Operative dentistry aje qualtrough, jd satterthwaite la morrow, pa brunton

Enhanced visual examination
Transillumination
This uses an intense beam of visible light, usually directed on the 
lateral surface of the tooth to transilluminate it and aid with caries
diagnosis. This technique is most useful in the diagnosis of anterior
approximal caries and cracked teeth.
Fibre-optic transillumination
This technique uses a fibre-optic light source placed palatal to anterior
teeth to aid diagnosis of anterior approximal caries. With the increased
number of fibre-optic handpieces available, it is feasible to have a
fibre-optic tip attached to dental units.
Magnification
This is most commonly in the form of magnification loupes, to aid
with clinical examination and radiographic evaluation.
Dyes
A variety of different dyes that stain caries are currently available.
These help to make the visualisation of caries easier. However, they
are primarily used during cavity preparation and result in over 
preparation and hence are not used routinely.
Radiographic examination
Radiographs can be used to confirm a clinical suspicion of caries,
detect early lesions and for monitoring disease activity. Bitewing
radiographs are the view of choice for diagnosis of occlusal and 
proximal caries in posterior teeth; however diagnostic problems may
arise because of superimposition of the cuspal pattern and contact
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point overlap. Periapical radiographs are required for anterior teeth.
Extraoral radiographs such as dental panoramic radiographs should
not be used for the diagnosis of dental caries owing to their lack of
sensitivity
5,6
.
Laser fluorescence
Lasers can be used as an aid to detection of caries, especially early
enamel lesions. The principle is based on laser fluorescence. Caries
illuminated by a laser will fluoresce, the degree to which this occurs is
an indicator of the disease process. However, heavy fissure staining
can affect the degree of laser fluorescence.