Dental caries remains a major global health challenge, affecting billions through biofilm-mediated demineralization driven by dietary sugars and acidogenic bacteria. This comprehensive review synthesizes 2020-2025 evidence from systematic reviews and meta-analyses, covering pathogenesis (pH <5.5 threshold), epidemiology (72% prevalence in pediatric populations), advanced diagnostics (fluorescence scanners with ICC > 0.8 agreement), and interventions including fluoride (20-38% caries reduction) and silver diamine fluoride (SDF). High-burden regions, including India, demonstrate rising early childhood caries (ECC) trends projected to 2040 without significant policy interventions. Modern management emphasizes minimally invasive techniques (selective caries removal) and comprehensive risk assessment (CAMBRA protocols). Novel agents such as postbiotics show promising preliminary results for biofilm inhibition. Integrated prevention strategies—combining fluoride, sealants, dietary modifications, and health promotion—offer equitable solutions while linking oral health to systemic well-being [6]. These findings underscore the urgent need for tailored, evidence-based strategies addressing vulnerable populations in resource-limited settings.