STATEMENT OF THE PROBLEM: The clinical performance of enamel microabrasion alone for aesthetic management of dental fluorosis is debatable. PURPOSE OF THE STUDY: This study aimed to compare the clinical efficacy of enamel microabrasion for the aesthetic management of mild-to-severe dental fluorosis. METHODS/MATERIALS: A total of 154 fluorosed incisors and canines in 14 patients on the basis of the fluorosis were included; the teeth were classified as mild (group I, n = 53), moderate (group II, n = 56), and severe (group III, n = 45). All teeth were treated with enamel microabrasion (Opalustre, Ultradent Products, South Jordan, UT, USA). “Improvement in appearance,” “changes in brown stains,” “changes in opaque white areas,” and “requirement for further treatments” were assessed by using visual scale systems. The data were analyzed using nonparametric tests (a = 0.05). RESULTS: The “improvement in appearance” score was the worst for group III (p?<?0.05), whereas the “changes in opaque white areas” score was the best for group I (p < 0.05). Groups II and III did not differ with respect to “changes in brown stains.” The proportion of patients who needed further treatment was the highest in Group III (p < 0.05). CONCLUSIONS: The severity of fluorosis affected the clinical performance of enamel microabrasion except for its performance of removing brown stains. Increase in fluorosis severity led to increased requirements for further treatments. CLINICAL SIGNIFICANCE: The clinical performance of enamel microabrasion is affected by the severity of dental fluorosis, except for its performance of removing brown stains. Even though its performance of improving appearance decreases with the increase in severity of fluorosis, it may not only remove the fluorosis stains but also may increase the success of additional subsequent treatment.