Acid etch surface enamel microbiopsies were performed on teeth from 378 children aged 6-12 years; 318 of the children lived in Belgium, an industrialized country, and 60 lived in a rural part of Kenya. In addition to lead and cadmium, calcium and phosphorus were also quantitatively determined in the etch solutions. Calcium was chosen as an internal reference for the expression of the lead and cadmium concentrations and for the assessment of the etch depth. The mean lead level in surface enamel of the Belgian children was approximately eight times higher than that of the Kenyan children. The cadmium levels were not significantly higher. An appropriate regression model taking into account differences in etch depth showed that a significant decrease of lead and cadmium with etch depth occurred and that a significant correlation between lead and cadmium in surface enamel existed for the Belgian cohort. Moreover, the same mean calcium/phosphorus ratios were obtained for the Belgian and Kenyan surface enamel samples, and were found not to play a significant role in the calibration of the lead and cadmium levels.