Although dentistry recognizes that dental caries management encompasses more than restoring the consequences of the disease, caries risk assessment and management that go beyond traditional restorative care have not always had a strong and organized voice during clinical curriculum development and competency assessment in U.S. dental schools. This has resulted in confusion and great variability between the need for risk-based caries management and prevention and how practitioners apply these concepts in private and community settings. Dental education is in the unique position of being able to help bridge the gap to improve dissemination of new information and to enhance communication between research and the practice of dentistry to accelerate adoption of validated approaches for the diagnosis and management of dental caries. This paper presents one example of how a dental school totally revamped its approach to teaching cariology--from a few lectures scattered throughout the curriculum to a Cariology Management Program that is integrated into all four years of the curriculum, that includes both didactic and clinical components, and that emphasizes critical thinking and problem solving. From its inception, the program was centered on a competency requirement for graduation and the principles of evidence-based practice. The process, competency, and initial programmatic outcomes assessment measures are discussed. Barriers encountered are briefly reviewed from the following perspectives: dental school structure, faculty support/calibration, students, reimbursement, and standard of care/public expectations.