Background Ethiopia is a large and diverse developing sub-Saharan African country with increasing prevalence of non-communicable diseases, including oral conditions. Oral health and dental care have been given little consideration, and there is limited information relating to population oral health and use of dental services in the country. The aim of this study was to examine the burden and impact of dental caries experience and investigate access to dental care amongst adults within Ethiopia. Methodology This community-based oral health survey is a baseline study for the ASSET - Health System Strengthening in sub-Saharan Africa project undertaken in the Butajira area, south-central Ethiopia. A stratified random sample of households and individuals were participated in the study. The survey was informed by the World Health Organization (WHO) Oral Health Survey Methods (5th ed.) at International Caries Detection and Assessment System (ICDAS) threshold 4 and the UK Adult Dental Health Survey 2009. Face-to-face interviews and clinical dental examinations were conducted. The data were analysed using descriptive statistics; and a binary logistic regression model was built to assess the association of dental caries and predictor variables: demographics, health behaviours, quality of life, dentition status and consequences of untreated caries data in adults (≥18 years).Result Most of the study population (n=626) were female (63.9%), married (71.4%) and Muslim (76.0%). Just over half (53.2%) lived in rural areas and many (44.4%) had no formal education. A majority (74.0%) reported never attending a dental service. Sixty percent (n=377) of the adults had experienced dental caries, 88.0% (n=332) of whom had untreated carious teeth. In the fully adjusted logistic regression model; increasing age, dental attendance and Khat chewing had a positive significant association with dental caries experience, whilst education status was negatively associated (p<0.05).Conclusion This study demonstrated a high burden of dental caries and considerable impact resulting from untreated disease in this population of adults. There was also evidence of social inequity and limited overall access to dental care, highlighting the need for health system strengthening.