Dental anxiety is a familiar problem among children, which may affect their oral health. This cross-sectional study aimed to evaluate dental anxiety during the first dental examination in relation to dental caries and salivary alkaline phosphatase, taking into account the nutritional status of children. Eighty-two children (45 boys and 37 girls), aged six to eight years old (average 6.96), were recruited from public clinics in Baghdad city. Participants were divided into the anxious and the non-anxious groups according to physiological measures (oxygen saturation and heart rate) before the first dental treatment. The weight and height of each child were measured to determine the nutritional status (normal weight, overweight, and obese). Dental caries (prevalence and severity) in children with different nutritional statuses were recorded using dmf, DMF, and the guidelines outlined by Manjie et al. Saliva was collected to analyze salivary alkaline phosphatase. No statistically significant differences were observed between anxious and non-anxious children in means of dmf and DMF indices (teeth and surfaces) in primary and permanent teeth (p>0.05) in the three nutritional status groups. However, non-anxious children exhibited a higher mean of d1 (initial enamel caries) compared to anxious children, with statistical significance (p<0.05) observed only in normal-weight children. Salivary alkaline phosphatase was not significantly different between the two groups. In conclusion, dental anxiety did not appear to significantly impact caries development in primary teeth or salivary alkaline phosphatase levels in children with varying nutritional statuses. Anxiety reduced the initial enamel caries in normal-weight children.