Background: Dental caries is the most common chronic oral condition affecting millions of people worldwide. There are several predictors of dental caries that include amongst others water source, fluoride use, smoking status, alcohol use, employment status, level of education, diet and socioeconomic status. Aim: The aim of this study was to determine the risk factors and or predictors associated with dental caries among adults attending dental clinics at public health facilities in eThekwini and uMgungundlovu districts in the KwaZulu-Natal (KZN) province of South AfricaSetting: The study took place at thirteen dental public health clinics in eThekwini and six from uMgungundlovu districts in KZN province, South AfricaMethods: An observational cross-sectional study was conducted over a 5-month period from November 2018 to the end of March 2019 with a sample of 4716 patients of all adults 18 years and above age groups. A clinical examination as well as a close-ended questionnaire on the diagnosis, basic demographics data, socioeconomic status (SES), as well as lifestyle-related questions such as smoking, alcohol use and dietary choices, was administered to all consenting participants. Bivariate analysis and multivariate analysis using logistical regression were used to measure the association.Results: Females participants OR 1.4 (95% CI 1.2-1.6) p < 0.001**, patients consuming an unhealthy diet OR1.2 (95% CI 1.2-1.6) p < 0.001** were more likely to develop dental caries. Patients Achieving more than secondary level education were OR 0.8 (95% CI 0.7-0.9) p = 0.02* less likely to develop dental caries. Despite showing a slightly increased odds ratio OR 1.25 (95% CI 0.93-1.67) p = 0.14, lack of access to water was not a statistically significant contributor to dental caries.Conclusion: This study showed that female sex, consumption of an unhealthy diet and lower than a secondary level of education were the predictors of dental caries. It is hoped that these findings will contribute in influencing dental public health policy planning to ensure that planning for dental services takes a more comprehensive approach that includes health promotion, primary prevention, secondary prevention and tertiary prevention at appropriate levels of the health system.