The aims of the study were to compare the opinions of both the children and the parents with an orthodontist's assessment of treatment need, to investigate the children's self-esteem, and parents' opinion of treatment results. The study group of 359 children (51% girls, 49% boys, mean age 10.6 years) and their parents were asked about their opinions in separate questionnaires. The self-esteem of the children was measured by the global negative self-evaluation scale (GSE). An orthodontist assessed the children's dental casts with the index of Orthodontic Treatment Need (IOTN). Allocated to the dental health component (DHC) of IOTN, 53.2% children had very great to moderate need and 46.8% had little to no need. No sex difference was noted. The children's own assessments of the aesthetic component (AC) of IOTN were closer to the attractive end of the scale than the orthodontist's (p < 0.05). Desire for treatment was more frequent than dissatisfaction with children's occlusion (p < 0.001). The patients' orthodontic concern correlated significantly with both DHC and AC grades (p < 0.001). The children's GSE scores were not correlated to components of IOTN. For children with very great need, high self-esteem was related to orthodontic concern. The parents (90.8%) perceived dental esthetics to be equally important for girls and boys. Most parents (93.0%) thought the results of orthodontic treatment were good. The results indicate meaningful association between orthodontic concern and orthodontic treatment need assessed by IOTN. However, some patients with great need do not express orthodontic concern, whereas others with near ideal occlusion express concern.