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.