both oral health and the impact it may have on overall health. This includes measuring pocket depths, bleeding points, recession, furcations, mobility, etc.

-develop a dental hygiene treatment plan, present it to you, and review with the doctor

-administer nitrous oxide, if applicable

-perform oral prophylaxis (yeah, that’s the cleaning part-but it’s so much more!) 

-apply fluoride varnish, perform laser bacterial reduction or antimicrobial irrigation, if warranted

-polish teeth


-perform oral hygiene instructions and dispense and demonstrate any recommended tools

-clean retainers or night guards, if applicable

-periodic oral examination by Dr. Markle, if applicable

-answer any questions 

-assist you in making your next appointment, disinfect operatory, complete chart notes and sterilize instruments

-and my favorite part—-getting to know you and hopefully becoming more than your hygienist.

Whoa!! Seriously? That’s a lot, right? And I’m sure I left something out. 

But here’s the thing. We love the opportunity to provide you with the most detailed and comprehensive care available. And our goal  is for you to leave feeling like you had an excellent experience. 

And I believe that in order to make that happen for you, we need to be on time. Am I right? Because we know you have places to be!

So, in order to make the most of the time we have together, please let us know before the day of your appointment (as soon as possible, really) if there are any specific issues you would like to discuss with the doctor. The time with your hygienist is pretty much planned out to include all the above-mentioned, incredible services (thank you very much!) and we want you and Dr. Markle to have the time you both need, and deserve, to address anything unexpected or additional that has come to your attention. If you let us know in advance, we can allow time on his schedule as well, and it won’t interfere with the service we provide for you during your hygiene appointment.

Now we are talking about a well-oiled machine! 

As your dental team, we want  to offer you amazing dental health care and awesome customer service. We also want to be able to answer any questions, and for you to leave our office feeling like you had an excellent experience and are part of the family. 

Thanks for being our wonderful patients, and see you next time!

Lorna Smith, RDH 

Botox and Dermal Fillers in Dentistry

Dentists are uniquely qualified to help patients improve their smiles and maintain good oral health.  But did you know that specialty trained dentists, like Dr. Markle can also enhance the face to smooth and relax the muscles and skin? For example,  the lips can be gently enhanced to compliment your smile.  Fine lines and wrinkles around your nose, forehead and eyebrows can be smoothed and relaxed with Dermal Fillers and Botox combination treatments.  Ask us to help you evaluate your particular needs and develop a plan to keep your face and smile looking healthy and youthful.

Yes, You Still Have to Floss.

'woman flossing in mirror'The AP recently released an article making the claim that “there’s little proof that flossing works”. Their review cited a series of studies that found flossing does little or nothing to improve oral health.

Here’s the problem: the studies were flawed.

The AP concluded that floss does little for oral health, but it’s important to note that the evidence they cited was very weak at best. In fact, they said so themselves.

As acknowledged by the AP, many of these studies were extremely short. “Some lasted only two weeks, far too brief for a cavity or dental disease to develop” (Associated Press). They also say that “One tested 25 people after only a single use of floss” (Associated Press).

Of course the evidence is unreliable. You don’t simply develop gum disease because you forgot to floss yesterday. Cavities and gum disease do not happen overnight. You can prevent gum disease by maintaining a clean mouth over a long period of time. Wayne Aldredge, President of the American Academy of Periodontology explained: “gum disease is a very slow disease”. In his interview with the AP he recommended long-term studies which he believes would clearly show the difference between people who floss and people who don’t.

Lets put it this way: If a study claims drinking milk does nothing for bone health, but draws conclusions after only three glasses of milk, is it a reliable study? What do you think?

The fact of the matter is floss removes gunk from teeth. You can see it. Gunk feeds bacteria which leads to plaque, cavities, poor gum health, and eventually gum disease. Floss has the ability to reach the food particles that your brush can’t get to.

Aldredge also pointed out that most people floss incorrectly, using a sawing motion instead of moving up and around the teeth to clean the cracks. Positive results come from correct use and it’s critical that people learn to use a tool properly before discarding it as useless.

That’s just what floss is: a tool. Just like your toothbrush, it is designed to keep your mouth clean, and therefore keep your body safe from infection. Both your toothbrush and floss are designed to do what the other can’t, and both successfully remove bacteria from your mouth. Just like proper brushing technique, it is important that you know how to use floss properly, so that you can reap the long-term health benefits of good oral hygiene.

It’s a shame that studies on an important tool such as floss have yielded poor results, but it’s a bigger shame that the studies themselves were poorly designed. Oral hygiene is a long term process, and requires long term observations to make worthwhile conclusions. In the mean time, it’s obvious that you should continue to do everything you can to protect your well being, and floss is one of many tools that can help you do that. If you would like a refresher on the best, most efficient techniques for floss use feel free to call our office today at 415-781-4725!

March: Walking for Those Who Crawl

March of Dimes'baby crawling'
Premature babies are those that are born before the normal 37-week gestational period. These babies have various health issues, which can affect them over their lifetime. Sadly, some premature babies won’t make it – which is what March of Dimes aims to prevent.

What is March for Babies?
March for Babies supports the prevention and research of pre-term births through charitable walks in the month of March. The goal is to raise funds to help mothers give birth to healthy, full term babies while researching the possible causes and preventions of premature birth.

Why You Should Get Involved
Whether you’re a mother, father, kid, soon-to-be mother/father, know someone who’s been pregnant or is thinking about children – this affects you and you can make a difference. Becoming informed and learning more about premature babies is the first step.

How You Can Help
March for Babies makes it easy to help! Spread awareness about premature babies and encourage everyone around you to do the same. If you are interested in donating, rest assured that your money will go toward supporting premature babies through research into prevention and causes of premature birth.

You don’t need to donate money to help. Some other ways to contribute include:
• Getting informed by visiting the March for Babies website:
• Raising awareness
• Walking in a local event

Donate a Homemade Hat to a Local Hospital
If you can knit or crochet and are interested in hand-making a preemie baby hat, consider donating one to a local hospital! Local hospitals are always in need of hats for babies and you can take pride in knowing that you are keeping a baby’s head warm.

Will you help us get the word out?