Background: Most caries prevalence studies are conducted in community-based settings, usually with no radiographs, therefore, it is questionable if visual examination alone captures the true extent of disease. Aim: Since it is relatively easy to diagnose occlusal and facial/ lingual surface (nonproximal caries) on visual examination, our aim was to evaluate for an association between nonproximal caries (NP) and proximal caries (P), which if present can provide a tool to help decision makers in estimating the true extent of the disease. Design: A cross-sectional retrospective chart audit was done using records of 106 children to determine the association between NP and P caries in the primary dentition. Results: Our mean dft for NP lesions only was 1.55. Based on our data, the mean dft considering all pit and fissure plus the proximal lesions was 2.54, which is a 63.2% increase from the dft based on NP caries only. We found a significant association between NP caries and radiographically detectable P caries. Proximal lesions were twice as likely to exist on primary molars when non-proximal/pit and fissure carious lesions were present. Conclusion: The results imply that proximal caries, and thus need for treatment, are being underestimated during visual exams.