Purpose: To assess esthetic perceptions among Tanzanian adults regarding missing teeth using a cross-sectional clinical study of a convenience sample of 5,532 subjects in the Northern coastal zone of Tanzania. Materials and Methods: The dental status of urban and rural Tanzanian adults (5,532 subjects, ages between 20 and 80 years) was recorded. A structured interview was used to assess esthetic perception (yes/no complaint) considering the location and number of missing teeth. Logistic regression analysis was applied to determine the effects of the variables age (2 groups: £ 45 years vs > 45 years), gender, socioeconomic status (high/middle vs low), and residence (urban vs rural) on the number of complaints. Results: Of the subjects with 1 or more missing maxillary anterior teeth, 54% reported a complaint. Dissatisfaction was reported by significantly more subjects £ 45 years of age and subjects with high/middle socioeconomic status. Gender and residence had no significant influence. Of the subjects with missing maxillary premolar(s) (no missing anterior teeth), 25% reported esthetic complaints (missing first premolar: 24%; missing second premolar: 11%; missing first and second premolar on the same side: 44%). Dissatisfaction was significantly greater in women, subjects £ 45 years of age, and subjects with high/middle socioeconomic status. Residence had no significant influence. Fewer than 1% of the subjects were dissatisfied with missing maxillary molars. Conclusion: Among this group of Tanzanian adults, absence of teeth played a considerable role in the esthetic appreciation of their dentition. Complaints were associated with both number and location of missing teeth. Int J Prosthodont 2008;21:169–173.