Abstract: Dental caries is one of the most common chronic infectious diseases of the oral cavity worldwide. Rather than resulting from infection by a single cariogenic pathogen, dental caries is essentially a disease associated with oral microecological dysbiosis driven by the interplay of host, dietary, microbial, and environmental factors. The human oral microecology exhibits distinct developmental stage-specific characteristics, ranging from postnatal oral microbial colonization and the establishment of the oral microecosystem to the formation of tooth-surface ecological niches during primary tooth eruption, and then to microbial succession and homeostasis maintenance across the primary, mixed, and permanent dentition stages. Accordingly, caries-associated microecological dysbiosis exhibits distinct patterns at different stages of dentition. In recent years, caries risk assessment models based on salivary and dental plaque microbial profiles have undergone continuous development, providing new insights into early warning and precision prevention of dental caries. In addition, caries prevention and management are gradually shifting from conventional antimicrobial approaches toward ecological regulation. Strategies such as natural products, antimicrobial peptides, caries vaccines, biofilm-degrading enzymes, bacteriophages, probiotics, prebiotics, and their derivatives have shown potential in modulating the oral microecology, suppressing the cariogenic virulence of major cariogenic bacteria, and maintaining microbial homeostasis. This review is focused on the dynamic changes in the oral microecology across different dentition stages of the child growth and development. We summarized current progress in caries-associated microecological dysbiosis, caries risk assessment models, and ecological intervention strategies, aiming to provide a reference for the early identification, precision intervention, and ecological prevention and management of dental caries.