BACKGROUND: In light of the various challenges faced by public dental health services, especially when large geographical areas and isolated communities are concerned, targeting of high risk groups within these populations needs to be investigated. This study aimed to assess caries experience, dental health behaviour and dental service utilization among a sample of pre-school children in a rural community in Western Australia. METHODS: The study was a cross-sectional oral health survey of pre-school children between the ages of 2 and 5 in Carnarvon, Western Australia. RESULTS: In total, 70 pre-school children (representing approximately 15 per cent of the total 2-5 year old population of Carnarvon) were examined. Less than half of the children were caries free. Both caries prevalence and severity (mean dmft) were significantly higher among Aboriginal children than non-Aboriginal children. Caries prevalence and severity were also significantly higher among children who often consumed carbonated drinks. CONCLUSIONS: This survey indicates that some pre-school children in rural areas, and especially Aboriginal pre-school children, are at high risk of developing dental caries. Effective oral health programs commencing well before the usual first contact with dental services at age 5 are needed for young children at high risk of dental caries.