An optical instrument is described which quantitates incipient smooth surface caries lesions in vivo. The possible role of such quantitation in caries management and in clinical caries research is discussed. The instrument uses a bundle of small fibres in an 'optical needle' with a flat end that is placed on the lesion. Half the fibres are used to illuminate the lesion and the other half to collect the light backscattered by the lesion interior. In this geometry, lesions reflect much more light than does sound enamel. The instrument has been validated against natural lesions in extracted teeth, and the depth of these lesions and their mineral loss were measured by microradiography. The correlation coefficient between these two parameters was 0.96 and the correlation between optical measurement and lesion depth 0.71.