The concept of dental neglect may allow a better understanding of the complex relationship between individual behaviour, environmental factors and dental caries in children. Dental neglect has been previously explored among elderly people, but little is known of its occurrence among children. A study of children's use of dental services in South Australia provided demographic and attitudinal data from parents of each of a stratified sample of 2659 children from age groups 10-11 and 14-15 years. Dental examinations were undertaken of a random sub-sample of 769 children. Parental responses were sought to seven statements on different aspects of dental neglect. Factor analysis revealed two factors, one of which confirmed a general "dental neglect" phenomenon (which was significantly associated with all seven items); the other revealed an "avoidance of care" phenomenon which involved only two of the items. The internal consistency of responses across all seven items was confirmed (Cronbach's alpha = 0.74), and the scores for the seven were summed to create a composite dental neglect variable. Linear regression analysis revealed that dental neglect was greater among males, younger children, those whose mothers had had less education, children who had not received dental care in the previous two years, and those for whom the responding parent's last dental visit was symptom-driven rather than for a routine examination. The dental neglect variable was then dichotomised in order to examine its association with caries experience. Among the older children, those in the higher dental neglect group had significantly higher overall permanent caries experience (DMFS), and greater numbers of decayed permanent tooth surfaces (ANOVA, P < 0.05). The outcome of this study indicates that the Dental Neglect Scale may have utility in predicting and understanding variation in dental health, and in designing and targetting dental health promotion strategies.