Evidence-Based Dentistry Caries Risk Assessment and Disease Management Margherita Fontana, DDS, PhD*, Carlos Gonzalez-Cabezas, DDS, MSD, PhD INTRODUCTION Dental caries is a multifactorial, dynamic disease process that results from a dysbiosis in the biofilm, driven by exposure to fermentable carbohydrates, which over time leads to demineralization of dental hard tissues. 1 In spite of the significant reduction in caries prevalence in many parts of the world, dental caries remains a major public health problem affecting people of all ages. 2 Furthermore, the disease is not equally distrib- uted, with multiple population groups at increased risk. 3,4 If allowed to progress, over time the disease will result in the development of detectable changes in the tooth Disclosure: Drs M. Fontana and C. Gonzalez-Cabezas do not have any commercial or financial conflicts of interest. They are both active in cariology research. Dr M. Fontana currently receives funding from the National Institutes of Health in areas of caries risk assessment and caries management. Department of Cariology, Restorative Sciences and Endodontics, University of Michigan School of Dentistry, 1011 North University, Ann Arbor, MI 48109, USA * Corresponding author. 1011 North University, Room 2393, Ann Arbor, MI 48109. E-mail address: mfontan@umich.edu KEYWORDS  Dental caries  Risk assessment  Fluoride  Sealants  Evidence KEY POINTS  Dental caries is a multifactorial, dynamic disease process that results from a dysbiosis in the biofilm, driven by exposure to fermentable carbohydrates, which over time can lead to demineralization of dental hard tissues.  Over time the disease can result in loss of minerals within the tooth structure, or caries le- sions, which initially are noncavitated (ie, surface is apparently intact, sometimes referred to as “white spot” lesions), but that eventually might progress to cavitation.  Modern caries management stresses a conservative and preventive evidence-based phi- losophy, with personalized disease management, detection and monitoring of caries le- sions, and efforts to remineralize and/or arrest lesions whenever possible, that aims to preserve tooth structure and maintain health. Dent Clin N Am 63 (2019) 119–128 https://doi.org/10.1016/j.cden.2018.08.007 dental.theclinics.com 0011-8532/19/ª 2018 Elsevier Inc. All rights reserved.