Aim: To evaluate the asperity of malocclusion and orthodontic treatment need among young Saudi obtain free treatment at government dental practices. Background: In the present hypothesis, the perceptive need as evaluated by patients and the actual need to orthodontic treatment, as assessed by orthodontists, were evaluated at deferent types of government dental practices in the city of Makkah using the Index of Orthodontic Treatment Need (IOTN). Methods: A consecutive sample of 400 adults seeking orthodontic treatment at two different types of government dental practices in Makkah, (Free treatment), was examined for orthodontic treatment need using of the IOTN. The self-perceived need for orthodontic treatment was also determined using the aesthetic component (AC) of the IOTN. The IOTN score and the incidence of each variable were calculated statistically. Results: Supplanting, increased overjet, and Class II and III malocclusion were the virtually common orthodontic issues in this hypothesis. High percent of orthodontically treated patients at Makkah clinics were in great need of treatment (P=0.003). Conclusion: Patient\\\\\\\'s perception to orthodontic treatment does not always correlate with professional assessment. The IOTN is a valid screening tool that should be used in orthodontic clinics for better services especially, in health centers that provide free treatment.