Dr. Kristen Whetsell 

2020 got you down?  It’s fair to say that this has been a stressful year all around. Believe it or not, the effects of all this extra stress (working from home, zoom school, general background stress) are already showing up in our mouths. This added stress can often manifest as clenching and grinding our teeth, which is called bruxism. Bruxism is an extremely destructive condition of the mouth where the teeth are ground down by excess forces from clenching and grinding. This can result in pain in the muscles around the jaw, pain and tenderness in the teeth, and even headaches. It can also crack and destroy teeth to the point where they need root canals, crowns, or to be removed and replaced with an implant. Even a tooth that has never had a cavity can break from the stress of grinding!

When you see your dentist, they will look for signs of damage in your teeth and ask if you are feeling pain in your muscles. If you are noticing any jaw or neck muscle pain, sore teeth, headaches on waking, definitely tell your dentist! This can be treated with a splint, or guard. The guard is an appliance that you wear over your teeth to protect the teeth from the forces produced in grinding. It also takes the stress off your jaw joints and relieves sore muscles. It is usually worn at night but if daytime grinding is your problem it can also be worn during the day. It is important to see your dentist to be professionally evaluated and determine if a guard will help and which type to fabricate. Your dentist should also give you other tips and ways to reduce jaw pain. 

Bottom line, while we may not be able to eliminate the stress of 2020, your teeth should not have to suffer for it! Now more than ever it is important to be proactive in our health, and that starts with our mouths. If you are experiencing any of the symptoms described here, please let your friendly dentist know and see if they can help you!

Dr. Whetsell is very involved in the dental profession and is on the Board of Directors for the San Diego County Dental Society. She is also the New Dentist Committee chair. She has always had a passion for humanitarian work and has volunteered with UC San Diego Free Dental Clinic Project. She also participated in the USNS Mercy humanitarian mission in Southeast Asia in 2006. Dr. Whetsell values cultivating lifelong relationships with her patients. She believes that each patient should have personalized attention and that there is no one size fits all approach to dental health. She lives in North Park with her husband, Ian. She enjoys the active lifestyle living in San Diego offers and loves hiking, stand up paddle boarding, yoga, skiing and traveling. 

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As a pediatric dentist a question I am commonly asked by parents is, “when should my child get braces?”  Parents see children of all ages in different types of orthodontic appliances and begin to wonder if their child should be starting treatment as well.  This is a question that can only be answered if we look at the dental issues concerning each individual child.  For each child who will benefit from orthodontic treatment there is an ideal time for that treatment to begin but that time is specific to the child’s orthodontic concerns.

When To Get Braces

As early as the child’s first dental visit the pediatric dentist is starting to examine the child’s occlusion or bite and give the parents an idea of their child’s future orthodontic needs.  At a very early age we can begin to look for discrepancies between the growth of the upper and lower jaws, or if the teeth are in cross-bite, crowded or malpositioned. Some children will benefit from preventative orthodontic treatment even before all of their permanent teeth have erupted.  In some cases this care can be started as early as 4 or 5 years of age.  A growth discrepancy between the upper and lower jaws, known as an under-bite or over-bite, oftentimes will benefit from treatment which is initiated while the child is still growing in an attempt to modify the growth into a more favorable relationship.  Some children will be referred to an orthodontist around the age of 7 or 8 years old when they have a mixture of both baby teeth and permanent teeth.  The goals of treatment at this time may be to guide jaw growth, correct oral habits, lower the risk of trauma due to severely protruded front teeth, guide permanent teeth into the proper position, create space for the remaining permanent teeth to erupt into, align teeth to make home care easier, or to improve self-esteem.  Other children are able to wait until around age 12 when all of their permanent teeth have erupted before orthodontic treatment is initiated.

When timed properly, orthodontic treatment and a child’s growth can complement each other quite nicely.  In certain situations, early orthodontic treatment can prevent more extensive or complicated treatment later.  Although it will be the decision of the orthodontist and the parent as to when a child’s orthodontic treatment will begin, as the primary dental care provider, your pediatric dentist will be monitoring your child’s growth and development and making recommendations as to when an orthodontic consultation should take place.

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Infants Should See a Pediatric Dentist before their 1st Birthday

Many parents are surprised to hear that their infant should visit the pediatric dentist before their first birthday to insure their child the best smile possible.  Parents can expect this initial visit to include an oral exam with additional emphasis on developing a plan to support the child’s healthy oral development.  At the child’s initial visit healthy dietary and oral hygiene habits will be discussed.  At the same time, we will check for early childhood caries, also known as baby bottle decay.  This condition can be detected as early as the first exam if unhealthy dietary habits such as frequent snacking on sugary foods and prolonged bottle feeding are occurring.   

