Purpose: The aim of this study was to assess the perceptions and concerns about dental fluorosis among high school children in an area that is endemic to fluorosis, and to correlate the children's perceptions of dental fluorosis with different scores of tooth surface index of fluorosis. Materials and Methods: The study was conducted among 155 children affected with fluorosis, aged between 12 and 16 years, studying in all four high schools of Kaiwara, Karnataka, India. Fluorosis was assessed on labial surfaces of maxillary anterior teeth using tooth surface index of fluorosis, and the data were collected using a self-administered pretested questionnaire that was given to the study subjects. Analysis was performed using frequency distribution, chisquare test and Spearman's correlation coefficients. Results: Significant high correlations were found between tooth surface index of fluorosis scores and the perception of the importance of the condition (r = 0.226, χ2 = 72.065, P 0.01), considering the condition to be a disadvantage in the future (r = 0.166, χ2 = 73.097, P 0.05) and also the last visit to the clinician for the condition (r = -0.184, χ2 = 14.252, P 0.05). Conclusion: Perceptions and concerns of dental fluorosis among this age group of children appear to be of aesthetic concern making it essential to focus on this issue and to intervene. Schlagwörter: aesthetic concerns, dental fluorosis, perceptions, TSIF