OBJECTIVE: This study aimed to assess the perceived oral health status and to explore its relationship with clinically assessed dental fluorosis among school children in Arusha town, Tanzania. METHODS: A total of 478 students (mean age 15.7 years) completed questionnaires administered in the schools during May to July 2000. Clinical photos of the upper and lower incisors were taken under field conditions. A total of 461 slides were rated under laboratory conditions. The severity of dental fluorosis in the permanent maxillary central incisors was assessed using the Thylstrup & Fejerskov Index (TFI). RESULTS: The prevalence of dental fluorosis at TFI score > or = 2 was 74%. A total of 67% of boys and 70% of girls rated their teeth as yellow to brown, 58% of boys and 68% of girls (P < 0.05) confirmed dissatisfaction with their dental appearance. Kappa values of 0.40-0.44 were obtained between dental fluorosis (TFI > or = 2) and self-reported discoloration. The proportion of school children reporting dissatisfaction with oral condition and dental appearance increased with increasing TFI scores. Stepwise multiple logistic regression analysis explained 21% and 32% of the variance in the dissatisfaction with oral condition and dental appearance scores; TFI scores 11% and 15% of variation in points, and social and psychological variables 11% and 17%. CONCLUSION: Whereas dental fluorosis at different diagnostic cut-off points impacts self-rated oral health negatively, social and personal factors are as important in shaping the responses of school children to oral condition and dental appearance.