A newly designed intraoral swept source cross-polarization optical coherence tomography (CP-OCT) imaging system was used to examine the integrity of the subsurface enamel below resin composite restorations placed in primary teeth. CP-OCT analysis was performed using images obtained from resin composite restoration in 62 () pediatric subjects. Clinical examination was performed by a single examiner prior to CP-OCT imaging and analysis. CP-OCT images are presented using a unique combined intensity image, where a false color scale is overlaid on the grayscale intensity image. There was a clear difference in the distribution of the mean-backscattered intensity (mR) between restorations recently placed and those possessing frank cavitation (Student’s t-test, ). For mR above 15.49 dB, the sensitivity was 80% and specificity 86%. The Youden index J was 0.8 above 12.3 dB where sensitivity was 100% and specificity was 80%. CP-OCT imaging may be used to confirm the subsurface marginal integrity below resin composite restorations but with careful consideration of limitations of the imaging modality. CP-OCT imaging may be a useful adjunct to clinical visual investigation to confirm that a composite margin has a sound and well-adapted interface.