Dental caries is a widespread chronic infectious disease which may induce a series of oral and general problems if untreated. As a result, early diagnosis and follow-up following radiation-free dental caries therapy are critical. Terahertz (THz) waves with highly penetrating and non-ionizing properties are ideally suited for dental caries diagnosis, however related research in this area is still in its infancy. Here, we successfully observe the existence of THz birefringence phenomenon in enamel and demonstrate the feasibility of utilizing THz spectroscopy and birefringence to realize caries diagnosis. By comparing THz responses between healthy teeth and caries, the transmitted THz signals in caries are evidently reduced. Concomitantly, the THz birefringence is also unambiguously inhibited when caries occurs due to the destruction of the internal hydroxyapatite crystal structure. This THz anisotropic activity is position-dependent, which can be qualitatively understood by optical microscopic imaging of dental structures. To increase the accuracy of THz technology in detecting dental caries and stimulate the development of THz caries instruments, the presence of significant THz birefringence effect induced anisotropy in enamel, in combination with the strong THz attenuation at the caries, may be used as a new tool for caries diagnosis. (C) 2022 Optica Publishing Group under the terms of the Optica Open Access Publishing Agreement