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The aim of the study was to assess the perception of dental aesthetics and treatment need in 10- to 11-year-old children using the Aesthetic Component (AC) of the Index of Orthodontic Treatment Need. Subjects were asked to rank the 10 AC photographs in order from the one which looked the best set of teeth to the worst. They were also asked to say whether or not the teeth in each picture required orthodontic treatment. Three hundred and seventy-nine children completed the first task but only 369 were able to decide on treatment need for every picture. Girls ranked the pictures in the order 1, 3, 2, 4, 5, 6, 7, 9, 8, and 10; the boys' sequence was 1, 2, 3, 4, 5, 6, 9, 7, 8, and 10. Significant differences were found between girls and boys for the median rankings of photographs 2 (P &lt; 0.02), 3 (P &lt; 0.004), 5 (P &lt; 0.03), 6 (P &lt; 0.05), and 8 (P &lt; 0.01). The sequence selected by the total sample was similar to that chosen by boys. The cut-off point for which photograph indicated a need for treatment was grade 4 (54.5 per cent), which was 34.7 per cent above the grade 3 score of 19.8 per cent. Three pairs of photographs were allocated similar median ranks, two and three received a rank of 3; five and six a rank of 6; and seven and nine a rank of 7. It is therefore possible that the number of AC grades could be reduced to the five photographs: 1, 4, 6, 8, and 10 in order to simplify the index without reducing its reliability. This premise could be tested by presenting firstly the five photographs and then the 10 on a separate occasion to see how the same participants rated the two sets of pictures.

The perception of dental aesthetics and orthodontic treatment need by 10- to 11-year-old children