The aim of the present study was to compare patient, parent and clinician perceived need for orthodontic treatment in relation to normative orthodontic treatment need as measured by the Index of Orthodontic Treatment Need (IOTN). A prospective cross-sectional study was designed to address this aim. The sample comprised 103 patients attending the 'new' patient clinic at the Jordan University Hospital. The patients' mean age was 15.3 years (standard deviation 3.8 years); 33 per cent were males and 67 per cent females. One clinician scored the patients' normative orthodontic treatment need using the IOTN, then determined perceived need using a 10 cm visual analogue scale (VAS). The subjects then assessed their own perceived need and aesthetic component (AC) score and the parents carried out similar assessments for their children. All scoring was carried out blind. The parents had the highest average perceived need scores, followed by patient and clinician scores (6.6, 6.1 and 5.4 cm, respectively). A significant difference was found between the parents and the clinician (P < 0.05). When the relationship between perceived need and clinician-measured normative orthodontic treatment need was investigated, significant differences were found with the dental health component (DHC) for all three groups (P < 0.05). Differences between AC and perceived need scores were also significant for the patients and parents, but not for the clinician (P > 0.05). The present study has shown that perceptions of orthodontic treatment need are multifactorial and influenced by elements other than health measures of normative orthodontic treatment need and perceptions of aesthetics.