Diagnosis of occlusal caries: Part I. Conventional methods

Accurate diagnosis of the presence or absence of disease is a fundamental requirement in health care. The diagnosis of non-overt occlusal decay is challenging and can be highly subjective, and its inherent uncertainties can lead to widely differing treatment decisions. The development of more sensitive, specific and reproducible diagnostic tools for occlusal surfaces would contribute greatly to more precise planning of preventive and operative therapy. The purpose of this 2-part paper is to review current knowledge concerning conventional and new diagnostic methods for occlusal caries. Part I looks at established diagnostic methods for occlusal surfaces. Conventional visual, tactile and radiographic examinations provide less-than-ideal diagnostic sensitivity. Neither fissure discolouration (black or brown) nor the use of an explorer has been shown to improve diagnostic accuracy. However, the combination of careful visual examination with optimal radiographic examination affords better diagnostic performance. The best visual indicators involve precise features associated with the presence of disease, such as opaque fissure demineralization and the presence and extent of localized breakdown of the enamel. For best results, teeth should be clean, thoroughly dry and well illuminated. Part II will examine new and emerging technologies, including the DIAGNOdent laser fluorescence device, which are being developed for the diagnosis of occlusal decay.