Objective To determine trends in the prevalence and severity of dental caries in 2- to 5-year-old children. Basic research design Repeated cross-sectional surveys in 1981, 1983, 1985, 1987, 1989, 1991, 1994, 1997 and 2002. Clinical setting Nursery schools in Germiston, South Africa. Participants Dental caries was diagnosed by calibrated examiners using WHO criteria in 7,185 2- to 5-year-old children whose parents had given informed consent. Main outcome measures Caries prevalence (%), caries experience (dmft). Results Both caries prevalence and experience showed statistically significant (p<0.001) fluctuations between study years from 1981 to 2002. A worry is an increase in rates between 1997 and 2002. Conclusion There is a suggestion of a cyclical pattern to the caries rates observed. Key words: caries prevalence, dental caries, dental epidemiology, dmft, surveillance