Caries prevalence among 3- to 4-year-old Head Start children and psychosocial information from their parents were obtained. The prevalence of maxillary anterior caries in the 369 children was 16%, with the most severely affected tooth surfaces being the mesial surfaces of the central incisors. Approximately 90% of parents whose children were found to have maxillary anterior caries knew that allowing their child to take a bottle to bed would harm the child's teeth. Significant differences were found in mutans streptococci levels between children with and without the anterior caries pattern. Although 86% of children with anterior caries were reported to have taken a bottle to bed, 69% of those children who did not have anterior caries also were reported to have taken a bottle to bed. Of the children with maxillary anterior caries, 87% had posterior caries, suggesting that anterior caries subsequently may contribute to an increased caries risk in other teeth.