BACKGROUND: As part of a large-scale fluoridation cessation study, standardized examiners assessed 8,281 school-aged children for dental fluorosis using the Thylstrup Fejerskov index, or TFI, in which scores range from 0 (no fluorosis) to 9 (severe loss of enamel with change of anatomical appearance). METHODS: Dentists, parents and children were asked to respond to a statement, “The color of these teeth (mine or my child’s) is pleasing and looks nice.” Agreement or disagreement with the statement was indicated on a five-level scale, with a rating of 1 representing total agreement with the reference statement. The authors used repeated-measures analysis of variance to ascertain differences in satisfaction with the esthetic appearance of the subject’s tooth color across dentists’, parents’ and subjects’ perceptions. RESULTS: Girls were more critical of their tooth color than were boys; however, parents and dentists were more critical of boys’ tooth color than of girls’. While younger subjects were more critical than older subjects, parents of younger subjects were less critical than those of older subjects. Dentists’ ratings were not significantly associated with subjects’ age group. Subjects with a TFI score of 1 or 2 were not significantly more critical than subjects with a TFI score of 0, while those with a TFI score of 3 of higher were. Similarly, only parents of subjects with a TFI score of 3 of higher had significantly different ratings. CONCLUSIONS: The three stakeholders in the esthetic treatment of children-parents, dentists and patients-appear to see the potential outcome of such treatment differently. CLINICAL IMPLICATIONS: Dentists should ensure that parents and children agree about the course of treatment, the rationale for undertaking it and the results that could reasonably be expected.