Dental caries remains a public health problem in Gauteng. There is anecdotal evidence that specific areas of the province have extremely high rates of untreated decay. This information is important for planning of oral health services. Objectives: The aim of this cross-sectional study was to determine the prevalence and clinical consequences of dental caries among school children in the West Rand district of Gauteng. Methods: The study sample comprised of 800 preschool and primary school children (4-5 & 6-8 years old). Cluster sampling was used to randomly select the participating schools. Of the 81 primary schools in the district, 2% were selected and all pupils (4-5 & 6-8 years old) within these schools received an oral examination using World Health Organization (WHO) criteria. These were conducted in natural light using mouth mirrors and ball ended probe. Oral Health status was determined by computing the DMFT /dmft index [caries status] and the PUFA/ pufa index [clinical consequences]. Results: Of the 800 children, 282 were in the 4-5 year old age group and 518 were 6-8 years old. For 4-5 year olds, mean dmft score was 2.24, prevalence of caries was 49%; clinical consequences of caries was scored with mean pufa index of 2.9, and the percentage of untreated decay was 47 %. For 6-8 year olds, mean DMFT/dmft scores were 0.1 and 2.4 respectively, prevalence of caries was 46%; clinical consequences of caries was scored with PUFA/ pufa index as 0.0 and 3.4 respectively, and the percentage of untreated decay was 44%. Conclusion: There are high levels of untreated caries in children in this district. The pufa scores indicate that children suffer serious consequences of untreated decay.