Tools

The traditional method of detecting caries signs is by visual inspection of dental surfaces, with the aid of a bright light and dental mirror, if necessary, to see the teeth from all angles. Reflecting light onto the mouth mirror also can be done to search for underlying dark shadows that could indicate dentin lesions.

For more than a decade, the use of sharp dental probes in clinical examinations has been challenged as an unsuitable method for evaluating dental lesions.^21,22 The pointed tip of these probes can potentially cause irreversible harm to demineralized enamel, leading to the formation of cavities.⁸ While the use of a dental probe continues to be controversial, it is extremely helpful when used correctly and judiciously. A dental probe can be used to remove plaque that may be covering lesion, and when the blunt side of the probe is used, it can help remove biofilm to check for signs of demineralization and to assess the surface roughness of a lesion. The accuracy of caries detection does not increase if probing is used. A probe is unnecessary if visual inspection detects a cavity.²⁰ During a visual-tactile examination, the dentist will also use a syringe or drying tool to blast air on to the tooth, which makes it easier to see some lesions.¹¹

Despite these concerns, many general dentists continue to rely on sharp probes for tactile assessments.²³ As a safer alternative, the use of a ball-ended explorer has been recommended for caries evaluation. While sharp probes may provide better differentiation of surface roughness, the ball-ended explorer is considered a safer option due to its rounded tip, which minimizes the risk of enamel damage. ^24,25

Other tools used in visual–tactile examination may include magnifying devices to look at teeth, or orthodontic elastic separators to separate teeth over the course of 2 to 3 days for a closer look between teeth prone to caries lesions. Fiber-optic transillumination is also sometimes used. This is a method by which visible light is emitted through the tooth using an intense light source. If the transmitted light reveals a shadow, this may indicate a carious lesion.