Until the child can tie his or her own shoes, they do not have the dexterity to brush their own teeth effectively; therefore, an adult should assist the child with both brushing and flossing if appropriate.  Fluoride toothpaste can be used once the child can rinse and spit which is usually around two to three years of age.  Some water supplies are not fluoridated and a pediatric dentist can determine if an adequate amount of fluoride is being obtained through alternative sources or if fluoride supplements would be beneficial.  

Many other topics can be addressed at a child’s first visit such as pacifier and thumb habits, and growth and development.  Parents will be informed about their child’s future needs regarding early or preventive orthodontic care.  

As parents know all too well, as a child learns to walk and explore their surroundings the chance of oral trauma inevitably increases.  Emergency dental care can be provided more comfortably if a relationship with a pediatric dentist has already been established.  

At the Smile Shop our patient’s first visit begins with a tour where we introduce both the parents and the children to our friendly, fun, and inviting office designed specifically for children.  The child will have their picture taken for the parents to take home to remember the first of many more happy visits to see the dentist.  They will then meet the dentist and will either sit in the dental chair or in the parent’s lap depending on their child’s comfort level.  After seeing the dentist, an oral hygiene instructor will see the child and demonstrate proper brushing, lending some advice to make brushing at home easier, more enjoyable, and more effective.  A pediatric dental office is full of smiling people who are very comfortable working with kids and have many skills to make the visit easy for the parents and exciting for the children. 

  Our baby teeth play a vital role in chewing, speaking clearly, guiding the eruption of our permanent teeth and allowing children to smile with confidence.  When we see children early we have a much better chance of preventing many dental problems.  Infant oral exams are intended to get the child on the right path for a lifetime of healthy smiles.

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It’s been a stressful several months. Amid the global COVID-19 pandemic, it’s been tricky to stay on top of our normal routines, and dental care is no exception. Brushing and flossing your teeth at home remain a critical part of maintaining good dental hygiene.

With no end in sight for Coronavirus concerns, dentists are reporting a new phenomenon linked to the increase in stress: cracked teeth. 

Day and night

Cracked teeth can be caused by grinding your teeth or clenching your jaw. Many people do this at night without knowing it due to stress or conditions like sleep apnea. To prevent further gum and enamel damage, dentists will often prescribe a mouthguard or retainer.

Since the COVID-19 pandemic, dentists are noticing increases in cases of cracked teeth, and stress is the underlying factor.  Increases in stress also leads to clenching and grinding teeth during the day. 

A San Diego dentist noted that before the COVID-19 pandemic, his office was treating a couple of patients with cracked teeth per week, but now they are treating those patients a couple times per day.

More than meets the eye

The uptick in patients with cracked teeth can also be linked to other indirect factors of the pandemic.  People are out of their daily routine: brushing and flossing habits are more lax and  snacking and drinking habits have changed. All of these factors have led to patients coming into the office with new presentations atypical of pre-Covid dental findings.. 

Safety first

In addition, because of the shelter-in-place order that took effect in March, many San Diegans missed their regular appointment and fell off of their routine care schedule. Approximately 12% of patients are still reluctant to reschedule dental appointments and await a medical breakthrough like a vaccine Now, over six months later, we know so much more about COVID-19, how it spreads, and how to keep our patients and staff safe.

 The mouth is the window to your body health. Check ups with your dental team  focus on preventative measures and are vital to keeping up with our overall health. Preventative healthcare signals changes in our health and even alerts healthcare professionals to other underlying health conditions. As time goes on, dental issues only become more severe and solutions become more complex to treat. It is beneficial for you and your family to schedule and attend routine dental appointments to ensure we are minimizing the need for invasive treatments

We miss you at 4s Pediatric Dentistry

We look forward to seeing you soon at 4s Pediatric Dentistry. Book your appointment today at https://4spediatricdentistry.com/xwp/ or call us at


Please take note of our COVID-19 precautions to keep both you and our staff safe and healthy https://4spediatricdentistry.com/xwp/covid19

Read more about our Text2chair protocol https://4spediatricdentistry.com/xwp/covid19

Clean Teeth During Halloween


Halloween is approaching fast! While Halloween may look a little different this year, we’re certain candy (and lots of it) will be involved in this year’s activities so we wanted to put together some tips you can follow to insure you and your children have a dental safe Halloween! 

“The Dental Team at 4s Pediatric Dentistry Says Have Fun And Brush Well!”

Whether you have kids or not, Halloween is the season for sugar consumption. Candy seems to be available everywhere you look. Your workplace, your child’s school, your home, the bank. And when Halloween does finally arrive, the average kid will wind up consuming about 675 grams of sugar, on just that day! That’s like eating 170 sugar cubes which is why it is important to take steps to protect your teeth even on Halloween. 

