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Objectives: To describe and analyse the caries prevalence, caries experience and treatment needs in the deciduous dentition of 5-6 year- old school children, and in the permanent dentition of 12-13 year old and 15 year old school children in the District of Sunsari; and to analyse the drinking water for fluoride content. Design and method: Multi- stage random sampling oral epidemiological survey conducted by trained and calibrated examiners using WHO Pathfinder methodology. Water samples were analysed with a calibrated Orion Expandable Ion Analyser Model EA 920. Setting: Surveys were conducted in private and government; rural town, rural village and urban schools in 15 Illakas in Sunsari District, Eastern Nepal. Subjects: A total of 600 5-6- year- old, 600 12-13 year- old and 600 15- year old school children were examined between April and September, 2001. Outcome measure: Prevalence of caries and dental caries experience (dmft/DMFT); and fluoride content of the drinking water in mg/l(ppm). Results: Caries prevalence and mean dmft score of 5-6 year- olds was 52% and 1.99. Caries prevalence and mean DMFT score of 12-23 year old was 24% and 0.49. Caries prevalence and mean DMFT score of 12-13 year old was 24% and 0.49. Caries prevalence and mean DMFT score of 12-13 years. The d/D – component constituted almost the entire dmft/DMFT index. In the 5-6 year-old age group, 36% of the treatment required could be met through one surface restorations, 33% through two or more surface restorations and 18% through extraction. For the 12-13 year- olds and the 15 year olds, the major treatment need was for single surface fillings (47% and 48% respectively) followed by the need for extractions (13% for both) and two or more surface fillings ( 9% and 8% respectively). The mean fluoride level of the drinking water sampled was 0.27 ppm and the fluoride content ranged from 0.3 to 0. 83 ppm.  Conclusion:  The prevalence and mean dmft of 5-6 year – old school children was high. The prevalence and mean DMFT of 12-13 year olds and 15 year olds was low. The recorded prevalence of untreated dental caries in school children requires an appropriate oral health response based primarily on oral health promotion. Foremost in this regime would be the promotion and use of affordable fluoridated toothpaste. The treatment needs of school children can be met in the school setting using appropriate cost effective technology such as ART and ACT.