Baby bottle tooth decay (BBTD) is a disease characterized by severe dental caries in the primary dentition that may have significant short-term and long-term implications for the health of children. Its prevalence and various etiologic factors have not been addressed fully in the dental literature. In 1985, 514 Native American Head Start children in Alaska and Oklahoma were screened to establish the prevalence of BBTD in those populations. The prevalence of BBTD ranged between 17 and 85 percent, with a mean of 53 percent. BBTD is clearly a significant health problem for this population group. Concerted intervention efforts to lower the prevalence of this preventable condition should be instituted and their effectiveness evaluated for potential utility among other affected groups.