This paper reviews the influence of the geochemical environment on the epidemiology of human dental caries. The best documented association is that between water borne fluoride and reduced caries prevalence. The influence of fluoride was first reported during the early decades of this century in Colorado, USA, and led to the fluoridation of some public water supplies in several countries. In all cases, fluoridation has been followed by significant improvements in dental health and no adverse effects in general health. Other trace elements in food and water have now been linked with dental caries. Molybdenum has been associated with reduced caries prevalence whereas selenium and lead appear to have adverse effects. Cavity formation in teeth probably involves a localised dissolution of the enamel surface by the products of bacterial activity. It is possible that the incorporation of trace metals into the apatite microcrystals of enamel may alter their physical properties, especially solubility, and hence their susceptibility to degradation.