The aim of the present study was to evaluate if orthodontists in Sweden agree with the grading in the Dental Health Component (DHC) of the Index of Orthodontic Treatment Need, to analyze if certain malocclusions are graded differently, and to determine if there are any background factors among Swedish orthodontists that could be related to their judgements. Two questionnaires were sent to 272 orthodontists in Sweden. In one questionnaire, they were asked to grade different malocclusions (defined in the DHC) according to the need for orthodontic treatment and in the other to provide details of their background. Eighty-one per cent (219) answered one or both questionnaires and 216 answered the questions concerning the need for orthodontic treatment. The Swedish orthodontists' judgements were then compared with the gradings in the DHC. Statistical analysis was undertaken using chi-square, likelihood ratio chi-square, phi coefficient, contingency coefficient, and Cramer's V tests. The result showed that almost all participating orthodontists agreed that grade 1 of the index indicated no need for treatment. For grade 2 (little need), the opinions differed, but still the majority were in agreement with the index. The judgements for malocclusions in grade 3 (borderline need) were widespread, but the majority considered 3a, 3c, and 3f to have a need or a great treatment need. The only statistical correlation with background factors was that female orthodontists graded 3f higher than borderline. For grades 4 and 5 (need and great need), the Swedish orthodontists thought that all the malocclusions required treatment except 4x, which the majority considered to be borderline. The participating Swedish orthodontists in this study graded fewer malocclusions in grade 3 and the majority were of the opinion that compared with the DHC, more malocclusions needed treatment.