The quality of the consumed drinking water may affect oral health. For example, the presence of iron in drinking water can cause aesthetic problems related to changes in dental enamel color. This study assessed the prevalence of extrinsic enamel color changes and their relationship with the quality of the water in the town of Caapiranga/AM-Brazil. Three hundred and forty six residents of the urban area were examined, and they also answered a questionnaire on eating habits and self-perceived oral health. As the initial results indicated an insufficient number of observations for the application of variance analysis (one-way ANOVA), the Student t test was chosen to compare levels of iron content in the water coming from two sources. The change in tooth color had a prevalence of 5.78% (20 people). The majority of the population (n = 261, 75.43%) consumed well water. Those who presented extrinsic stains were uncomfortable with the appearance of their teeth (15.09%). We conclude that while there is excess of iron in the water in this region of Brazil, no association between extrinsic stains on the enamel and the level of iron in the water was found. There was a low prevalence of extrinsic stains in Caaparinga, being found only in children and adolescents. In the present study, an association between the presence of stains and the consumption of açai was determined, and those who presented them felt uncomfortable about their aesthetics.