Contemporary Approaches to the Diagnosis and Management of Dental Caries: A Clinical Review

Abstract

Dental caries remains the most prevalent non-communicable disease worldwide, with an estimated 2 billion people affected by caries of permanent teeth and over 500 million children by caries of primary teeth. Over the past two decades, caries has been reconceptualised from an infectious disease treated by "drill and fill" to a dynamic, sugar-driven, biofilm-mediated disease that can be arrested or reversed when detected early. This shift has transformed clinical practice. Contemporary care begins with individual caries risk assessment, followed by detection and staging of lesions by severity and activity using systems such as the International Caries Detection and Assessment System (ICDAS) and the International Caries Classification and Management System (ICCMS). Visual-tactile examination remains the foundation of diagnosis,
 supported by bitewing radiography and adjunctive technologies, including fluorescence-based devices, transillumination and, increasingly, artificial intelligence applied to radiographs. Management follows the principles of minimal intervention dentistry: non-operative control of the disease through fluoride, diet modification, biofilm control and remineralising agents; micro-invasive treatments such as sealants, resin infiltration and silver diamine fluoride; and, where cavitation demands it, minimally invasive operative care with selective carious tissue removal, the Hall Technique and the atraumatic restorative treatment approach. Adhesive and bioactive restorative materials have largely replaced amalgam in line with the Minamata Convention. This review summarises current evidence and consensus recommendations on caries diagnosis and management and offers a practical, patient-centred framework for clinicians.