BackgroundIn dental clinical practice, self-perception of orofacial appearance is highly correlated with treatment satisfaction. Therefore, it is important to explore factors correlated with self-perception of orofacial appearance. Perfectionism may be one such factor. This study investigated the role of perfectionism in self-perception of orofacial appearance.MethodsParticipants completed an online questionnaire that included demographic data, a measure of perfectionism, a measure of self-perception of orofacial appearance (including body image, smile appearance concern, and self-esteem), and a measure of anxiety and depression.ResultsHigh perfectionism scores significantly predicted greater age, body image, smile appearance concern, and mental health scores and lower self-esteem scores (p< 0.005). After adjusting for possible confounding variables, smile appearance concern largely disappeared. Mental health acted as a mediator in the relationships between perfectionism and three orofacial appearance characteristics.ConclusionHigh perfectionism predicted higher self-perception of body image, and lower mental health and self-esteem in college students. Mental health could mediate the relationships between perfectionism and self-perception of orofacial appearance.