Purpose: This study was designed to assess (i) the prevalence of extrinsic stains in preschool children (ii) the correlation between extrinsic stains and the occurrence of early childhood caries (ECC) (iii) to compare the distribution of caries in pits and fissures, smooth surfaces or both among children with and without extrinsic stains. Methods: A cross-sectional study was carried out among 1,486 children aged 0-3 years. Extrinsic stain and ECC were scored by two calibrated examiners. Correlation between ECC pattern and extrinsic stains was analysed by logistic regression. Caries distribution in fissures, smooth surfaces or both were analysed using Mann Whitney test and Pearson chi-squared test. Results: The prevalence of extrinsic stains among 0-3 years children was 6.2%. Children with extrinsic stain had a 1.13-fold greater chance of exhibiting ECC (OR = 1.132, 95% CI: 0.739-1.733). Statistically significant differences were found for fissure caries (p 0.0002) and both smooth surface and fissure caries (p 0.0328) among children in both groups. Conclusions: Occurrence of ECC appears to have surface-specific variations in children with and without extrinsic stains. However, the interaction of these individual factors and their impact on oral health outcomes needs to be identified through further research. Keywords: cross-sectional study, early childhood caries, epidemiology, extrinsic stain, public dental health