Objectives: To establish the relative need for treatment of defects of dental appearance, identify differences between individual and group assessments, and suggest guidelines for treatment. Methods: Using a 100mm visual analogue scale (VAS), three groups of subjects (N=42), two of patients (one referred for specialist treatment of a defect of appearance, and one not) and one of dental students, assessed urgency of need for correction of appearance of 4 dental defects randomly presented as colour prints. Results: All groups rated urgency of treatment need of the 4 cases in the same order. Data sets were non-normal with wide ranges (s.d. range=14-24). Plots of ordered VAS data sets showed patients without an acknowledged defect of appearance to assess treatment need as less urgent than others. Conclusions: The severity of defects of dental appearance can be measured in terms of urgency of need using a VAS. Patients without a perceived need for treatment judge the need for corrective treatment as less urgent than do dental students or patients with an appearance defect. However, the assessment ranges and individual variations are so great that accusations against dentists of under or overprescription may sometimes be unavoidable. Guidelines based on group decisions could cause dissatisfaction unless clinicians clarify them to individual patients.

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