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In general, most dental practitioners’ use the term “caries diagnosis” synonymously with “caries detection” [1]. This might derive from the fact that the therapeutic step is indirectly linked to the diagnostic step [2, 3]. Because therapy is remunerated, and operative intervention more so than non-operative intervention, a dichotomous “caries yes/no thinking” is often employed in daily practice – although this is not sufficient. However, it is worthwhile considering the distinct differences between these two terms.

“Caries detection” means the discrimination between a healthy tooth surface and a tooth surface affected by a carious lesion to a certain degree. To a great extent the different methods of caries detection aim at staging the caries process in order to facilitate treatment decision making: initial stages of caries usually require different treatment options than further progressed stages. In this respect, caries detection also and most importantly involves the assessment of surface integrity of a tooth. Once a frank cavitation occurs on a tooth surface, removal of the biofilm in that place is hampered. Thus, non-operative intervention is usually not recommended anymore, and the dental practitioner treats the lesion by cleaning, restoring, and sealing the cavity in order to facilitate plaque removal at the restored tooth surface [4].

Detecting a carious lesion does not say anything about whether the lesion is in a progressing or in a stagnating stage [5]. The lesion’s specific behaviour over time is referred to as “lesion activity” [6]. Lesion activity assessment is a crucial factor because its outcome contributes to clinical decision making [7]. Furthermore, in a broader perspective “caries diagnosis” also considers the local environment in which the respective tooth is embedded. Several patient-specific factors (location/position of the tooth or the lesion, saliva, microbiota, fluoride availability, cleaning habits, diet) that contribute to individual caries risk also play a significant role in the decision-making process of caries diagnosis. However, this chapter deals with the first two aspects, caries detection and lesion activity assessment.