The majority of the uninsured population in the Western Cape, estimated at about 4.5 million, are dependent on public dental clinics. Dental caries remains the most common chronic disease world-wide. Caries experience among 6-year-old children in the province increased from 82% to 84% in the period 2002 - 2015. Oral health programmes to promote good oral health at schools and clinics are very limited. A cross-sectional study investigated 128 dental clinics in the Western Cape to determine the availability of the basic oral health care package, which includes promotion of oral health, preventing oral disease and basic oral health treatment. Less than a third (31.5%) offered the basic treatment package and slightly less than two thirds (65%) were only offering dental extractions. Despite clear policy guidelines, public dental care delivery in Western Cape is seen to be not adherent to the guidelines, norms and standards. There is an unavailability of dentists outside the main clinics and it appears there is a minimal focus on oral disease prevention and promotion of good oral health. Dental caries must be recognized as an epidemic in the Western Cape, and basic oral health care should be made available.