Background: The purpose of this study was to compare diagnostic performance for the detection of caries using photographs with an established visual examination method and histological sections as the reference standard.Methods: 50 extracted permanent teeth were assessed for the presence of occlusal caries by 9 examiners using two methods; traditional visual examination developed by BASCD and photographs produced by an intra-oral camera. For both methods, diagnoses were made at " caries into dentine" level. The teeth were histologically sectioned and the diagnostic decisions using visual and photographic assessment were compared to the histological reference standard. Inter- and intra- examiner reliability for the methods was assessed and weighted kappa values were calculated.Results: The visual examination method had a median sensitivity value of 65.6% and a median specificity value of 82.4%. The photographic assessments method had a median sensitivity of 81.3% and a median specificity of 82.4%.Conclusions: The photographic assessments method had a higher sensitivity for caries detection than the visual examination. The two methods had comparable specificities and good intra- and inter- examiner reliability. © 2012 Boye et al.; licensee BioMed Central Ltd.