What if my child cannot get orthodontic treatment on the NHS

Post by 
Clare Evans

irst off, I would like to say that the NHS is a fantastic asset and their hardworking staff right across the UK do an incredible job in very challenging conditions. The aim of this article is only to highlight the increasing difficulty that parents face when seeking orthodontic treatment for their kids on the NHS and what options are available to them if their child is refused.

The National Health Service (NHS) is the umbrella term for the publicly-funded healthcare systems of the United Kingdom (UK). There are four systems, one for each of the four countries of the UK: The NHS in England, NHS Scotland, NHS Wales and Health and Social Care in Northern Ireland. They were established in 1948 and the founding principles were that services should be comprehensive, universal and free at the point of delivery—a health service based on clinical need, not ability to pay. Each service provides a comprehensive range of health services, free at the point of use for people ordinarily resident in the UK, apart from adult dental treatment and optical care.

The Index of Orthodontic Treatment Need (IOTN)

If you have already taken your child for an NHS assessment then you will almost certainly have heard about the IOTN rating system. The IOTN is used to assess the need and eligibility of children under 18 years of age for NHS orthodontic treatment on dental health grounds.

NHS care is only intended to help those who need treatment to improve their dental health. It’s not designed to treat problems that are purely cosmetic. NHS treatment is only available for grade 4 and grade 5 cases. Grade 3 cases are rare and usually judged on an individual basis.

A simplified summary of the IOTN assessment follows.

Grade 1 is almost perfection

Grade 2 is for minor irregularities such as:

  • slightly protruding upper front teeth
  • slightly irregular teeth
  • minor reversals of the normal relationship of upper and lower teeth which do not interfere with normal function.

Grade 3 is for greater irregularities which normally do not need treatment for health reasons

  • upper front teeth that protrude more than 3.5 mm and less than or equal to 6mm
  • mild crossbites
  • irregularity of teeth which are less than 4 mm out of line
  • open bites of less than 4 mm
  • deep bites with no functional problems

Grade 4 is for more severe degrees of irregularity and these do require treatment for health reasons

  • upper front teeth that protrude more than 6 mm but less than 9mm
  • Crossbites which interfere with normal function greater than 2 mm
  • lower front teeth that protrude in front of the upper more than 3.5 mm
  • irregularity of teeth which are more than 4 mm out of line
  • less than the normal number of teeth (missing teeth) where gaps need to be closed
  • open bites of more than 4 mm
  • deep bites with functional problems
  • more than the normal number of teeth (supernumerary teeth)

Grade 5 is for severe dental health problems

  • when teeth cannot come into the mouth normally because of obstruction by crowding, additional teeth or any other cause
  • a large number of missing teeth
  • upper front teeth that protrude more than 9 mm
  • lower front teeth that protrude in front of the upper more than 3.5 mm and where there are functional difficulties too
  • cranio-facial anomalies such as cleft lip and palate

The Aesthetic Component (AC).

Those patients allocated a grade 3 can be assessed for Aesthetic Component (AC) which is on a scale of 0-10. Within the NHS if a patient in Dental Health category 3 has an Aesthetic Component rating of 6 or more NHS treatment is permissible.

Waiting times

NHS orthodontic treatment is free for kids under the age of 18 with a clear health need as outlined above. But because of high demand, and particularly because of the effects relating to Covid-19 waiting lists are getting significantly longer

Avoid the wait

If your child does not qualify for free NHS treatment or you do not want to wait for treatment to start, you may choose to have private treatment. You can register for a free initial assessment online for your child today with Cowbridge orthodontics and you don't need a referral from your dentist.

We will talk to you about specific treatment plans and how much each will cost. For removable appliances, the fees typically range from  £350-£1000, and for standard fixed braces from £1,000 to £3,000, depending on the complexity of the treatment and the type of appliances chosen.