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Primary diagnosis involves inspection of all visible tooth surfaces using a good light source, dental mirror and explorer. Dental radiographs (X-rays) may show dental caries before it is otherwise visible, particularly caries between the teeth. Large dental caries are often apparent to the naked eye, but smaller lesions can be difficult to identify. Visual and tactile inspection along with radiographs are employed frequently among dentists, particularly to diagnose pit and fissure caries. Early, uncavitated caries is often diagnosed by blowing air across the suspect surface, which removes moisture and changes the optical properties of the unmineralized enamel.

Some dental researchers have cautioned against the use of dental explorers to find caries. In cases where a small area of tooth has begun demineralizing but has not yet cavitated, the pressure from the dental explorer could cause a cavity. Since the carious process is reversible before a cavity is present, it may be possible to arrest the caries with fluoride and remineralize the tooth surface. When a cavity is present, a restoration will be needed to replace the lost tooth structure.

At times, pit and fissure caries may be difficult to detect. Bacteria can penetrate the enamel to reach dentin, but then the outer surface may remineralize, especially if fluoride is present.[64] These caries, sometimes referred to as “hidden caries”, will still be visible on x-ray radiographs, but visual examination of the tooth would show the enamel intact or minimally perforated.

Regular dental exams are an important part of preventive health care. During a dental exam for children, the dentist or hygienist will clean your child’s teeth and evaluate your child’s risk of tooth decay. A dental exam for children may include application of various protective measures, such as sealants or fluoride treatments. A dental exam for children may also include dental X-rays or other diagnostic procedures.

During a dental exam for children, the dentist or hygienist will likely discuss your child’s diet and oral hygiene habits and demonstrate proper brushing and flossing techniques. Other topics for discussion during a dental exam for children may include preventing oral injuries or, for adolescents, the health risks associated with tobacco, substance abuse or oral piercings.

There are two ways to perform this test. One method uses special tablets that contain a red dye that stains the plaque. One tablet is chewed thoroughly, moving the mixture of saliva and dye over the teeth and gums for about 30 seconds. The mouth is then rinsed with water and the teeth are examined to identify pink-stained areas (unremoved plaque). A small dental mirror may help to check all areas.

The second method uses a plaque light. A special fluorescent solution is swirled around the mouth. The mouth is rinsed gently with water, and the teeth and gums are examined while shining an ultraviolet plaque light into the mouth. The advantage of this method is that it leaves no pink stains in the mouth.In the office, dentists are often able to detect plaque through a thorough examination with dental instruments.

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