Dental caries represents a significant unmet treatment need in people living with disabilities. Each individual with special needs presents with a unique condition in terms of the type and severity of their disability as well as their socioeconomic and psychological situation. This mandates the utilisation of individualised risk assessment strategies. The treatment for carious lesions should prefer preventive strategies and non-restorative measures over restorative treatment paradigms with the ultimate goal being to preserve as much of natural dentition as is reasonably possible.