Objective-To compare dental esthetic perceptions of adolescents at age 13 with those of parents and to assess associations with dental fluorosis.Methods-As part of the Iowa Fluoride Study, 550 adolescents aged 13 underwent dental examinations for fluorosis on maxillary anterior teeth using the Fluorosis Risk Index. Adolescents and parents completed questionnaires concerning satisfaction with the adolescents' dental appearance. McNemar and Bowker tests of symmetry were used for comparisons of esthetics ratings between parents and adolescents. Comparison of satisfaction between fluorosis and nonfluorosis subjects was made using Cochran-Armitage Trend and Fisher's Exact tests.Results-Excluding subjects with orthodontic treatment, 376 adolescents were included and 26% of them had definitive fluorosis, mostly at a mild level. Fifteen percent of adolescents were dissatisfied with dental appearance, and concerns were mainly about the tooth color (45%) and alignment (35%). Adolescents were less satisfied with overall dental appearance (P<0.001) and color (P=0.048) and more concerned about tooth shape (P=0.002) than were their parents. Fluorosis status (yes/no) was not significantly associated with adolescents' satisfaction or areas of concern (p>0.05). Parents of subjects with fluorosis were more dissatisfied with dental appearance (P=0.014) and color (P<0.001) than other parents. The number of maxillary anterior zones exhibiting fluorosis was negatively associated with both adolescent (P=0.03) and parent (P=0.002) satisfaction.Conclusion-Adolescents generally had less satisfaction with dental appearance and color and they were more concerned with tooth shape than parents. For both parents and adolescents, decreased satisfaction was associated with the number of zones with definitive fluorosis.