Abstract: China has constructed a substantial number of reservoir dams, with a total exceeding 94 000, and has consistently maintained one of the world's lowest rates of dam failure since the 21st century. In the context of accelerating urbanization and intensifying climate change, downstream populations and assets are becoming increasingly concentrated, and extreme weather events are occurring more frequently. These challenges reveal the significant limitations of the conventional management model. Guided by the concepts of systemic safety, risk management, and whole-life-cycle management, dam safety management has undergone a profound transformation, shifting its core focus from “engineering safety” to “risk management.” This paper systematically reviews the development of dam risk management in China, tracing its evolution from the introduction of international concepts to the establishment of a localized system. It emphasizes significant technological advancements in the domains of risk identification and assessment, standard development, and prevention and response measures. Additionally, it delineates innovative practices, exemplified by the integrated intelligent risk perception system, the risk assessment standard framework, the digital twin platform, and the modern operational management matrix. The integration of these components establishes a comprehensive, end-to-end risk prevention and control technological system. This evolution signifies a paradigm shift in China’s dam safety management philosophy, transitioning from an “engineering safety” approach to a “risk management” strategy. This shift is of paramount importance in ensuring the long-term safety of dams and downstream public security.