Objective: To investigate the aesthetic perceptions of 100 consecutive patients and their parents of orthodontic treatment need and to compare their observations with that of orthodontists. Methods: The sample consisted of 100 consecutive orthodontic patients seen for the first time at a Nigerian Hospital. Of the total sample, 49 were males and 51 were females, with ages ranging from 7 to 21 years (mean + SD; 12.81 + 3.08). The self-assessment by patients and the recording by parents and orthodontists were carried out using the Aesthetic (AC) and Dental Health (DHC) Components of Index of Orthodontic Treatment Need (IOTN) as applicable. Results: The results showed a strong association in the perception of dental appearance by patients and the views of other dental assessors. These correlations were highly statistically significant (P<0.001) with the highest correlation between the parents and the orthodontists (r =0.791) while the least was between the patients and the orthodontists (r = 0.653). The study also found that about one-half of the patients were in the "definite need for orthodontic treatment". Conclusions: There is a strong relationship in the perceptions of dental appearance by patients, parents and orthodontists. This index could therefore be used as an effective tool in communication and achieving realistic treatment decisions.