The problem of occlusal caries and its current management

Occlusal caries has become relatively more important, due to the changing pattern of dental caries that has occurred in the developed countries of the world. Accurate diagnosis of the activity of a carious lesion is important, because arrest and remineralization are possible. Diagnosis of occlusal caries is difficult due to the morphology of the occlusal surface. Unfortunately, topical action of fluorides is thought to be making diagnosis increasingly difficult. The literature suggests that we should be examining for caries under good lighting and a dry field, the use of a blunt probe being reserved for gently removing debris from fissures to enable good visualisation. Bitewing radiography is valuable in the detection of occlusal as well as approximal caries, but good radiographic technique and careful viewing are essential. Electronic caries detection may well prove useful in the future. The traditional restorative approach to occlusal caries resulted in inconsistent treatment decisions, poor durability of restorations, and the unfortunate consequences of replacement restorations. It seems logical to take a more conservative, preventive approach in the management of dental caries. Fissure sealants should be used preventively for the caries-prone patient, and therapeutically for the suspect or early carious lesion. Where the caries has spread into dentine, as shown radiographically, then the sealant restoration may be more suitable. These techniques have been shown to be safe and effective, although careful case selection, appropriate manipulation of materials, recall, and maintenance are essential to long-term success.(ABSTRACT TRUNCATED AT 250 WORDS)