Nursing caries is a unique form of caries caused by prolonged exposure to pooled fermentable liquids and a lack of salivary flow during sleep. It is characterized by extensive destruction of the primary maxillary incisors generally beginning on the facial or lingual smooth surfaces. Nursing caries appears to have a particularly high prevalence in Native American populations and can be very costly to restore. The purpose of this study was (1) to determine the prevalence of nursing caries in a Mississippi Choctaw Indian Head Start program and (2) to determine the dollar costs of restoring nursing caries in a similar population. In part 1 of this study, 2 dentists independently examined 629 Native American Head Start children ranging in age from 3-5 years. It was found that 50.2% of these children had nursing caries. In part 2 of this study the cost of treating nursing caries in a Choctaw Indian population that ranged in age from 2-5 years was determined. It was found that the mean total cost of restoring a nursing caries patient requiring general anesthesia to provide treatment was $2,141.75. It was also determined that the mean cost of providing treatment for those children not requiring general anesthesia was $311.55. This study concluded that there was an extremely high prevalence of nursing caries in this Choctaw Indian Head Start population and that funds directed toward prevention would be a wise investment and that renewed and innovative efforts toward preventing nursing caries in these populations are indicated.