Abstract: Dental caries, a chronic infectious disease affecting oral health, has undergone significant evolution in its epidemiological characteristics throughout human history. Archaeological evidence indicates that caries is one of the oldest human diseases, with its origins traceable to carious lesions identified in early modern human fossils from the Paleolithic period. These findings suggest that caries had already emerged among hunter-gatherer populations prior to the advent of agriculture, although at a generally low prevalence, a pattern closely associated with a diet rich in coarse fibers and low in sugar. The Neolithic period witnessed profound dietary shifts driven by the development of agriculture and subsistence economies. The widespread consumption of starchy plants led to a marked increase in the incidence of dental caries, with regional disparities observed across different subsistence modes. The earliest written record of caries in China appeared in oracle bone inscriptions from the Yin Xu archaeological site, marking the beginning of documented human concern for dental health. Archaeological research on dental caries provides a deep-time perspective for understanding its pathogenesis, population-level prevention strategies, and the interplay between societal advancements and shifts in dietary structures. By analyzing carious lesions in ancient human dentition, insights into past dietary structures, subsistence practices, and climatic dynamics can be derived, offering valuable historical context for contemporary caries prevention and treatment.