Objectives A cross-sectional study was conducted to compare a visual dental examination method developed by the British Association for the Study of Community Dentistry with assessment of intra-oral photographs as means of detecting dental caries in 5-year-olds and 10- to 11-year-olds. Method 130 5-year-olds and 140 10- to 11-year-olds were visually examined by five trained and calibrated examiners. The children also had intra-oral photographs of their teeth taken. The same five examiners assessed the photographs for caries. Both photographic and visual assessments were undertaken at 'caries into dentine' level. Results Weighted kappas for the outcome DMFT/dmft as a measure of intra-examiner reliability for the visual examinations ranged from 0.94 to 0.98 (median = 0.98) in the 5-year-olds and 0.80 to 1.00 (median = 0.93) in the 10- to 11-year-olds. Weighted kappas as a measure of intra-examiner reliability for the photographic assessments ranged from 0.83 to 1.00 (median = 0.93) in the 5-year-olds and 0.69 to 0.95 (median = 0.81) in the 10- to 11-year-olds. Sensitivity values for the photographic assessment method as compared to the gold standard of the visual examination scores of a benchmark examiner ranged from 87.8% to 95.8% in the 5-year-olds and 58.5% to 71.7% in the 10- to 11-year-olds. Conclusion There was good intra-examiner reliability for both the visual and the photographic methods for all the examiners. There are no clinically significant differences between the photographic scores and the visual assessments using any of the metrics described. The photographic approach is therefore equivalent in diagnostic utility to the visual system and confers considerable advantages in terms of examiner bias reduction, remote scoring and archiving. These advantages must be weighed against the modest costs of the cameras and the increase time required to acquire the images. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.