Some Facts About Mottled Enamel

Children’s Diseases Bring Mottled Teeth

Acids from Bacteria and Mucous Gland Deposits at

Gum Line When Illness and Tooth Eruption

Occur Together are the Mechanism

Says Dr. Carvell O. Fossum in



                A smile is as pleasant as it should be flattering, but, unfortunately the chromogenic disfigurement of mottled teeth is disgustingly exposed with a smile. Radio advertising has made the public more conscious than ever of this situation.

Since my child may be subject to the curse of mottled teeth the dentist should acquire a true working knowledge of tooth mottling, and its causes.

The ineffective theories in the past regarding the cause or causes of mottled enamel have developed a bunglesome form of treatment and effacement, the porcelain jacket crown. This restoration is at least a poor practice when employed as “treatment” for mottled teeth.

The logical and only effective treatment is to bleach the stained tooth areas, effecting a permanent and effective obliteration. This procedure is obvious when we correlate the causes of mottled tooth enamel and the histology of the tooth.

                Briefly, a tooth is created through calcification, or impregnation of lime salts into the albuminous medium of the tooth tissues, in the process of its construction. This lime being obtained from organic sources through the digestive process, is carried to the tooth constructive cells in a colloidal form, where it is regularly fixed into microscopic crystals—each tooth differing only “en masse” and in hue.

Since crystallization always assumes a definite character with invariable regularity, any talk of the effect of heredity on tooth enamel structure is inane. At the instant of enamel crystallization, all communication with nutritional sources are severed. Thus, any discussion as to the effects of nutrition thereafter in the tooth enamel would not be founded upon fact.

Acid is the only factor that will affect the surface of a tooth. This, plus the permeability of the tooth enamel at the time of eruption, can cause fixed interstitial—enamel surface, discoloration defects; such as mottled enamel when certain health disturbances take place.

A health disturbing germ colony and its correlative acid waste matter together with excreta from the mucous glands may occur at the tooth eruptive areas due to some primary childhood health disturbance, such as disease of the respiratory tract, together with any of its appendages, or any of the exanthemata diseases, such as varicella (chickenpox), measles, typhoid fever, and others. Then, that eruptive gum area which acquires that acid reaction, will etch lines of individualistic demarcations on the tooth enamel parallel with the gum-line at time of tooth eruption. And, this is especially true where such colony-mucous excreta remains undisturbed for a reasonable length of time, by the saliva or the tongue, influences which usually prevent enamel mottling on the lingual surfaces.

                Mottled teeth in comparison to teeth with decalcified surfaces due to acid drinking-waters, have parallel markings with the gum line at time of tooth eruption. The mottled areas are tinted and marked in various aspects. Certain teeth are mottled only. The mottled ones are usually paired if eruption has been normal. The mottled tooth areas are quite natural in resistance, by comparison to the remaining portions of an affected tooth, or unaffected ones. Mottled areas are just as caries immune as unmottled areas—except when measles have caused stained pits. Mottling never takes place after teeth are fully erupted, but can take place during the periods of eruption in deciduous or permanent teeth. And, not all of the teeth in a mouth, nor all the members of a family are necessarily affected, as is more or less the case with acid drinking waters.

Observation discloses that certain diseases at certain periods of tooth eruption, cause certain types of true mottling, as attested by the parent for interpretative correctness. Observation discloses that water cannot account for individualism, either in tooth area affected, or family members so affected. Nor can acid waters account for parallel demarcations with the gums, in their various tinted aspects.

                Observation discloses that twins have exactly similar mottled areas, of a similar pattern and tint, upon exactly the same teeth, with broadness of bands affected similar—providing of course, they both had the same sickness at the same time, which is the usual case with twins.

Observation is South Dakota discloses endemic areas in regions where childhood hygienization was is far below the average such as areas where certain foreign nationalities predominate. These area areas noted for lack of general as well as oral hygiene, and, where children’s diseases are very prevalent.

Removing acid drinking waters will of course prevent tooth decalcification from this source. Preventing childhood diseases during the periods of tooth eruption will prevent tooth mottling. A precautionary method is to paint all bucco-labial tooth surfaces of all erupted teeth, at the gum line, with some adhesive water resisting paint or varnish, several times during the sickness siege. It should be applied under the free gum margin especially.

Carvel O. Fossum, D.D.S.,

Aberdeen, S.D.


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