Dental caries is the most common disease of children and remains a significant oral health problem worldwide for both children and adults. The traditional paradigm of treating dental caries solely by "drilling and filling," brushing and flossing and lowering sugar intake has evolved. Current science in the management of dental caries suggests a clear focus on the reduction of responsible infectious agents, remineralization of non-cavitated lesions and minimally invasive restorative approaches whenever possible. The paradigm shift is away from a purely surgical approach toward more preventive and curative clinical protocols. This paper provides a review of this caries management methodology and explores the role of the dental hygienist in this paradigm change.