The aim of this study was to investigate the relationship between dental fluorosis and dental caries among western Saharan refugee children. The western Saharan child population is characterized by adverse living conditions, an unbalanced diet, poor oral hygiene habits, and a concentration of fluoride in the drinking water of around 2 p.p.m. (2 mg l(-1)). A sample consisting of 360 children, 6-7 yr of age, and 212 children, 11-13 yr of age, was obtained from four refugee camps (Smara, Awsard, El-Aaiun, and 27-February) situated in the vicinity of Tindouf (southern Algeria). The children were examined using the World Health Organization criteria for caries diagnosis and Dean’s index for fluorosis. The decayed, missing or filled teeth (DMFT) score was 0.48 in the 6-7-yr-old children and 1.69 in the 11-13-yr-old children, with a caries prevalence (DMFT > 0 or decayed and filled primary teeth (dft) > 0) of 47.2% and 63.2%, respectively. Among the 6-7 yr-old children examined, 36.9% were free of fluorosis, 15.6% presented moderate fluorosis, and 7.8% presented severe fluorosis. Among 11-13 yr-old children, only 4.2% were free of fluorosis, 30.2% exhibited moderate fluorosis, and 27.4% presented severe fluorosis. The mean DMFT, decayed permanent teeth (DT), and caries prevalence (DMFT > 0 and DMFT or dft > 0) scores were significantly higher among the children affected by severe fluorosis, suggesting that severe fluorosis might increase the susceptibility to dental caries.