In 1988/89, a national study was carried out to investigate the prevalence of caries experience among children aged 5 to 6, 12, and 15 to 19 years and also to measure the level of dental fluorosis among 12 to 14 year-old pupils attending schools in urban and rural areas in Antigua with various levels of natural fluoride in public water. In the first part of the study, all three age groups who were life-long residents of three areas with 0.1-0.2 ppmF (urban), 0.1-0.3 ppmF (rural) and 0.6-1.0 ppmF (rural) showed that the caries levels for each age group were not significantly different among the three fluoride communities or between urban and rural samples. In all three age groups, occlusal surfaces were more frequently affected by caries, and untreated dental caries was common. In part two of the survey, the Tooth Surface Index of Fluorosis (TSIF) was used to record fluorotic enamel defects among children aged 12 to 14 years who were life-long residents of 0.1-0.3 ppm fluoride and 0.6-1.0 ppm fluoride areas. In the low fluoride areas, mottling was absent in 97 per cent of facial surfaces of anterior maxillary teeth. In contrast, in the 0.6-1.0 ppm fluoride area, the value was 87 per cent. In both communities mottling was limited to a whitish colour. Analysis of the highest TSIF scores revealed that statistically significant differences were apparent in children with fluorosis between two communities.