THE GOVERNMENT HAS CHANGED HOW NHS ORTHODONTIC TREATMENT IS TO BE RATIONED.
Orthodontic treatment under the NHS has always been rationed, with priority given to more severe cases. In the
past this was decided by the Dental Officers in the NHS Business Services Organisation (BSO) who assessed
patient records sent to them by the orthodontist.
WHAT IS CHANGING?
From April 2014 the eligibility of patients for NHS orthodontic treatment will be assessed with the Index Of
Orthodontic Treatment Need (IOTN). The assessment is carried out by your orthodontist who in most cases
should be able to tell you straight away whether or not your child is eligible for NHS orthodontic treatment. All
orthodontic practices in Northern Ireland must now use IOTN. This brings us into line with the rest of the U.K.
where IOTN has been in use for a number of years.
WHAT IS THE INDEX OF ORTHODONTIC TREATMENT NEED (IOTN)? : IOTN is internationally recognised as a valid
method of measuring the severity of orthodontic problems and the need for orthodontic treatment. It is
consistent and reproducible which means that every patient is fairly assessed against the same standards. The
orthodontists in our practice have all undergone approved training and have been tested to ensure they are using
IOTN correctly.
HOW DOES IOTN WORK? :
IOTN has 2 parts – The Dental Health Component (DHC) and The Aesthetic Component (AC).
Dental Health Component (DHC) measures the need for orthodontic treatment for dental health reasons. It is
based on accurate measurements taken either directly in the patient’s mouth or on models of the teeth later.
DHC has 5 grades:
DHC Grade 1-2:
Mild orthodontic problems
NOT ELIGIBLE for NHS orthodontic treatment
DHC Grade 3:
Moderate orthodontic problems SOMETIMES ELIGIBLE for NHS orthodontic treatment.
 The Aesthetic Component (AC) is used to decide which DHC Grade 3 cases are eligible.
DHC Grade 4-5:
Severe orthodontic problems
ELIGIBLE for NHS orthodontic treatment
Aesthetic Component (AC) recognizes that many children benefit from orthodontic treatment due to the poor
appearance of their teeth. The aesthetic component (AC) has 10 grades based on a scale of 10 colour
photographs showing progressively poorer dental attractiveness. The grading is made by the orthodontist
matching the patient to these photographs. The Aesthetic component determines which patients with moderate
orthodontic problems, i.e. DHC Grade 3, are eligible for NHS orthodontic treatment.
AC Grade 1-5 (DHC Grade 3)
NOT ELIGIBLE for NHS orthodontic treatment
AC Grade 6-10 (DHC Grade 3)
ELIGIBLE for NHS orthodontic treatment
WHAT WILL HAPPEN AT THE ORTHODONTIC ASSESSMENT (USUALLY THE FIRST VISIT)?
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In most cases we will be able to tell you during the appointment whether or not the patient is eligible for
NHS orthodontic treatment.
In a small number of cases, which will be DHC Grade 3, the orthodontist will not be able to decide on
eligibility at this appointment.
In these cases models will be made of the teeth. They will be analysed in more detail and/or sent to the
Dental Officer in the BSO for a decision.
Finaghy Orthodontics
April 2014
See Overleaf
WHAT IF I DO NOT AGREE WITH THE OUTCOME OF THE ASSESSMENT?
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The Index of Orthodontic Treatment Need (IOTN) means there are very clear criteria about who qualifies
for treatment.
However if you do not agree you can ask your family dentist to refer you to another orthodontic practice
for an independent second opinion.
Remember these changes are being brought in across Northern Ireland, and are being implemented by all
orthodontic practices in the same way, so another practice should make the same decision.
WHAT CAN I DO IF THE NHS WON’T FUND TREATMENT?
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Orthodontic treatment may still have many benefits even if not eligible for NHS funding.
These will generally be to improve the appearance of the teeth.
After discussion with your orthodontist you may wish to pay privately for the orthodontic treatment.
HOW DO I PAY FOR MY CHILD’S TREATMENT IF THEY ARE NOT ELIGIBLE FOR NHS FUNDING?
For children who are not eligible for NHS orthodontic treatment, we have:
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Discounted the treatment fees
Arranged to spread the cost of treatment by standing order
Cost will vary depending on the type and number of braces required, but here is a typical example:
UPPER AND LOWER FIXED APPLIANCES (“train-tracks”)
Discount
Deposit (paid at the start of treatment)
-£700
£400
Followed by
12 Monthly Payments (by Standing Order)
£100 per month
Total Due
£1600
These are significant changes to the provision of NHS orthodontics. Here at Finaghy Orthodontics our aim is to
help you understand how the changes will affect your child and help you make decisions that are right for you.
FURTHER INFORMATION
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The British Orthodontic Society provides a lot of information about IOTN and other orthodontic related
matters.
As a starting point go to their website at: www.bos.org
Follow the links for: Orthodontics for Children and Teens/Orthodontics and the NHS.