The main objective of this study was to identify the risk factors for the incidence of visible caries experience in a cohort of preschool children living in Flanders. Data were collected from 1,057 children; validated questionnaires on oral health-related behaviour were completed by parents at birth (2003-2004), at age 3 (2007) and 5 years (2009). At ages 3 and 5, the children were examined by trained dentists. Logistic regression analyses were performed with the following as outcome variables: visible caries experience at age 3 and increment in visible caries experience between ages 3 and 5. At ages 3 and 5, enamel and/or dentinal caries experience was observed in 22% and 41% of the cohort, respectively. The multivariable logistic regression analyses revealed that the presence of visible plaque accumulation on at least one primary tooth was a significant risk factor for visible caries experience at age 3 and for an increment in caries experience between ages 3 and 5. Children with previous caries experience at age 3 had significantly higher odds for new caries lesions at age 5. Presence of visible plaque and previous caries experience are confirmed as significant risk factors for visible caries experience in preschool children. Interventions aimed at caries prevention should focus on very young children and on the control of plaque accumulation. The presence of visible plaque accumulation as a screening tool to identify young children at risk for future caries experience shows high potential.