“Sour candy adds another level of harm to gummies because they are both sticky and acidic. Although it’s extra tasty, eating a lot of this candy can cause tooth enamel to break down or weaken, leading to cavities,” Dr. Spencer Mauseth said.

Here are some tricks for handling the treats, and protecting your teeth, and your dental health this Halloween season!

  1. Stay away from sticky treats! In addition to how often you snack, the length of time sugary food is in your mouth plays a role in tooth decay. Unless it is a sugar-free product, candies that stay in the mouth for a long period of time subject teeth to an increased risk for tooth decay. The stickier candies, like taffy and gummy bears, also take longer to get washed away by saliva. If you do choose to consume sticky treats on Halloween, be sure to brush your teeth thoroughly once you’re done. 
  1. Chew more gum. A great alternative to candy to consider is gum. Studies show that chewing sugar-free for 20 minutes after meals helps reduce tooth decay, because increased saliva flow helps wash out food and neutralize the acid produced by dental plaque bacteria.
  2. Watch your beverages. Sweet, sugary beverages are often a staple of Halloween.When teeth come in frequent contact with beverages that contain sugar, the risk of tooth decay is increased. If you’re planning on consuming sugary beverages on Halloween be sure to rinse your mouth out afterwards with some water (water with fluoride would be even better) or mouthwash and brush your teeth! 
  3. Incorporate candy with meals. Eat Halloween candy (and other sugary foods) with meals or shortly after mealtime. Saliva production increases during meals. This helps cancel out acids produced by bacteria in your mouth and rinse away food particles.
  4. Find alternative to sweet snacks. Snacking can increase your risk of cavities, and it’s double the trouble if you keep grabbing sugary treats from the candy bowl. Instead of your go to sugary snack, replace it with a healthier less sugary snack like fruits, vegetables or pretzels. 
  5. Choose your candy wisely. Avoid hard candy and other sweets that stay in your mouth for a long time. Aside from how often you snack, the length of time sugary food is in your mouth plays a role in tooth decay. Unless it is a sugar-free product, candies that stay in the mouth for a long period of time subject teeth to an increased risk for tooth decay.
  6. Have a post-Halloween plan for candy consumption. We all know that Halloween candy lasts longer than Halloween day so make sure you have a plan in place for yourself and your child for consuming all of that post Halloween candy. Encourage the practice of brushing your teeth after meal and excessive candy consumption to promote healthy teeth in your household. 
  7. Drink more water. Drinking more water  and water with fluoride can help prevent tooth decay. If you choose bottled water, look for kinds that are floriated.  
  8. Remember to brush. Brush your teeth twice a day for two minutes with an ADA-accepted fluoride toothpaste. Remember, replace your toothbrush every three or four months, or sooner if the bristles are frayed. A worn toothbrush won’t do a good job of cleaning your teeth.
  9. Floss! Floss your teeth once a day. Decay-causing bacteria get between teeth where toothbrush bristles can’t reach. Flossing helps remove plaque and food particles from between the teeth and under the gum line.

Needing some alternatives to your go-to Halloween snacks? Here is a list of snacks to avoid, better options, and the best options for you and your child’s teeth!

Snacks to Avoid 

These are the chewy, sticky, candy that gets stuck in the grooves and crevices of your teeth making it hard for saliva to flow and flush out your mouth which can lead to tooth decay. Sour candy has a high acidity content which can break down the enamel and lead to tooth decay. If you choose to consume these treats on Halloween be sure to implement the tricks above like brushing your teeth and flossing  so that you can have a healthy – cavity free Halloween!

Better Choices 

Better snack choices for Halloween include milk chocolate, fruit, and snack-sized packages of pretzels and crackers. These options are less sticky and do not have high acidity and are therefore less harmful to your teeth than gummies, caramel, sour candy, and bubble gum! Even though these are better options, it is still important to limit the consumption of these snacks because proper teeth health is less on what it consumed and more on how often you consume it. Be sure to implement the tips above if you are planning to consume these treats as well. 

Best Choices 

Dark chocolates contain antioxidants that can hinder bacteria from sticking to the teeth, battling tooth decay and preventing infections in the gums. Sugar-free gum made with the ingredient xylitol promotes the growth of tooth-protective, non-acidic bacteria which can make it nearly impossible for bacteria and plaque to form on the teeth. While these are some of the best alternatives to your typical candy consumption on Halloween, we still recommend that you implement the tips above to help promote health teeth, prevent gum disease and tooth decay. 

Halloween is the season that brings out the inner kid in all of us and it’s the time of year when it’s going to be practically impossible for most of us to stay away from the candy and other sugar-filled treats.  Rather than forgoing the sweets altogether, just try to incorporate some of these tips over the next few weeks to protect your teeth and promote healthy gums. 

