Dental caries has undergone a substantial conceptual shift, moving from an infectious disease model to recognition as a chronic, multifactorial non-communicable disease (NCD) influenced by diet, behaviour, biofilm dynamics, and broader social determinants. This evolution has reshaped contemporary approaches to diagnosis, prevention, and management. Modern cariology emphasises the distinction between caries as a disease process and the carious lesion as its clinical manifestation, highlighting that lesion progression can be prevented, stabilised, or arrested when underlying behavioural and biological factors are effectively managed. Central to this paradigm is the principle that non-operative care is not supplementary but constitutes the primary treatment for caries. Biofilm control with fluoride toothpaste, dietary modification, and supportive behaviour change strategies are essential for sustainable disease management, whereas operative interventions merely repair structural consequences and cannot halt disease progression when used in isolation.

Frameworks such as CariesCare International offer structured, outcome-focused pathways to integrate risk assessment, lesion staging, personalised care planning, and tooth-preserving interventions into routine practice. However, a persistent imbalance in dental education remains a major barrier: many curricula prioritise operative skills over prevention, risk assessment, communication, and minimally invasive care. Greater integration of cariology across programmes, enhanced calibration in diagnostic methods, and increased clinical exposure to non-operative strategies are needed to align training with contemporary evidence.

Contemporary caries management is moving firmly toward preventive, personalised, minimally invasive care. Aligning education, clinical practice, and health policy with this vision is essential to shift from cycles of repair toward sustainable, patient-centred disease control.