AIM: Australian pre-school children living in rural areas experience higher levels of dental caries than those in metropolitan areas. This may be because of a lack of community water fluoridation. The aim of this study was to evaluate the effectiveness of a community-based intervention to improve the oral health of children in non-fluoridated rural Victoria, Australia. METHODS: The study was conducted across three local government areas in Victoria, with two receiving the intervention and one remaining with standard care. Although multifaceted, the primary strategy of the intervention was the promotion of early exposure to fluoridated toothpaste, including the distribution, by maternal and child health nurses (MCHNs), of an oral health starter kit including toothpaste, toothbrush and information to parents at their child's 7-8-month health check. Children were followed up annually to the age of three. RESULTS: Infants in the intervention arm experienced less caries (cavitated and pre-cavitated lesions included) than infants in the control arm at the first and second examinations (3.1% with caries in the intervention vs. 6.9% in the control group at exam 1 (adjusted P= 0.07) and 10.8% vs. 19.5% at exam 2 (adjusted P= 0.11), respectively). However potential benefits disappeared at the third examination (29.5% vs. 28.9%, adjusted P= 0.67). CONCLUSIONS: This study suggests that an oral health promotion intervention delivered via local MCHNs promoting early exposure to fluoride may be successful in reducing caries in the second year of life but less so in older children when participants have less contact with MCHNs.