PURPOSE: The aim of study was to determine the rates of dental caries and assess the restorative needs of children under three years of age attending an urban university clinic from 1993-1997. METHODS: In this retrospective study, data were abstracted from patient records and included demographic information, caries experience, and restorative needs. RESULTS: Gender distribution of the sample included 55% males and 45% females. The study population was predominantly African-American (51%) and Hispanic (34%), with a mean age of 20 months. A majority of the population had dental benefits through Medicaid (92%). Nearly one-third of the study population and as many as 56% of the children between 24 and 36 months had dental caries. Among those off the bottle (50%), children with severe dental caries had been weaned off the bottle at a significantly older age compared to those without any caries (16.9 vs. 10 months, P = 0.000). CONCLUSIONS: This study provides further validity to the early oral health exam and early dental treatment, not only for preventive measures but also for restorative needs. The relatively high prevalence of early childhood caries could have been prevented by appropriate primary preventive strategies.