In 2004-2005, 349 of 541 eligible, mostly preschool, children in the Inuvik Region in the Northwest Territories of Canada were examined clinically, and the parents or caregivers of 315 of these children were interviewed to measure their oral health status, and its impacts and determinants. Dental caries is a highly prevalent health problem among these preschool children in Inuvik Region: we found that 66% (230/349 children) had the disease and had, on average, 4.8 affected teeth, of which 2.4 had untreated decay. Twelve percent (42/349) of the children needed urgent dental care. Among the 315 children whose parents or caregivers were interviewed, 46% (144/315) had severe early childhood tooth decay. Significantly more of the parents of children with severe decay reported that their children had pain and a decreased ability to chew than the parents of children with no or moderate disease. Using logistic regression, we found that protective factors for severe early childhood tooth decay were higher family income (OR = 0.68; 90% CI = 0.54-0.85), community water fluoridation (OR = 0.49; 90% CI = 0.26-0.91), and drinking milk (OR = 0.44; 90% CI = 0.24-0.81) and fruit juices (OR = 0.46; 90% CI = 0.24-0.90) after the child began to walk, whereas significant risks were consuming drinks made from flavour crystals before (OR = 2.4; 90% CI = 1.3-4.6) and after (OR = 2.0; 90% CI = 1.2-3.2) that age. This information should enable the Health and Social Services Authority to plan health promotion and service delivery programs for the children in Inuvik Region.