In this paper two new visual scoring systems are described, aimed at estimating both depth and activity of occlusal lesions. Their validity is acceptable for lesion depth estimation. However, the validity of the activity estimate is to be questioned. Both for approximal enamel and dentine lesions as for deep dentinal occlusal lesions, bite-wing radiographs are still useful for evaluation of new lesions and lesion progression. Many quantitative caries diagnostic methods are being developed, but to this date none of them has been shown to be reliably applicable in lesion monitoring. The evaluation of caries risk factors is primarily useful for selecting preventive treatment options. Orther caries predictiontests than those based on the present caries lesions are of little value. The main disadvantage of such prediction models is that they are usually limited to application in children, where caries is a disease that affects all ages.

By conducting an oral examination, during radiographic examination and in treatment planning procedures dentists make numerous decisions. A dentist will be required to make his decisions explicit. Decision trees and decision analyses may play an important role. In a decision analysis, the probability of correct and incorrect decisions are multiplied by the utility of the decision outcomes. The treatment outcome with the highest expected utility should be selected. Complex decision tasks such as the estimation of an individual’s caries risk or the diagnosis of bone disorders are currently available as computer applications. Also, a preliminary version of a computer programme which detects caries lesions from bitewing radiographs independent from the dentist has become available. It is expected that the applicability of decision analyses will increase when implemented in the dental practice software packages.

As a result of the caries prevalence of the Dutch population the character of the routine dental examination is changing. Caries screening remains relevant for high caries risk individuals but the interpretation of early caries lesions deserves more attention, especially the assessment of progression of caries lesions in time. Diagnosis of caries by dental practitioners in the Netherlands mainly consists of visual inspection in combination with bitewing radiography and both methods play an important role in the timing of bitewing radiographs and forthcoming recall visits for oral health examination. The content and frequency of the routine dental examination are discussed in relation to the individual risk prediction as relevant aspects of quality of dental care in the Netherlands.

The improvement of the dentition of children starting in the seventies of last century has come to a halt. There are indications that the interest of children and young parents in dental health is declining. The governement shows fewer activities to inform the public on dental health issue by mass communication. The future of dental health education by child care organisations or school medical services is uncertain. A great deal of dental health education has to be given in the dental office. In spite of all the preventive efforts in the past, there is a group of children still at high risk for dental caries. Older people may all become at risk when the interest in dental health or the ability for self care declines. New ways are to be sought to motivate these risk groups for adequate dental care. Parents, teachers, school medical services but also children of older people and volunteer and professional aid for the elderly should be involved.

In the last years the caries risk in the Netherlands has shifted to vulnerable groups consisting of people unable to commit themselves to independent preventive dental care. These groups, children with behaviour management problems, mentally disabled, and elderly people make a change in the perspective of preventive dental care necessary. A more individual approach is advised. The costs of the changes possibly have to be drawn from the regular dental budget.

Sealing of pits and fissures depends on patient- and tooth factors. Prevention of occlusal carious is indicated for children with a high caries risk and especially when the morphology makes teeth more susceptible for developing caries (deep pits and fissures). Good occlusal caries diagnosis is difficult and a golden standard does not exist. When sealing of pits and fissures is indicated a preventive or a therapeutic approach can be chosen. A generally accepted guideline for sealing is still missing. Every approach has its advantages and disadvantages and depends on the individual operator.

In this paper an overview is given of recent studies concerning the prevalence of dental caries in children and adults in The Netherlands. Compared to the oral status in the past, the prevalence in children is still low. The decrease of caries is now also visible in adults up to the age of 45 years. The caries experience of people in older age categories is still high. A significant relationship was found between caries prevalence in children and level of school education of the mother and between caries experience of adults and their level of school education. A relatively high caries prevalence was found in children whose mothers were born in Turkey or Morocco. On the other hand, adults born in these countries had a lower caries experience than native Dutch adults.

MEDLINEplus is a special website of the National Library of Medicine, maybe the largest medical library in the world. By providing ample information on more than six hundred diseases and conditions online, a virtual medical encyclopedia is offered to the visitor. On the basis of the subject caries, an overview of the MEDLINEplus website is given.