If you need a tooth fixed, or your teeth cleaned, or a fluoride treatment during, or after, Halloween be sure to schedule a visit online or call us at . Have a safe and happy Halloween from all of us at Insert Dental Practice name! 

Experts say COVID-19 spreads mainly from person to person. When we cough or sneeze we produce respiratory droplets that can reach people in our immediate surroundings (ex: 6ft radius). Such droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs. Social distancing is one of the most popular infection control method, however, there are more ways to prevent catching this virus:

Cover coughs and sneezes and avoid touching your eyes, nose, and mouth
Wash your hands often especially after coughing and sneezing
Stay home if you’re sick and avoid close contact with people who are sick
Cover your mouth and nose with a cloth face cover when around others
Clean AND disinfect frequently touched surfaces

Recent studies suggest that COVID-19 can you can still spread the virus even if you are not showing symptoms. No vaccine exists for this virus so the best way to prevent infection is by avoiding unnecessary contact with others and following the advice above.
Source: CDC

Many of you are already familiar with Teledoc services through your Medical Provider. Our Team is excited to announce the launch of TeleDentistry Services. This service will allow you to connect with a Dentist from the comfort of your home in a few simple steps.

1. Visit our website. Our team is available 24 hrs a day via live chat to help answer your questions.
2. Schedule or receive an invite to our virtual waiting room for dental consultation.
3. Connect with a doctor via live video.

In adjusting to the new times, new technology enables us to better serve our patients. Virtual consultations allows us to connect you to a Doctor for all types of dental consultations.

Emergency Treatment: TeleDentistry will allow us to better screen, triage and determine if you need to be seen in office.
Cosmetic & Elective Treatment: TeleDentistry will allow us to answer your questions on Implants, Veneers, Invisalign or any basic dental questions you may have.
– Second Opinions: TeleDentistry will allow us to review treatment plans. You may share your patient files and x-rays during your virtual consult to discuss your treatment options.

Similar to Teledoc consultations, your TeleDentistry consultation is likely covered by our insurance plan, is secure and most importantly it’s HIPAA compliant!

Even pediatric dentists’ kids get cavities.

A few weeks ago I got busy, like all of us do, and had to move my own kids’ dental appointment. Now I’m kicking myself because the COVID closures forced me to further delay our routine visit. Even with a pediatric dentist dad, my kids have gotten cavities. It happens.

We started coming in more frequently for cleanings and fluoride application to strengthen their teeth and gums. I wanted to keep their risk for problems low and make sure their oral health was optimal.

But now I find myself waiting on routine care for the next few weeks until we reopen for regular care. Already I can see the changes in my children’s mouths, which worries me because as a dentist, I know all too well that the mouth is a window to the body, reflecting my kids’ overall health.

Here’s what I’m doing to help prevent decay and slow down chronic diseases from developing:

  1. Floss. If I had to choose just one thing to do for my kids’ oral health, it would be to floss! Floss helps slow down decay from developing between your teeth and helps prevent gum disease. Believe it or not, his is more important than brushing. Healthy gums and bone are what hold your teeth in!.
  2. Rinse with fluoride mouthwash. You can pick up ACT brand mouthwash on your next grocery run. Bubblegum is our favorite flavor. The fluoride helps form a “shell” to protect enamel from attack by bacterial acids.
  3. Minimize processed carbohydrates. I love a good handful of Cheez-Its and Goldfish crackers as much as the next person, but they can wreak havoc on your teeth. They feed bacteria exactly what they want and stick to teeth in ways that are hard to clean. This really activates the bacteria creating adverse conditions in your mouth. If you do find yourself indulging, try to brush immediately afterwards and don’t graze throughout the day. Drinking lots of water also helps to offset the acid challenges from snacking.
  4. Brush your teeth an extra 30seconds. We normally recommend 2 minutes, but when you go past your regular care date, your mouth is likely to be building up plaque and debris faster now. Once some buildup in your mouth starts, it gains momentum and hardens, making it even more difficult to remove.
  5. Eat healthy, exercise, and try to reduce stress. The body is an interdependent system that is healthier when all of its parts are well. Science has shown the increasing importance and linkage between your overall well being and oral conditions.

Hang on! As soon as our association clears the way, we will be back to help you maintain your oral health. In the meantime we continue to be accessible with emergency care and teledentistry consultations. We remain committed to our community and expect elective care to open up soon!

About the Author

Dr. Chris L. Pham is a board-certified pediatric dentist serving the children of San Diego. Dr. Chris is an active member of the American Dental Association, California Dental Association and has served as president of the San Diego County Dental Society. Dr. Chris has two sons: Carlton (5) and Timothy (6).

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