X-rays and probing indicate a sound tooth. Neither a dental probe nor a toothbrush bristle can penetrate these fissures.
This tooth was then sectioned.
First section. The demineralization and decay are obvious. The ultra-white area to either side of the fissure indicate demineralization and loss of crystalline enamel structure through which acids percolate Note the decay below. X-rays do not pick it up until it is 2 – 3mm deep into the tooth’s second layer. Furthermore, a sealant won’t adhere to demineralized, ultra-white enamel.
Frank decay shows in the third section. OOPS!
A dental probe or x-ray will not catch the developmental crack in the sidewall of this fissure until decay is significantly advanced.
Images courtesy of Graeme Milicich.
The following x-ray was taken after air abrasion removed decay down nearly to the pulp towards the right side of the lower left tooth. The excavation is about 2mm wide, but still does not show on the x-ray. X-rays often diagnose disease in only its late stages. This tooth also did not “catch” an exploratory probe. These traditional diagnosis models are obsolete.