Background: Iran lies in the world’ s thalassemia belt; accordingly, the beta-thalassemia gene is carried by 4% of the Iranian population. Due to the dearth of research and literature available on the prevalence of malocclusions in the Iranian population with beta-thalassemia major, this study was conducted to determine the prevalence and severity of facial abnormalities among patients who were referred to Bu-Ali Sina Hospital, Sari, Iran. Methods: This descriptive cross-sectional study was conducted on 200 patients with thalassemia major who were referred to the care unit of Bu-Ali Sina teaching and therapeutic Hospital, Sari, Iran, in 2018. The patients were then visited by a trained dentist who had been given the necessary theoretical and practical training. Malocclusion was classifi ed based on Angle’ s classifi cation. Spacing, overcrowding, overjet, and overbite were measured, and the distances were recorded based on a checklist. Results: The prevalence of malocclusions obtained was 87. 5%, which included malocclusions of Class I (34%), Class II (31%), and Classes III (22%) amongst patients. There was no signifi cant relationship between the type of malocclusion and gender (P = 0. 77). Moreover, no signifi cant diff erence was observed among patients with thalassemia major and diff erent classes of malocclusions in terms of age both in males (P = 0. 49) and females (P = 0. 58). Conclusions: Malocclusions are common among adolescents and adults with thalassemia, which is not associated with age or gender. Therefore, patients should be regularly visited and followed up by a dentist to manage and control their dental problems. In addition, eff ective and preventive measures, as well as health education should be seriously considered in these patients.