Objectives: Despite the interest and need to assess orofacial aesthetics in prosthodontic patients, few self-report instruments are available to measure this construct and none describes how prosthodontic patients perceive the appearance of patients' face, mouth, teeth, and dentures. We report development of the Orofacial Aesthetic Scale (OAS), in particular its conceptual framework, how questionnaire items were generated, and the scale's measurement model. Methods: After test conceptualization, we solicited aesthetic concerns in 17 prosthodontic patients who were asked to evaluate their photographs. A focus group of 8 dental professionals reduced the initial number of concerns/items and decided on an item response format. Pilot testing in 9 subjects generated the final instrument, the OAS. We performed exploratory factor analysis to investigate OAS dimensionality and item analysis to investigate item difficulty and discrimination in 119 subjects. Results: Prosthodontic patients generated an initial 28 aesthetic concerns. These items were reduced to 8 preliminary representative items that were subsequently confirmed in pilot testing. Item analysis supported these 8 items assessing appearance: Face, Profile, Mouth, Tooth alignment, Tooth shape, Tooth color, Gums, as well as Overall impression measured on an 11-point numeric rating scale (0 ”Very dissatisfied”, 10 ”Very satisfied” with appearance). Exploratory factor analysis found only 1 factor and high positive loadings for all items (.73 to .94) on the first factor, supporting OAS' unidimensionality. Conclusion: The Orofacial Aesthetic Scale, developed especially for prosthodontic patients, is a brief questionnaire that assesses orofacial aesthetic impacts with freely available Swedish and English versions.