Occlusal caries diagnosis: a changing challenge for clinicians and epidemiologists

The diagnosis of occlusal caries is an integral part of an epidemiologist's task, whether carrying out cross-sectional national caries prevalence surveys to assist with planning and the evaluation of service provision, or clinical trials of caries preventive agents. Similarly, the clinician also carries out this same overall diagnostic procedure in order to plan care for individual patients, although he/she will usually have access to improved facilities and diagnostic aids. This paper reviews the different problems now being encountered by both epidemiologists and clinicians in the face of changes in the presentation of the disease at this site and the qualifications which should now be appreciated when extrapolating from the results of surveys employing comparatively gross criteria. It explores recent developments in diagnostic aids and makes suggestions as to how further information might be obtained in future which would aid the valid comparison of diagnoses made by these two groups of dentists.