NHS orthodontic treatment and braces on the NHS

Treatment on the NHS is available for individuals who are under the age of 18 and who have a clear need for treatment which is assessed by a rating scale known as the Index of Orthodontic Treatment Need (IOTN).

The IOTN is a reliable and objective scale that orthodontic specialists use to assess those children suitable for NHS funding for treatment and use of the IOTN scale requires specialist training. The IOTN consists of 2 scales of measurement:

1. Dental Health Component Scale
2. Aesthetic Component

The Dental Health Component has 5 grades, only those individuals that fall within grades 4 and 5 and certain borderline cases in grade 3 are eligible for NHS treatment.

Individuals who are over 18 are not eligible for NHS orthodontic treatment but in rare cases may be approved if the functional needs are severe enough. This is assessed on an individual case by case basis by a specailist orthodontist.

Grade 1 - Almost perfect teeth that don't require any orthodontic treatment

Grade 2 - individuals with minor teeth irregularities:

• Slight protrusion of the upper jaw
• Slight cosmetic irregularities in the teeth
• Mild overbite or underbite that does not affect the function of the teeth

Grade 3 - more severe irregularities than grade 2 but do not affect the health or function of the individual e.g:

• Protrusion of front teeth by 4mm or less from the normal position
• Position of upper teeth are out of position ( by less than 2mm) and only interferes with normal function to a minor degree
• Position of the teeth are irregular but less than 4mm out of line
• Open bite - the back teeth do not meet when the mouth is closed
• Deep bite - where the upper teeth overlap the lower teeth but not to the extent where it affects function.

Grade 4 - severe irregularities of the teeth that need orthodontic treatment for health reasons. e.g:

• Protrusion of front teeth by more than 6mm from the normal position
• Position of the upper and lower teeth is more than 2mm out in terms of symmetry and is interfers with normal function
• Lower front teeth protrude in front of the upper teeth by more than 3.5mm
• Teeth that are more than 4mm out of line from the normal position
• A deep bite that affects normal function

Grade 5 - most severe dental health problems, e.g:

• Teeth are prevented coming through into the mouth due to an obstruction e.g. crowding or additional teeth
• Mulitple missing teeth
• The position of upper front teeth that protrude by more than 9mm from the normal position
• Congenital or developmental problems with the skull or jaw such as cleft lip and palate.

The Aesthetic Component (AC)

Some children need orthodontic treatment based on the aesthetics (look) of their teeth and this is assessed using the aesthetic component which is a series of 10 colour photographs of teeth showing different levels of "dental attractiveness". The specialist matches the patient up with the closest photo and makes an assessment based on this. The AC is used for Grade 3 borderline cases and where the AC score is high NHS treatment may be available.