Esthetics in the orofacial region is important for perceived oral health and a common reason for treatment of discoloured, missing or crowded teeth. As one of the fundamental bricks of a patient's oral health, changes in the domain of orofacial esthetics resides within the Oral Health Related Quality of Life (OHRQoL) of an individual. Four main dimensions, Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact, are suggested to cover the concept of OHRQoL. The aim of this systematic review was to map the impact from oral conditions with principal impact on the Orofacial Appearance dimension of OHRQoL (PROSPERO: CRD42017064033). Publications were included if they reported Oral Health Impact Profile (OHIP) mean or median domain scores for patients with esthetic treatment need relating to tooth wear, orthodontics, orthognathic surgery, frontal tooth loss or tooth whitening. A search in PubMed (Medline), EMBASE, Cochrane, CINAHL, and PsycINFO June 8, 2017 and updated January 14, 2019, identified 2,104 abstracts. After screening of abstracts, 1,607 articles were reviewed in full text and 33 articles included. These 33 articles reported OHIP-data for 9,409 patients grouped in 63 patient populations. Median orofacial appearance impact scores on a standardized 0 to 8 scale, for populations with treatment need relating to tooth wear, orthodontics, orthognathic surgery, frontal tooth loss and tooth whitening, ranged from 0.13 for tooth wear to 3.04 for tooth whitening populations. In conclusion, a moderate impact for the Orofacial Appearance dimension of OHRQoL was found in patients with different conditions with esthetically related treatment need.