This paper assesses the risk from sugar consumption in a population of school children with low caries experience. It relates eight different measures of sugar consumption to the occurrence of any DMFS increment, and, separately, to approximal and pit-and-fissure DMFS. The data are from a 3-yr longitudinal study of 429 children, initially aged 11-15, residing in non-fluoridated rural communities in Michigan, USA. All children completed at least three dietary interviews, were present for baseline and final dental examinations, and had a parent or guardian provide questionnaire information on residence history, use of fluoride and dental services, and family history. Results indicated that a higher proportion of total energy intake from sugars increased the probability of caries on all surfaces, and a higher total intake of sugars was also associated with total caries increment. No relationship, however, was found between DMFS increment and the frequency of eating high sugar foods. Each additional 5 g of daily sugars intake was associated with a 1% increase in the probability of developing caries, and those whose energy intake from sugars was 1 SD above the mean had 2.0 times the risk of developing approximal caries than did children whose energy intake from sugars was 1 SD below the mean.