2-16. ENAMEL HYPOCALCIFICATION
Defective development of the enamel matrix may cause hypocalcification. This
implies a poor quality of enamel, although the amount is normal. The enamel may be
chalky, crumble easily, and contain white or brown areas or spots. Dental fluorosis is a
form of hypocalcification.
2-17. MOTTLED ENAMEL
Mottled enamel (figure 2-15), also called dental fluorosis, is a form of enamel
hypocalcification which results from the ingestion of excessive fluoride during the period
of enamel formation. To cause mottling, fluoride must be present in concentrations
several times that found in controlled fluoridated water supplies. The mottling of enamel
varies in extent and severity, depending on the amount of fluoride in the water and how
long it was routinely used. In mild cases, the enamel is opaque but of good structure.
In severe cases, it may be chalky and crumble easily. The area of involvement varies
from spots on a few teeth to extensive mottling of many teeth. The mottled areas may
have a white, opaque appearance or they may have a stained appearance ranging from
yellowish-brown to dark-brown. This condition is significant because it makes teeth
unsightly. Superficial bleaching and acid etch composite may be used to correct the
condition. Severe cases may require porcelain veneers or crowns.
When teeth are discolored by fluoride, treatment may be required to improve
Figure 2-15. Mottled enamel.