The diagnosis of occlusal caries and the initiation of more effective treatment present a considerable challenge. Caries not only has decreased in prevalence, but also has changed in pattern and in progression because of the increased use of fluorides. Correct diagnosis is crucial, distinguishing lesions that can be arrested by noninvasive treatment from those that may justify restorative treatment. For incipient lesions, it is necessary to improve the patient's home care preventive methods, to apply fluroide or other prophylactic agents, or even to seal fissures, preserving the maximum amount of sound tooth structure. This article discusses the diagnosis of occlusal caries and noninvasive treatments for the management of early caries.