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The Malthouse, Wraysbury Road, Staines, Middlesex TW18 4XP

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Since  April 2006, the Index Of Treatment Need (IOTN) has been used to asses if patients under 18 are eligible for NHS funded treatment . We use this assessment on all NHS patients in the full permanent dentition to determine if you qualify for NHS funded treatment. If you do not qualify we can still offer you treatment but this will only be on an independent of private basis.

The IOTN scale is split into two component Dental health component and the Aesthetic component. To be eligible for free NHS treatment, the overall score must be 3.6 or higher. The first number relates to the dental health component and the second to the Aesthetic component.

Dental Health Component

This identifies the most severe occlusal trait and is graded as 1, 2, 3, 4 or 5

Grade 1 – No Treatment required

  1. Extremely minor malocclusions, including displacements less than 1 mm

Grade 2 – Little need

  1. Increased Overjet > 3.5 mm but <= 6 mm (with competent lips)
  2. Reverse overjet greater than 0 mm but <= 1mm
  3. Anterior or posterior crossbite with <= 1mm discrepancy between retruded contact position and intercuspal position
  4. Displacement of teeth > 1mm but <= 2mm
  5. Anterior or posterior open bite > 1mm but <= 2mm
  6. Increased overbite >= 3.5mm (without gingival contact)
  7. Pre normal or post normal occlusions with no other anomalies. Includes up to half a unit discrepancy

Grade 3 – Borderline need

  1. Increased overjet > 3.5 mm but <= 6 mm (incompetent lips)
  2. Reverse overjet greater than 1 mm but <= 3.5mm
  3. Anterior or posterior crossbites with >1mm but <= 2mm discrepancy between the retruded contact position and intercuspal position
  4. Displacement of teeth >2mm but <=4mm
  5. Lateral or anterior open bite > 2mm but <= 4mm
  6. Increased and incomplete overbite without gingival or palatal trauma

Grade 4 – Treatment required

  1. Increased overjet > 6mm but <= 9 mm
  2. Reverse overjet > 3.5 mm with no masticatory or speech difficulties
  3. Anterior or posterior crossbites with > 2 mm discrepancy between the retruded contact position and intercuspal position
  4. Severe displacements of teeth > 4
  5. Extreme lateral or anterior open bites > 4 mm
  6. Increased and complete overbite with gingival or palatal trauma
  7. Less extensive hypodontia requiring pre-restorative orthodontics or orthodontic space closure to obviate the need for a prosthesis
  8. Posterior lingual crossbite with no functional occlusal contact in one or more buccal segments
  9. Reverse overjet > 1 mm but < 3.5 mm with recorded masticatory and speech difficulties
  10. Partially erupted teeth, tipped and impacted against adjacent teeth
  11. Existing supernumerary teeth

Grade 5 – Treatment required

  1. Increased overjet > 9 mm
  2. Extensive hypodontia with restorative implications (more than one tooth missing in any quadrant requiring pre-restorative orthodontics)
  3. Impeded eruption of teeth (apart from 3rd molars) due to crowding, displacement, the presence of supernumerary teeth, retained deciduous teeth, and any pathological cause
  4. Reverse overjet > 3.5 mm with reported masticatory and speech difficulties
  5. Defects of cleft lip and palate
  6. Submerged deciduous teeth

The Aesthetic Component

This consists of a ten-point scale illustrated by a series of photographs which were rated for attractiveness by a lay panel and selected as being equidistantly spaced through the range of grades. A rating is allocated for overall dental attractiveness rather than specific similarities to the photographs. The final value reflects the treatment need on the grounds of aesthetic impairment and by implication the sociopsychological need for orthodontic treatment. Both parents and patients find this easy to apply and there is a high level of agreement between the scores obtained by dentists, parents and children

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