This study sought to determine whether there was an association between sickle cell disease (SCD) and dental caries in African-American adults. A sample of 102 African-American adult patients with SCD from Washington, D.C., and Baltimore, Maryland, were matched to 103 African-American adult subjects, who did not have SCD. The match was by age, gender and recruitment location. Each subject underwent a standardized oral examination as well as an interview to ascertain risk factors for dental caries. For individuals with incomes of less than dollars 15,000, subjects with SCD had more decayed (10.36 versus 1.58) and fewer filled (2.86 versus 8.45) surfaces compared to subjects without SCD with both differences being statistically significant (p<0.05) after adjusting for age and gender. The results suggest that low-income African Americans with SCD may be at increased risk for dental caries and are less likely to receive treatment with a restoration.