To determine the prevalence and pattern of nursing caries in Saudi preschool children of Riyadh area. Cross-sectional. A list of kindergartens was derived through random selection of one kindergarten from every area of Riyadh. A sample of 1,016 children with primary dentition only was examined for dental caries. The criterion used for nursing caries was presence of caries on the labial or lingual surfaces of at least two maxillary incisors with absence of caries in mandibular incisors. Two hundred and seventy-seven (27.3%) children were diagnosed as having nursing caries. The mean dmft of nursing caries children was 8.6 (+/- 3.4), with dt component of 7.6 (+/- 3.5), mt of 0 4 (+/- 0.9) and ft of 0.6 (+/- 1.7). The older children had significantly higher mean dmft as compared with younger children. The teeth most affected by caries were maxillary central incisors (93.9%), whereas the least affected were mandibular canines (9.6%). A great majority of children (95.7%) had caries in both anterior and posterior teeth. The probability of bilateral molar caries was very high in nursing caries children; highest (94.7%) in mandibular first molars. The caries prevalence was high in the study population. The maxillary central incisors were most affected by caries. The probability of bilateral molar caries was very high.