Background: The objective of this study is to evaluate the prevalence of malocclusion and treatment needs in transfusion dependent β-thalassemia major children. Methods: One hundred transfusion dependent β-thalassemia major children visiting the Department of Pediatrics were selected randomly and evaluated for malocclusion with Angle’s classification and Dewey’s modification. The orthodontic treatment needs were also assessed using Grainger’s treatment priority index (TPI). The orthodontic treatment needs were compared to normal children. Results: The assessment of treatment needs revealed a higher prevalence of handicapping and severely handicapping malocclusion in thalassemic children compared to normal children. The thalassemic patients were found to show significantly more Angle’s Class II malocclusion (55 % vs. 15.7 %) when compared to normal children. Conclusions: The higher prevalence of Angle’s Class II malocclusion and definitive malocclusion in thalassemic children indicates the importance of preventive orthodontic procedures and efforts towards providing orthodontic treatment to these children.