Aim: The aim of the Child Dental Health Survey in Lithgow was to establish the oral health status of primary schoolchildren to assist the local council in deciding whether to fluoridate the water and to provide a baseline for future monitoring of changes in caries rates. Methods: All six primary schools in Lithgow were invited to participate, and 653 children aged 6–12 years were clinically examined for dental caries. World Health Organization criteria were used, whereby a decayed tooth is defined as a cavity into the dentine. Caries prevalence was measured as the mean number of decayed, missing and filled teeth (primary: dmft; secondary: DMFT). Significant caries indices were calculated to categorise children with the mean dmft/DMFT score of the highest 30 percentage (SiC) and the highest 10 percentage (SiC) of caries. Data for Lithgow were compared with school dental service data for the socioeconomically comparable fluoridated townships of Bathurst and Orange. Results: The primary dentition caries estimates (dmft, SiC and SiC) in Lithgow children aged 6 years were 0.92, 2.72 and 5.81, respectively; the estimates for permanent dentition caries (DMFT, SiC and SiC) in Lithgow children aged 12 years were 0.69, 2.05 and 6.41, respectively. The caries prevalence in the permanent dentition of Lithgow children was significantly higher than that in children living in the fluoridated towns of Bathurst and Orange. No significant differences were observed in the estimates for primary teeth. Conclusion: Although the mean levels of dental caries in schoolchildren in Lithgow were low, oral health inequalities exist between children residing in non-fluoridated Lithgow and the fluoridated locations of Orange and Bathurst. The local council decided that Lithgow will have fluoridated water by December 2010.