In spite of the high prevalence of malocclusion in adolescents reported worldwide, there are few studies that have investigated the association between normative malocclusion and self-rated dental and gingival appearance among adolescents. The aim of this study was to identify the association between normative malocclusion and dissatisfaction with dental and gingival appearance among Brazilian adolescents. A cross-sectional study was carried out with adolescents aged 15 to 19 years (n= 16,126) living in 250 towns of all five Brazilian regions. Dissatisfaction with dental and gingival appearance was the outcome. The main explanatory variable was malocclusion assessed by using the Dental Aesthetic Index - DAI. The other explanatory variables included were per capita family income, schooling delay, study conditions, sex, age, skin color, dental outcomes (untreated dental caries, missing teeth due dental caries, dental calculus, fluorosis, and dental pain) and use of dental services. Simple and multivariable Poisson regression analyses were performed. Dissatisfaction with dental appearance reached 11.4% (95%CI: 10.4-12.5) of the entire sample. All levels of malocclusion were associated with dissatisfaction with dental appearance. Adjusted multivariable analysis showed that dissatisfaction with dental appearance among individuals affected by severe or very severe malocclusion was respectively 40% and 80% higher than among those with normal occlusion. Malocclusion was associated with dissatisfaction with dental and gingival appearance. The results contribute to include self-rated dental appearance criteria in orthodontic treatment decision, mainly within the National Health System - SUS.