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Diagnosis of early occlusal caries has proved more difficult than that affecting smooth or approximal surfaces. With time, this type of lesion has come to form a greater proportion of caries as a whole and its accurate diagnosis is consequently becoming more important. The most widely used methods of diagnosis are visual inspection and bitewing radiography but the value of both of these for occlusal caries has been questioned. The aim of this study was to investigate the validity of diagnosis using each of these two methods in extracted teeth. A total of 100 first permanent molars and 100 second primary molars were used and teeth and sites with questionable or borderline caries were selected for examination. The condition of the tooth on section was used to validate. In these samples sensitivity of radiographic diagnosis was greater than that of visual diagnosis. Both methods showed good specificity. When radiographs were used together with visual examination the status of 82% of first permanent molars and 91% of second primary molars were correctly classified.