The aim of this study was to investigate whether there was an association between normative and self-perceived orthodontic treatment need, and to evaluate the influence of sex and socioeconomic background on treatment need. A total of 139 high school students, aged 14 to 18 years, from 2 districts in Kuwait were included. The study consisted of a questionnaire and a clinical examination. Normative need for treatment was assessed clinically by using the index of orthodontic treatment need (IOTN). Both the dental health component (DHC) and the aesthetic component (AC) of the IOTN correlated positively with self-perceived treatment need. In 53% of the subjects, there was agreement between self-perceived treatment need and the DHC score. Between the AC component and self-perceived need, the agreement was 77%. The odds of self-perceived treatment need were 10-fold for subjects having AC scores higher than 4, indicating moderate or definite need. Sex and socioeconomic factors did not significantly affect the normative treatment need. These results suggest that the AC component of the IOTN clearly reflects the self-perceived need for treatment.