fissure caries is more difficult to accurately diagnose
than smooth-surface caries. Errors are made when a
sharp explorer sticks into normal anatomy and gives
a clinician the feel of caries when none exist (Figure
2–2). Hence, the profession is reevaluating the
methods of detecting pit and fissure lesions and
questioning the adequacy of the explorer to probe
for caries.1,2,12–14,17 Fluoridation makes it difficult to
distinguish a surface stain in enamel from a darker
organic plug that can promote caries within a pit or
fissure. In addition, fluoride-containing enamel is
stronger and less likely to fracture and collapse than
is nonfluoridated enamel, even when undermined
by carious dentin.12 The appearance of strength
makes detecting diseased dentin more difficult. A
very thin, very sharp explorer (eg, a sharp Suter No.
2) may stick in these grooves. Clinicians also look
for color shifts through the enamel. If the color is
darker than the surrounding enamel, caries should
be suspected.33 Studies question the effectiveness of
radiographs in diagnosing pit and fissure caries,
because the decay is hidden by the sound enamel,
and the current emphasis on reducing exposure to
radiation has resulted in less film contrast.12,28 To
improve detection, clinicians should dry radiographs
well and view them under high magnification.
Mounting films and projecting them onto a large
screen helps detect early-stage dentin lesions. Digital
radiographs are easily magnified, and specialized
software can enhance image reading.