Objectives: The first clinical sign of an early caries lesion is a chalky white spot, the visibility of which varies with the hydration state of the lesion. The aim of this study was to test the hypothesis that a white-spot lesion that is visible only when the enamel has been thoroughly dried is likely to have penetrated about half way through the enamel, while a white-spot lesion that is visible on a wet tooth surface is likely to have penetrated all the way through the enamel and possibly into the dentin. Methods: 200 extracted human teeth were examined by a benchmark examiner (BE) and two calibrated examiners, JA and JP (Kappa value with respect to BE was JA = 0.76 and JP = 0.85). All detected lesions were marked and categorized into two groups: (1) visible only after 5 seconds drying with air-syringe and (2) visible when wet with saliva. Following consensus by all examiners on the category of each lesion, a tooth slice was cut from the lesion, microradiographed and the depth of the lesion determined using transverse microradiography (TMR). Results: Only 32 (38%) of 85 lesions categorized as group1 were detected by TMR, with the depth of all lesions limited to outer half of the enamel thickness. All 105 lesions categorized as group 2 were detected by TMR; however, the depth of 35 (33.3%) lesions were limited to outer half of enamel, 58 (55.2%) were limited to inner half of enamel, and 12 (11.4%) lesions have extended into the dentin. Conclusions: This study demonstrated that early caries detected only when the tooth surface is air-dried are limited to enamel, while lesions seen on wet surface may be within or beyond enamel tissue. Supported by NIDCR, Grant #DE14318 for the COSTAR Program.

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