Occlusal pit-and-fissure caries diagnosis: a problem no more. A science-based diagnostic approach using a laser-based fluorescence device.

The subject of occlusal pit-and-fissure caries diagnosis elicits controversy and multiple opinions, depending on the clinician being questioned. The literature, however, points to which direction the profession should be headed in this field, as did the views expressed by the National Institutes of Health's "Consensus Development Conference on Caries Prevention and Management," held in March 2001, showing the need for more diagnostically specific caries management protocols and methods. Many clinicians have been surprised by the extent and severity of the carious involvement of a specific tooth, particularly when radiological as well as clinical examination indicates that little or no carious process should be present. It is unfortunate that at the stage when an explorer finally detects an occlusal catch, the degree and extent of demineralization and compromised tooth structure is already far advanced. This leads to the removal of large amounts of tooth structure to achieve a functional restoration. The consequential structural weakening of the tooth could have been prevented if the carious lesion had been detected earlier in its clinical course. Finite, quantitative, and reliable early diagnosis of carious occlusal lesions has remained elusive until now. Intercepting the carious process at an early stage leads to a conservative cavity preparation that preserves sound tooth structure and increases the structural integrity of the tooth. This article reviews the literature related to this topic and describes a relatively new diagnostic methodology that uses a laser fluorescence device (KaVo's DIAGNOdent). It is hoped that this article will serve as a catalyst for adopting a science-based approach to detecting and diagnosing occlusal pit-and-fissure caries at an early stage. The cases presented demonstrate the clinical efficacy and simplicity of this method of caries diagnosis, as well as show how invasive and destructive this "hidden caries" phenomenon can be.