The Index of Orthodontic Treatment Need (IOTN) is a classification system used to determine who will receive treatment and on what basis. It is used to determine treatment need in young people under the age of 18 and assigns a grade according to the level of need.

Sadly, there are not enough NHS orthodontists in certain areas of the country which can mean a long wait until one becomes available. If you are the parent of a child who requires orthodontic treatment then you not only have to meet the qualifying criteria but may need to be put on a waiting list.

If you are an adult then you will have to pay for private treatment unless you meet the criteria for NHS treatment. But this only applies in exceptional cases.

The reality is that there are insufficient numbers of NHS orthodontists to cope with patient demand.


The IOTN uses a system of 5 grades which start from Grade 1 for almost perfect teeth through to Grade 5 for severe orthodontic problems, e.g. abnormal development of the jaw.

The grades are as follows:

Generally, NHS treatment is provided for all conditions which are assessed as Grade 4 to Grade 5. Grade 3 conditions are eligible but only on an individual basis.

The fact remains that there has to be a demonstrable need for treatment. If a child presents with a serious orthodontic condition then they will receive NHS treatment but it all depends upon this rating system and whether there is an NHS orthodontist available to treat him/her.

Waiting lists

If you are unable to find an NHS orthodontist in your area then you will have to go on a waiting list. Waiting lists are organised by your local Primary Care Trust (PCT) and the length of time you will wait varies from one location to another.

Waiting times vary from several months through to two years or more.

This may seem harsh but the truth of the matter is that there are not enough trained and experienced professionals to handle orthodontic cases. And the NHS is subject to funding restrictions like every other organisation and especially in the current economic climate.

Your only other option is to pay for private treatment.