Mottled enamel, despite its notorious undercalcification or imperfect calcification of enamel rods and cementing substance, is not more liable to caries than enamel that has been ” normally” calcified. This fact bears directly upon the concept, long and widely held, that one of the chief factors—perhaps the most important—in initiation of caries is the integrity or quality of enamel calcification.
The points or areas of carious attack, on mottled teeth, correspond with those on teeth of which the enamel is normal; namely, pits, fissures, and other stagnation areas. There is no general carious attack on other areas where enamel is imperfectly calcified. Caries supervenes, if at all, at interruptions in the continuity of the enamel surface in stagnation areas—not inherently because of any undercalcification. After caries has begun in a mottled tooth, it progresses in the same manner as in a tooth that is not mottled. Recent studies indicate that the attack-rate in mottled teeth may be below that in normal teeth. All the facts indicate that mottled teeth are not more liable to caries than are normal teeth. There seems to be some justification for a recent hypothesis that use of waters containing fluoride, which is now recognized as the causative factor in mottled enamel, may exert inhibitory effects on the active causes of caries.
Reference: Den. Cosmos, 71, 747, 1929.