Objective: This article aims to measure parental knowledge and practice regarding their children's malocclusion and orthodontic treatment need. Materials and methods: A cross-sectional survey was distributed in the Al-Madinah region, Saudi Arabia. Parental demographic data, knowledge, and practice were collected. The maximum possible mean score was 1.0 for both knowledge and practice. Results: Three-hundred and fifteen participants completed the survey. The overall mean scores for parental knowledge and practice were 0.44 and 0.49, respectively. No statistically significant difference was detected between sexes, age, parental history of orthodontic treatment, education, and income levels. Females were more aware than males regarding the impact of malocclusion on their children's self-esteem (p = 0.004). Lower- and middle-income groups were less aware of increased risk of trauma with prominent incisors (p = 0.001) and various types of orthodontic appliances (p = 0.004). Although, 80% of parents stated that they were willing to convince their children toward orthodontic treatment based on professional advice. However, 40.5 and 34% of the lower- and middle-income groups would rather wait for public-funded services even if their child is in high need for treatment (p <0.000), compared to 18% of the higher-income group stating the same. Conclusion: Moderate to high parental knowledge and practice was demonstrated. Females and higher socioeconomic status parents were more aware and proactive than their counterparts. Public health services should consider parental socioeconomic status when allocating care for children's and adolescent's orthodontic treatment need.