Clinical diagnosis of dental caries: a North American perspective

This paper summarizes current trends in the clinical diagnosis of occlusal caries in response to the RTI/UNC review and reflects the dilemma felt by many dentists who understand the difficulty in accurately assessing the extent and activity of pit and fissure caries in many of their patients. They are unsure if they should be aggressive in instrumenting suspicious lesions and provide small restorations, some of which may not be indicated. Alternatively, should they wait until signs are more clear-cut and provide larger restorations? Discussed here is the advantage of practicing dentists who obtain immediate false-positive feedback when they instrument a tooth with no clinical caries and false-negative feedback when a recall patient exhibits progression of an equivocal lesion. They should be encouraged to use this feedback as part of their diagnostic procedure and explain to their patients the difficulty of providing an accurate and precise diagnosis with existing tests.