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38 PATHOLOGY OF THE HARD TISSUES OF THE TEETH.
world. This endemic feature gives this description unusual nov-
elty. When I visited a number of susceptible areas during the
summer of 1909 I examined the children, and many of adult
age, myself. Great numbers of children seemed to be easily
gathered. It was quickly seen that the reports had not been
exaggerated. The settlement of these regions is comparatively
recent, and about half of the children were born and passed the
earlier part of their lives elsewhere.
I spent considerable time walking on the streets, noticing
the children in their play, attracting their attention and talking
with them about their games, etc., for the purpose of studying
the general effect of the deformity. I found it prominent in
every group of children. One does not have to search for it, for
it is continually forcing itself on the attention of the stranger
by its persistent prominence. This is much more than a defor-
mity of childhood. If it were only that, it would be of less conse-
quence, but it is a deformity for life. The only escape from the
deformity is by the placing of crowns, and possibly of bridges
or artificial dentures later in life.
SPORADIC CASES.
A few sporadic cases have been seen from different sec-
tions of the country which, in considerable part, simulate the
endemic cases. I have a photograph showing the upper incisors
of a person born and reared in Chicago which are much like
the endemic condition. There are also some white flecks on sev-
eral of the other teeth, but these are slight. Another case is
that of a boy who grew up on a farm in Indiana. The incisors
were badly marked with a dark band across their labial surfaces.
All of the other teeth were normal. I have seen two other spo-
radic cases of this character, but failed to obtain photographic
records of them.
DIAGNOSIS.
The diagnosis of mottled enamel is usually not difficult, as
the areas are generally most prominent on the labial surfaces
of the incisors, particularly the central incisors. (See Figures
40, 41, 42 and 43.) In studying these cases as representing an
endemic condition, it becomes important to associate the age
of the individual with the mottled areas on the various teeth.
Faults in the form or color of the teeth may occur from
errors in growth, or may occur from causes acting upon them
after the teeth have been fully formed. Any departure from
the normal in the enamel of the teeth, the dentin, or the form
of the teeth, from errors in development, must occur while the