OBJECTIVE: To assess dental fluorosis, dental caries and quality of life factors associated with dental fluorosis among schoolchildren living in a Colombian endemic dental fluorosis area. METHOD: 110 12-year olds were visually examined for dental caries (ICDAS) and dental fluorosis (TF) and a self-administered quality of life and fluorosis questionnaire was applied. RESULTS: The prevalence of dental fluorosis reached 100% in this sample with most children falling within the TF 3 severity category. Varying degrees of severity were observed as follows for TF 1 to 6: 1%, 16%, 62%, 16%, 4%, 2%. The prevalence of caries experience (DF-S2) was 54%. The DF-S2 mean was 4.4 (sd 4.3). The principal contributor to the DF-S2 outcome was the decayed component. When initial caries lesions were included (ICDAS-scores 1-3) the mean DF-S1,2 increased to 10 (sd 5.1). The association between fluorosis and dental caries was not statistically significant (p > 0.05). Children not only detected the presence of something abnormal in their teeth but also reported feeling embarrassed, and worried due to their dental appearance. Almost 60% of the children reported avoiding smiling because of their teeth’s appearance. CONCLUSIONS: The high prevalence of dental fluorosis and dental caries combined with the schoolchildren’s negative perception about their dental health reflects the need to propose effective dental public health policies to regulate multiple exposures to fluoride at an early age, and to improve health outcomes in a highly vulnerable population.