How do we decide whether you qualify for NHS treatment?

All orthodontic practices in England have NHS Contracts with their local commissioning bodies.

These Contracts provide the terms and conditions under which NHS treatment can be provided.

All Contracts held by any practice have a section that refers to the Index of Orthodontic Need (IOTN).

Index of Orthodontic Treatment Need (IOTN)

This is a scoring system that tells us a patient’s “need” for treatment.

Some patients have a very high need for treatment. Examples might include patients whose teeth stick out a lot, or are very crooked. Providing orthodontic treatment will improve the health of the teeth.

Other patients have a low need for treatment. Examples included patients whose teeth are only slightly crooked. Providing treatment will not necessarily maker the teeth any healthier, although it might make them look a little nicer.

And of course, there are many patients who are somewhere in the middle of these two extremes.

This patient of ours had a high need for orthodontic treatment

The result after having orthodontic treatment at Cleveland Orthodontics

The IOTN allows an orthodontist to give a score that indicates how great a patient’s need for treatment.

The score consist of two numbers. The first refers to measurements that the orthodontist makes of the teeth, and ranges from 1 to 5.  The second refers to comparing your teeth to a set of photographs and ranges from 1 to 10.

A high score indicates a high treatment need and therefore a large health benefit to the patient if treatment is provided.

A low score indicates a low treatment need, with little or no health benefit if treatment is provided.

How does IOTN work in deciding whether I can have NHS treatment?

NHS treatment is available to patients with the following IOTN scores:

  • All patients whose first score is 4 or 5
  • All patients whose first score is 3, and the second score is 6 or above

This ensures that NHS treatment is provided to those patients who have the greatest need for treatment and will have clear health benefits as a result of that treatment.

What if my IOTN score is too low for me to have NHS treatment?

Some patients have crooked teeth and would still like to have them straightened but unfortunately do not qualify for NHS treatment due to a low IOTN score.

If you have a low score this may suggest that your teeth are not very crooked, and that having treatment will only provide minimal benefits. There is also a possibility that if retainers are not worn long term, your teeth could become crooked again, resulting in no benefit at all in the long run.

Your orthodontist will counsel you on whether pursuing treatment is appropriate, and of the risks and benefits involved.

If you decide to proceed with treatment, there are a number of options available as alternatives to NHS treatment.