Dental caries continues to be one of the most common chronic diseases of childhood. Medical management of this disease has the potential to decrease the burden of disease in the most vulnerable children and delay the need for surgical intervention. Effective medical management requires early and effective risk assessment to identify individuals at risk prior to disease occurrence. The purpose of this review of clinical decision-making for caries management in children was to translate current knowledge of cariology into clinically relevant concepts and procedures. Patient-specific approaches, such as individual risk assessment, active surveillance, and preventive therapies-supplemented, when necessary, by restorative care-should be emphasized. Clinical findings should inform the type and frequency of therapy recommended on an individual basis. As more is learned about this common complex disorder, it is anticipated that educational strategies for students, practitioners, and families will change to reflect new evidence and risk-based care.