4.2 Caries Diagnosis

Location and Quality of Stained Fissures

The dentist should note the location and quality of stained fissures on the patient’s record and should plan treatment accordingly. Coalesced or shallow pits and fissures may be left alone in patients at low or moderate risk for dental caries, but shallow pits or fissures should be sealed in patients at high or very high risk. Uncoalesced or deep pits and fissures should be sealed on newly erupted teeth.

Pits and fissures should be assessed for chalky color changes and shadowing to rule out the presence of larger subsurface lesions. Non-cavitated lesions should be sealed. Cavitated lesions may be restored with traditional techniques or techniques that minimize removal of sound tooth structure, such as preventive resin restoration (PRR), depending on modifying factors and clinical circumstances. (For more information about PRR, see “Pit-and-Fissures Caries.”)

When restoring a pit-and-fissure lesion, the dentist should assess the depth and type of the lesion encountered and adjust the diagnosis and treatment of lesions in other teeth accordingly. For example, upon preparing to place a restoration, a dentist may find that the lesion is not active, that progressive caries barely extends into the dentin, and that the dentin, although discolored, is hard. In this case, smaller lesions that have not yet been treated should be sealed rather than restored. Conversely, if a lesion that the dentist thought was small and planned to treat with a PRR turns out to contain a large amount of soft dentin, the dentist may need to reevaluate the patient’s other lesions.

The dentist should note these findings in the patient’s record, inform the patient about them, and reassess the patient’s risk classification. X-rays are useful in confirming the dentist’s visual assessment of occlusal lesions.27

The decision to restore or monitor a tooth with decay under an intact sealant depends on the size of the lesion, other information collected during the examination, and modifying factors, including the likelihood of the patient returning for recall.

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