Objectives: The aim of this study was a) to assess the validity of DIAGNOdent in comparison with other two methods for occlusal caries diagnosis: visual examination and conventional radiography and b) to investigate its influence on treatment decision. Methods: 143 extracted molars and premolars teeth with sound occlusal surface or incipient caries were selected. After prophylaxis, the teeth were dried and evaluated by two independent examiners. The teeth were cut in a buccolingual direction for gold standard histological examination in polarizing light microscope. Results: The mean values for Sensibility (SE) and Specificity (SP) were calculated for all methods, considering enamel (e) and dentin (d) caries: (Visual Examination: SEe=40%, SPe=96,3% and SEd=75%, SPd=96,2%; Radiographic Examination: SEe=6,4%, SPe=92,8% and SEd=41,6%, SPd=98,7%; DIAGNOdent: SEe=56%, SPe=36,5% and SEd=75%, SPd=74,5%); ROC curves were plotted for DIAGNOdent readings, one for each examiner. The quality of interexaminer reproducibility was calculated using Cohen's Kappa statistical test, with substantial agreement for Visual Examination (K=0,645) and Radiographic Examination (K=0,647) and almost perfect agreement for DIAGNOdent (K=0,865). The influence of DIAGNOdent on treatment decision was assessed by McNemar statistical test, showing significant results on the decisions for the two examiners (x2=16,96 e 15,04) after the use of laser device. There were significant statistical differences between the evaluation of both examiners. Conclusion: Diagnodent presented higher values of SE and lower values of SP than the conventional methods and the treatment decision was improved after the use of DIAGNOdent. The laser device can be used as a complementary method for occlusal incipient caries diagnosis.

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