Understanding NHS Orthodontic Eligibility
In the UK, NHS orthodontic treatment for children is strictly regulated and only available for those with moderate to severe dental issues. The system uses the Index of Orthodontic Treatment Need (IOTN) to determine eligibility, meaning many children with mild concerns may not qualify for funded treatment.
Why Might a Child Be Denied NHS Braces?
Your child may not be eligible for NHS-funded orthodontic treatment if:
- Their case is classified as mild or cosmetic under the IOTN scale.
- They are under 14 years old and still have baby teeth.
- Their dental alignment does not pose a functional problem (e.g., severe bite issues, crowding, or impacted teeth).
- NHS waiting lists are too long, and treatment is deemed non-urgent.
A Personal Perspective – Why Early Treatment Matters
With over 10 years of experience, I have seen many cases where children with clear orthodontic needs were denied NHS treatment simply because their case wasn’t considered severe enough under the system’s funding criteria.
One case that has stayed with me involved a 9-year-old girl with severe crowding, narrow arches, and ENT issues, including enlarged adenoids (confirmed by her specialist). One of her lower permanent incisors had erupted behind another incisor due to lack of space. Her parents came to see me because they were concerned about the crowding, but during our assessment, I discovered that she was also experiencing disturbed sleep and chronic mouth breathing—both of which can significantly impact jaw development.
I explained to the parents how everything in a child’s well-being is connected and how poor tongue posture and mouth breathing contribute to narrow arches and crowding. Given that she still had 12 baby teeth, I recommended an early interceptive treatment plan that involved expanding her arches to create space for her developing teeth. We also took a CBCT scan (3D X-ray) to determine the exact positioning of her teeth and ensure the best approach.
Her parents, wanting to explore all options, consulted the NHS orthodontic service. Before seeing me, they had already visited an NHS orthodontic clinic, where they were told to wait until she lost all her baby teeth, which would mean treatment wouldn’t start until around age 12-14. I warned them that by waiting, there was a high risk that her lateral incisor would have to be extracted because there simply wouldn’t be enough space left to align it properly.
Hoping for another NHS alternative, I referred them to a major dental hospital in London, which sometimes provides interceptive treatment. They secured an appointment two months later, and I didn’t hear back from them afterward.
Two years later, I received a letter from the hospital’s orthodontic department. They were asking me, as the referring dentist, to extract not just the lower lateral incisor but also both upper premolars. Their recommendation was to remove three perfectly healthy teeth due to severe crowding—a direct result of waiting too long.
I cannot describe how heartbroken I felt. That little girl had options when she was younger. She could have undergone early treatment to expand her arches and preserve all her natural teeth. Instead, by following the standard NHS pathway, she ended up losing three teeth unnecessarily. Cases like this fuel my passion for raising awareness among both parents and fellow dentists. Every child deserves to know all their options, and with the advancements in modern dentistry and technology, we have the ability to offer solutions beyond just extractions.
What Are Your Options If Your Child Doesn’t Qualify?
If your child is denied NHS orthodontics but you still have concerns about their teeth, here’s what you can do:
- Seek a Private Orthodontic Consultation
Private orthodontics offers early intervention and comprehensive treatment without the strict NHS criteria. Benefits include:
- No waiting lists – Start treatment as soon as needed.
- Access to modern treatment options – Including clear aligners and discreet braces.
- Personalized care – Treatment tailored specifically to your child’s needs.
- Consider Interceptive Orthodontics
Early intervention (ages 7-10) can help guide jaw development and prevent future complications. Many countries encourage early orthodontic assessments, yet the NHS often does not provide treatment until later.
- Monitor & Reassess
If treatment isn’t urgent, we can schedule follow-ups to track dental changes and start treatment at the optimal time.
The Importance of Early Dental Assessments
General dentists play a key role in identifying orthodontic issues early on. Parents should ensure their child has regular six-month dental check-ups, where potential concerns can be flagged before they become complex problems.
Need Expert Advice?
If your child has been denied NHS orthodontics but you still have concerns, book a private consultation today to explore all available options for their smile and oral health.
