The clinical diagnosis of occlusal caries: a problem.

The problem of the diagnosis of occlusal caries is discussed on the basis of a pilot study. Out of twenty-six selected molars and premolars with a virtually intact enamel cover, twenty were found to be affected by occlusal caries extending into the dentine. In six cases in which the enamel was covered by a sealant, dentinal caries could not be excluded. Two teeth had a sound enamel surface in spite of the presence of much dentine caries. The bitewing radiographs of these cases showed a distinct radiolucency. Until it becomes possible to diagnose occlusal caries more effectively, the combination of bitewing radiograph and clinical examination with mirror, light, and probe is to be regarded as optimal. The dentist in general practice should keep in mind that even a tooth classified as clinically sound may contain extensive dentinal caries. The prevalence of this form of caries should be investigated further, and the search for better diagnostic aids should continue.