Abstract
Deep dentinal caries, despite being preventable, is an ongoing widespread global issue. This review addresses deep carious lesions from aetiology through to management, and onto barriers in management implementation and ongoing research. Understanding the aetiology of dentinal caries and the histopathology of both carious lesions and the pulp-dentine complex reactions are crucial for providing the best clinical management, swinging the balance in favour of pulpal vitality. How caries removal techniques and terminology have changed over the past 100 years will also be explored together with current international guidelines and position statements on the management of deep carious lesions. However, despite this published guidance in support of more minimally invasive selective caries removal techniques, informed by decades of research, there remains a division among dental professionals globally on which technique should be routinely carried out for deep carious lesions. This paper briefly sets out some of the challenges associated with changing dental professionals' behaviour to align with implementation of the best available evidence, and how ongoing studies comparing the clinical and cost effectiveness of deep caries removal techniques and the environment for implementation are being led to strengthen the evidence base.