BACKGROUND This study investigated the prevalence of early childhood caries (ECC) among Hutterite preschool children from different colonies in southwestern Manitoba, Canada. METHODS Following informed consent from the child's parent, children under 72 months of age underwent a dental screening examination. Approval was granted by the University of Manitoba's Health Research Ethics Board. RESULTS A total of 66 children with a mean age of 40.1 ± 20.1 months participated. The prevalence of ECC was 53%, while the mean decayed, extracted and filled teeth (deft) score was 2.8 ± 4.0 (range 0-20). A total of 42.4% had severe ECC (S-ECC). There was no difference in prevalence among the 6 participating colonies. Only 15 children had already been to the dentist, with the majority of these visits due to decay or dental pain. Of those, the mean age for a first visit was 2.7 ± 0.6 years. Children with ECC were determined to be significantly older than those who were caries-free (p<.0001). Early childhood caries and higher caries rates were associated with lower maternal ratings of their child's dental health. Both ECC and increased deft scores were significantly associated with the number of children in the home. CONCLUSIONS This is the first study to report the prevalence of primary tooth decay in Hutterite children. Rates were comparable with other Canadian data for rural dwelling children. Effective and culturally appropriate prevention and health promotion activities are warranted, including fluoride varnish and early dental visits.