National Health Service

National Health Service

National Health Service (NHS) patients are treated with the same care as our private patients. According to NHS guidelines, orthodontic treatment is provided under general dental services (GDS) only if there is a clinical need. A system known as the Index of Orthodontic Treatment Need (IOTN) is used to determine if orthodontic treatment is necessary and can consequently be provided under GDS. The IOTN consists of five grades:

  • Grade 1: Teeth are almost perfect.
  • Grade 2: There are minor irregularities. For example, the bite is slightly uneven.
  • Grade 3: There is significant irregularity to the bite, but treatment is normally not required for health reasons. An example of this would be upper front teeth protrusion.
  • Grade 4: There is severe misalignment. Treatment is necessary for health purposes. For example, the upper front teeth protrude beyond six mm or there is missing teeth where gaps must be closed.
  • Grade 5: There are extensive dental problems, such as several missing teeth and upper front teeth protrusion beyond nine mm.

Patients classified as grade 1 or 2 cannot normally receive orthodontic treatment under GDS. Typically, patients identified as grade 3 are judged on a case-by-case basis, depending on the appearance of the teeth. So as a result these patients may be eligible for orthodontic care under GDS. Patients identified as grade 4 or 5 are eligible to receive orthodontic care under GDS.


Generally, to qualify for orthodontic treatment under GDS, the patient must maintain good oral hygiene.

If the dentist recommends orthodontic treatment, you or your child may need to see an orthodontist so he or she can determine if treatment is required. Receiving a referral to an orthodontist for an exam does not mean orthodontic care is needed or that it will be provided under GDS.