Recent Advances in Caries Prevention and Non-Invasive Management: From Ecological Modulation to Precision Interventions

Background: Dental caries remains a globally prevalent biofilm-mediated disease driven by microbial dysbiosis and progressive enamel demineralization. The traditional “drill and fill” paradigm has increasingly given way to biologically informed preventive frameworks emphasizing ecological management. Methods: This narrative review synthesizes 134 studies (2016–2026) retrieved from PubMed, Web of Science, Scopus, and Google Scholar to evaluate emerging caries prevention strategies across three domains. Results: Three interrelated domains of advancement were identified. First, microbial ecological modulation—including probiotics, prebiotics, and targeted antimicrobial peptides—aims to restore oral microbiome homeostasis by disrupting cariogenic virulence without eliminating commensal flora. Second, nanomaterial-based targeted interventions utilizing stimuli-responsive carriers and biofilm-penetrating nanoparticles enable site-specific drug delivery with enhanced therapeutic efficacy. Third, precision-guided strategies incorporating caries risk assessment models and salivary biomarker diagnostics facilitate individualized prevention protocols. Conclusions: These findings demonstrate a fundamental paradigm shift from indiscriminate microbial eradication to equilibrium-driven, ecology-centered disease management. Future directions include AI-assisted personalized prevention, chairside microbiome diagnostics, and smart responsive biomaterials for sustained caries control.