This study aimed to investigate pre- and perinatal determinants as risk factors for caries development in offspring. In this longitudinal register-based cohort study, we included all children (n = 18,142), of 13 years of age who resided in the county of Stockholm, Sweden, in 2000. The cohort was followed until individuals were 19 years of age. In total, 15,538 subjects were examined. Dental caries (decayed, missing and filled teeth/surfaces), were collected from the Public Health Care Administration in Stockholm. Data concerning pre- and perinatal factors, as well as parental socio-demographic determinants, were collected from the Swedish Medical Birth Register and Swedish National Registers at Statistics Sweden. Mean approximal caries increment (DMFSa) was 1.34 +/- 2.74. The results showed that the prenatal factors, "maternal smoking" and "maternal overweight" exhibited an increased risk of approximal caries increment, (OR 1.33; 95% CI = 1.22-1.44) and (OR 1.21; 95% CI = 1.07-1.37), respectively. Concerning maternal overweight, the excess risk enhanced in relation to the magnitude of the caries increment and maternal smoking was significant across the various DMFSa outcome cut-off levels. In conclusion, this study demonstrates that the prenatal factors, maternal overweight, as well as smoking, are risk factors for approximal caries development in offspring during the teenage period.