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Objectives: Early childhood caries (ECC) is a particularly destructive form of tooth decay that afflicts young children. Although few prevalence data have been published for Manitoba, long waiting lists for treatment of ECC in hospital indicate that many children in the province suffer from this condition. The purpose of this investigation was to determine the prevalence of ECC and the oral health status of children under 6 years of age in 4 communities in Manitoba and to identify risk factors associated with ECC.Methods: The 4 Manitoba communities were selected according to the best available data regarding the number of young children scheduled for dental treatment under general anesthesia. Two of the communities were located in the southern region of the province, and the other 2 were northern communities. In each region, one community represented a disadvantaged population in a large urban centre, whereas the other was a First Nations (on-reserve) community. The parent or guardian (primary caregiver) of each child under 6 years of age was invited to participate. After informed consent had been obtained from the caregiver, each child underwent a dental examination of the deciduous dentition, and the caregiver completed a retrospective questionnaire by interview.Results: A total of 408 children and their caregivers participated in the study. The overall prevalence of ECC was 53.7%, and the prevalence was similar in all 4 communities, with no statistically significant difference in caries between the high-risk urban communities and the First Nations (on-reserve) communities.The mean number of decayed, extracted or filled teeth ñ standard deviation was 4.2 ñ 5.0. Older children were more likely to have ECC (p p > 0.05). Children with ECC also exhibited more plaque (p Conclusions: The results of this study indicate that ECC is a serious problem in Manitoba. In addition, this investigation establishes a baseline to help evaluate the effectiveness of current and future prevention initiatives in these 4 communities.