Whilst the literature is replete with studies on caries and endodontic procedures, relatively little has been published on the relationship between caries and the vital pulp-dentine complex. This article therefore aims to review the literature on pulp-dentine complex reactions to caries and the direct pulp capping technique. It will also aim to address when to place a direct pulp cap and when to undertake root canal treatment, what materials to use and the long-term prognosis of such a procedure. More importantly, an alternative technique of caries removal will be discussed which has been shown to reduce the risk of pulpal exposure.