DR. M.Z. RIZKALLAH DDS MSD PC

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30 College Ave.  AT DAVIS SQUARE  617.591.9999

Bite Equilibration

BITE EQUILIBRATION: UNDERSTANDING ENAMEL MATURITY

We live in a funny Society. Our society likes words like “organic and natural.” We are bombarded by television ads that say “protect your enamel” and “protect your gums”….by buying (of course) our toothpaste product. This is misleading.

The misleading part of it all is that there are certain procedures that a dentist and orthodontist must do to provide you with “organic and natural” shapes to your teeth, and “protect your enamel” and “protect your gums” that will surprise you.

What procedure am I referring to? Reshaping (Maturing) of your enamel!

QUESTION 1: How can grinding my enamel help me? You are removing my enamel….don’t I need that to protect my teeth?

ANSWER 1: Moderate Grinding of enamel during adolescence is actually a process that IS NATURAL AND ORGANIC that humans should do themselves if they are developing properly.

Parents often come in when children are developing their adult teeth and say “Doctor, my son is grinding his teeth all the time….what do I need to do to stop this.” My answer is to look in the mouth and try to understand just what the child is grinding. If the child is grinding strange shapes of their teeth to make them normal, I tell the parent that the grinding is normal….and don’t worry about it for now……it should pass once the teeth have fully erupted into the mouth. If, however, the grinding is excessive, I will look more closely and identify solutions.

The subtle point here is that some children do not grind at all, and so they develop bite problems because they have not “naturally and organically” adjusted their teeth to fit by reshaping their enamel themselves. In these instances, the role of the dentist or orthodontist is to remove these areas (called “prematurities” because the enamel shape has not matured to normal).


QUESTION 2: Does removal of my enamel “prematurities” predispose me to tooth decay?

ANSWER 2: Enamel “prematurities,” by definition, should be matured to create a healthy set of teeth. You are born with an excess of natural enamel, some of which is supposed to be naturally removed in order to produce a healthy bite. If your enamel is not matured, the shapes will cause functional problems that will lead to “enamel breakage” rather than “enamel maturity.”

The impact of removal of enamel prematurities does NOT predispose a person to decay, for many reasons. FIRST, decay does not occur on the surfaces (tooth edges) where prematurities exist (Decay occurs in pits and grooves of teeth, and between teeth). SECOND, decay is a matter of oral chemistry, not enamel thickness. If your oral pH stays above pH 5.5, you will not develop decay. Google the “Stephan Curve” to learn more on mouth pH and cavities…..it is one of the most misunderstood concepts in dentistry. I will be writing an article on this, so keep an eye out in the “Patient Education” section of this website.


QUESTION 3: What if you do not “mature” the enamel shape by removing the “prematurities.”

ANSWER 3: The impact of not correcting the shape of the teeth is devastating to oral health! If a patient’s bite is not equilibrated (teeth and jaw joints in balance, with no single tooth being overly stressed), they tend to develop enamel breakage, gum recession, TMJ breakdown, and unstable results after orthodontic treatment.

The AES (American Equilibration Society) is a national organization dedicated to the impact of bite prematurities as it relates to Temporomandibular Joint Disorders (TMJ) http://www.aes-tmj.org/

The dental literature, orthodontic literature, periodontology literature, and endodontic literature is filled with studies showing the importance of occlusal equilibration (enamel reshaping) to protect the teeth from breakdown.

QUESTION 4: My orthodontist did a beautiful job straightening my teeth and bite, and I have been wearing my retainers religiously, but now that I have been out of braces for a few months, my bite feels weird and I feel like my teeth are shifting when I don’t have my retainer in.

ANSWER 4: The role of the orthodontist is not complete when braces are removed. Bite “settling” and adjustment of prematurities should still be monitored and managed by your orthodontist.

The bite “settles and perfects” after a few months after braces are removed. As the bite settles, you will need a followup appointment to allow the orthodontist to identify any areas that of “prematurities” as the teeth settle into the bite. These “prematurites” need to be “matured” to allow the dynamics (right, left, and forward movements) of the bite to not overly stress a tooth. Excessive forces from the bite on any single tooth will cause that tooth to move. So if your teeth seem to be shifting (presuming you are wearing your retainers as prescribed), you should please visit your orthodontist and ask for an occlusal equilibration to remove any dynamic prematurities. This is very important.

QUESTION 5: My teeth grew in with THREE little bumps on the edges of each tooth that I don’t like. Can I have these THREE bumps removed?

ANSWER 5: Those are called “Mamelons.” Yes. They can be removed.

The THREE Mamelons on each tooth are areas of “unorganized enamel” (meaning mineralized but not crystallized) areas that represent the location of initial tooth mineralization (crystallization occurs a short distance away from these mamelon regions). They are usually very soft unorganized areas of enamel crystal that wear and dissolve off of the tooth a few months or years after the tooth erupts into the mouth (around 7 – 12 years old). Prior to 1945 (when water fluoridation was initiated in modern countries), the mamelons of children naturally wore/dissolved away to leave the final naturally beautiful and functional form of the tooth. After 1945, water fluoridation caused these “unorganized” areas of enamel to become hardened by fluoride, and so these unattractive and dysfunctional shapes disallowed natural wear patterns to allow the tooth shape to “mature” the teeth, and humans now often have these mamelons well into their adulthood, and even for their whole lives. While Water Fluoridation is a wonderful public health benefit, it has unintended consequences, such as Mamelon persistence and greater prevalence of enamel prematurity.

Removal of Mamelons is OPTIONAL if they are only causing esthetic problems. But if they are causing any functional problems, they should be removed to protect the teeth and jaw joints from unusual bite dynamic stresses.