OBJECTIVES: To evaluate the significance of variables such as oral hygiene, dietary habits, socio-economic status and medical history of a child in assessing the level of caries risk and to generate a caries prediction model for pre-school Saudi children. DESIGN: Cross-sectional study of pre-school children. SETTING: Clinics and schools in Riyadh, Saudi Arabia. SAMPLE AND METHODS: A sample of 446 Saudi pre-school children, 199 males and 247 females, with a mean age of 4.13 years, were selected at random from clinics and schools. Selection was limited to subjects who either had no caries (dmft = 0) or who had high caries experience (dmft > 8). Each child was examined for caries experience and oral hygiene status. Their mothers were interviewed through a standardized questionnaire for information about oral hygiene habits of the children, diet history, childhood illness and socio-economic status. RESULTS: There was a highly significant difference between the two groups in: debris index (P < 0.0001), aged child started tooth brushing, (P < 0.0001), age breastfeeding was stopped (P < 0.005), nocturnal bottle feeding with milk formula (P < 0.001), use of sweetened milk (P < 0.0001), frequency of use of soft drinks (P < 0.0005), frequency of consumption of sweets (P < 0.0001), and age at first dental visit (P < 0.0001). A caries prediction model developed through stepwise multivariate Logistic Regression (LR) analyses showed debris index, use of sweetened milk in bottle, frequency of consumption of soft drinks, frequency of intake of sweets and child's age at the first dental visit to be significant. Predictive probability of the model was 86.31% with a sensitivity of 90.1% and a specificity of 80.6%. CONCLUSIONS: Risk factors for dental caries have been identified and a caries prediction model has been developed for Saudi pre-school children. The prediction model, if verified, may provide with guidance in identifying high caries risk Saudi preschool children as targets for preventive programmes.