Objectives. The purpose of this study was to assess the association between ECC and access to dental care in children up to 4-years-old children of Portuguese-speaking immigrants. Methods. The study used a case-control design. Fifty-two cases and 52 controls were identified using a network-sampling approach. Data collection involved a dental examination (dmfs) and parental interview (ECC risk factors). Chi-square tests, t-Tests, and Logistic regression were used to compare cases and controls. Results. Factors significantly (p ≤ 0.01) associated with ECC case were: parental and child dental visit, dental insurance, family income, mean age of weaning from breastfeeding and starting bottle-feeding, snacks consumption, father/mother's place of origin and year of immigration. No family dentist, no dental insurance and snacks consumption remained in the model. Conclusions. Among the access to dental care variables, having no family dentist and no dental insurance was highly associated with ECC in this immigrant population.