BACKGROUND The role of fluoride in dental caries prevention when applied at optimal levels is well established. However, ingestion of excessive fluoride during tooth development can cause structural changes in tooth enamel named fluorosis. At Gandiaye a city situated in the Senegalese endemic fluorosis area, the main water supply provided by a unique drilling with highly fluoridated water has broken down in 1996. Since then, the drinking water comes from wells which have poor levels of fluorides. The aims of this study were to evaluate the prevalence and severity of dental fluorosis and tooth decays in children born and reared continuously at Gandiaye after the stoppage of the drills and who were drinking water well. METHODS Water samples were collected from two wells and analyzed using a spectrometer and a specific fluoride electrode. The prevalence and severity of dental fluorosis was evaluated according to Dean's method, and the caries experience was measured using the DMF teeth index in 150 children aged from 6 to 8 years. RESULTS The fluoride levels in the water well were comprised between 0.03 ppm and 0.09 ppm according to the method used. The prevalence of dental fluorosis was 39.33% with the predominance of the very low to low fluorosis forms. The tooth decay prevalence was 48.66% and the mean DMF tooth was 0.98. A significant relationship was found between the dental fluorosis and the low caries levels. CONCLUSIONS A low to moderate dental fluorosis associated with a significant decrease of caries prevalence was found in children living in a high-fluoride area and consuming poorly fluorided water.