BACKGROUND: The high prevalence of dentofacial anomalies and their systemic effects on the morphofunctional state of the body highlight the importance of timely diagnosis and correction of occlusal disorders. In adult patients, the clinical picture is complicated by completed facial skeletal growth and concomitant conditions, requiring detailed epidemiological analysis and the development of sound clinical and organizational strategies. AIM: To assess the prevalence of dentofacial anomalies and the need for orthodontic treatment in the adult population of St. Petersburg using medical records and survey data. METHODS: We reviewed 768 outpatient medical records (form No. 043/u) of patients receiving dental care at City Dental Polyclinic No. 15 and selected 478 records for analysis from patients aged 18 to 44 years. We assessed the prevalence of dentofacial anomalies and administered a questionnaire to 122 patients, including those who had not undergone, had completed, or were undergoing orthodontic treatment. We determined objective and subjective levels of orthodontic treatment need. The need for treatment was assessed based on clinical findings and the Dental Aesthetics Index. The article presents mean values expressed as percentages of the total sample. RESULTS: The prevalence of dentofacial anomalies in the adult population of St. Petersburg, according to medical records, was 73.3%. Objective treatment need was identified in 72.6% of those examined, and subjective need in 71.0%. No significant sex-related differences were found in the distribution of pathologies. In the 18–26 age group, a trend toward a lower anomaly frequency was observed (67.9%), which may reflect orthodontic treatment received in childhood. CONCLUSION: The high treatment need highlights the need to improve and develop new clinical and organizational approaches to healthcare delivery, particularly through stronger interdisciplinary collaboration among specialists, to improve oral health and quality of life in the adult population of the metropolis.