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NHS Treatments |
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NHS orthodontic treatment is available for children under 16
years of age with moderately severe problems who need braces for
dental health reasons from very crowded teeth and teeth that
stick out to cross-bites and deep bites. |
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Acceptance for NHS Treatment |
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The decision concerning a
patient's eligibility for NHS treatment is based on the clinical
need for treatment to secure dental health when they are ready
to have their braces fitted. An NHS assessment and subsequent
review appointments do not guarantee that NHS treatment will be
offered. |
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The aim of NHS treatment is to
achieve a vast improvement in the appearance of the teeth and a
healthy dentition. Perfect alignment of the teeth is not always
possible.
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NHS Appointment Times |
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We would like all of our patients
to receive a high standard of treatment; to achieve this within
the NHS effective time management is extremely important and
there is little flexibility with appointment times. These appointments are often short
in duration and are restricted to specific treatment sessions
during school time. NHS appointments are not usually available
during school half terms or Christmas holidays.
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Costs Associated with NHS
Treatment |
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NHS patients will need to pay for
oral hygiene products (£14 - £20), lost or broken appliances,
missed appointments and late cancellations with less than 24
hours notice (£20 - £120) |
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NHS Waiting Lists |
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There may be a delay of up to 6
months before NHS treatment can start. However, there is no harm in this
delay in terms of dental health.
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Hospital NHS Treatment |
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Some orthodontic treatments are
extremely complex and very time consuming. Occasionally we need
to refer these patients to a consultant orthodontist working in
a Hospital Orthodontic department.
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Restrictions to NHS Treatment |
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Children who have mild
irregularities of their teeth may not be accepted for NHS care
because there are no dental health benefits from having
treatment. The major benefit of treatment in these cases is
cosmetic, therefore private treatment is the only
option if you want to have a more perfect smile. |
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All ClearStep Centres
(excluding London) accept
patients for NHS care if they have started orthodontic treatment. |
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Index of
Treatment Need (IOTN) |
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Starting
on the 1st April 2006 the use of the Index Of Treatment Need (IOTN)
became compulsory in NHS funded Orthodontics. This index was
first devised in 1989 by Brook and Shaw [1]. Its purpose is to
determine those cases that most need (rather than want)
orthodontic treatment. This allows limited resources to be
targeted at those patients with greatest need while avoiding the
treatment of mild cases. So how is this done? |
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When
assessing a patient a standard procedure is used, and to be
eligible for NHS treatment a score on the IOTN of more that 3.6
must be attained. |
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The index
is made up of two components. The Dental Health Component (DHC),
to assess dental health needs, and the Aesthetic Component (AC),
to assess aesthetic needs. |
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The DHC
has five categories (1-5) and uses a graded table to identify
the most severe occlusal trait for a particular patient so that
the patient can be categorized according to the trait. This
table is reproduced below but obviously needs an understanding
of orthodontic terms to fully appreciate the traits assessed. |
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Grade 1
- No Treatment Required |
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1.
Extremely minor malocculsions, including displacements less than
1 mm |
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Grade 2
- Little |
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2.a
Increased Overjet > 3.5 mm but <= 6 mm (with competent lips) |
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2.b Reverse overjet greater than 0 mm but <= 1mm |
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2.c
Anterior or posterior crossbite with <= 1mm discrepancy between
retruded contact position and intercuspal position |
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2.d
Displacement of teeth > 1mm but <= 2mm |
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2.e
Anterior or posterior open bite > 1mm but <= 2mm |
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2.f
Increased overbite >= 3.5mm (wthout gingival contact) |
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2.g
Prenormal or postnormal occlusions with no other anomalies.
Includes up to half a unit discrepancy |
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Grade
3 - Borderline Need |
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3.a
Increased overjet > 3.5 mm but <= 6 mm (incompetent lips) |
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3.b
Reverse overjet greater than 1 mm but <= 3.5mm |
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3.c
Anterior or posterior crossbites witt >1mm but <=2mm discrepancy
between the retruded contact position and intercuspal position |
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3.d
Displacement of teeth >2mm but <=4mm |
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3.e
Llateral or anterior open bite > 2mm but <= 4mm |
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3.f
Increased and incomplete overbite without gingival or palatal
trauma |
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Grade
4 - Treatment Required |
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4.a
Increased overjet > 6mm but <= 9 mm |
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4.b
Reverse overjet > 3.5 mm with no masticatory or speech
difficulties |
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4.c
Anterior or posterior crossbites with > 2 mm discrepancy between
the retruded contact position and intercuspal position |
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4.d
Severe displacements of teeth > 4 |
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4.e
Extreme lateral or anterior open bites > 4 mm |
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4.f
Increased and complete overbite with gingival or palatal trauma |
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4.h Less
extensive hypodontia requiring pre-restorative orthodontics or
orthodontic space closure ot obviate the need for a prosthesis |
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4.l
Posterior lingual crossbite with no functional occlusal contact
in oneor more buccal segments |
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4.m
Reverse overjet > 1 mm but < 3.5 mm with recorded masticatory
and speech difficulties |
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4.t
Partially erupted teeth, tipped and impacted against adjacent
teeth |
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4.x
Existing supenumerary teeth |
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Grade
5 - Treatment Required |
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5.a
Increased overjet > 9 mm |
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5.h
Extensive hypodontia with restorative implications (more than
one tooth missing in any quadrant requiring pre-restorative
orthodontics) |
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5.i
Impeded eruption of teeth (apart from 3rd molars) due to
crowding, displacement, the presence of supernumerary teeth,
retained deciduous teeth, and any pathological cause |
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5.m
Reverse overjet > 3.5 mm with reported masticatory and speech
difficulties |
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5.p
Defects of cleft lip and palate |
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5.s
Submerged deciduous teeth |
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If the
patient is deemed to fall into category 4 or 5 then the patient
is eligible for NHS treatment (without the need to be assesed
'aesthetically'). Conversely, if they fall into 1 or 2 then the
patient is ineligible for NHS treatment. However, if they fall
into category 3 the patient is further assesed using the AC. |
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The AC has
10 categories and uses a set of photographs to further assess
the patients need on grounds of aesthetic impairment. These
photographs are shown below and give an overall representation
(obviously the orthodontist is not looking for an exact match). |
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The
combination of DHC and AC scores (in the form DHC.AC) gives a
score of 3.1 to 3.10. |
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To be
eligible for free NHS treatment, the overall score must be 3.6
or higher. |
