NHS or Private Orthodontics: Eligibility, Waiting and Choice
This guide is written for anyone weighing up NHS or private braces. It covers NHS eligibility, the IOTN grades, the age rule, waiting lists, NHS braces, paying privately and the practice's provision. In short, NHS guidance says braces are often free on the NHS for children under 18, and adults usually pay for them privately.
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Clinically reviewed by Dr Ibraheem Ijaz, dentist · GDC 301711
Medical disclaimer: This page is for general information only. It does not replace an examination or treatment by a dentist.
Dr Ibraheem Ijaz, principal dentist, reviewed this page. He is a General Dental Practitioner, with BDS, BSc (Hons), MSc (Leeds), PG Dip Implant Dentistry and PG Cert Restorative and Aesthetic Dentistry.
How do NHS and private orthodontic treatment compare?
NHS and private orthodontic treatment differ in who qualifies, who pays and how treatment starts. Most cells give what NHS guidance, NHSBSA and BOS say; two private cells add a step to take.
| NHS orthodontic treatment | Private orthodontic treatment | |
|---|---|---|
| Who it is mainly for | NHSBSA: under-18s with a clear health need; for adults, NHS orthodontic care is not usually available but may be approved case by case for health reasons | NHS guidance says those aged 18 or over usually pay for braces |
| How it starts | NHS guidance: a dentist who thinks a child needs braces refers them for an orthodontic assessment | Contact the practice you choose; BOS says a fee can normally be quoted only after an assessment |
| Cost to you | Free for under-18s who qualify (NHSBSA) | BOS says private fees vary widely |
| Waiting | NHS guidance says there may be a long waiting list to be seen after a dentist refers a child | Ask the practice you choose when it can see you |
| Brace | NHS guidance says a fixed brace is usually offered, and other types may be offered depending on the problems with the teeth | NHS guidance says the cost of private braces can vary with how complicated the problem is and the type fitted |
More comparisons of orthodontic approaches sit among the options in this section.
How does NHS orthodontic eligibility work?
NHSBSA says NHS orthodontic treatment is free for people under 18 with a clear health need for treatment. Eligibility is assessed with a rating system called the Index of Orthodontic Treatment Need (IOTN).
NHS guidance says that if a dentist thinks a child needs braces, they will refer them for an orthodontic assessment. Whether a child is eligible depends on how their teeth are affecting their day-to-day life, for example by causing problems with eating or cleaning their teeth.
What is the IOTN, and which grades qualify for NHS treatment?
NHSBSA describes the IOTN as a scale measuring orthodontic need, with two parts: a Dental Health Component and an Aesthetic Component.
NHSBSA says NHS-funded treatment is normally restricted to Dental Health grade 4 or 5, or grade 3 with an Aesthetic Component of 6 or more. Its patient guidance adds that grade 3 cases are usually judged on an individual basis, and that NHS treatment may also be available if the appearance of your teeth, jaw or face is of concern.
| Dental Health grade | NHSBSA need level | Examples from an archived 2014 BOS summary |
|---|---|---|
| 1 | No need | Almost ideal teeth |
| 2 | Little need | Minor irregularities, such as slightly protruding upper front teeth or slightly irregular teeth |
| 3 | Borderline need | Greater irregularities that normally do not need treatment for health reasons, such as teeth less than 4 mm out of line or deep bites with no functional problems |
| 4 | Need | More severe irregularities that do need treatment for health reasons, such as upper front teeth protruding more than 6 mm, teeth more than 4 mm out of line, or missing teeth where gaps need to be closed |
| 5 | Very great need | Severe dental health problems, such as teeth that cannot come into the mouth normally because of obstruction by crowding, extra teeth or another cause, upper front teeth protruding more than 9 mm, or cleft lip and palate |
For the Aesthetic Component, the archived 2014 BOS page says the patient's teeth are matched against 10 colour photographs showing different levels of dental attractiveness. NHSBSA groups scores of 1 to 4 as little or no need, 5 to 7 as borderline need and 8 to 10 as great need.
What is the age limit for NHS braces?
NHSBSA says NHS-funded orthodontic treatment is only available to patients under 18 who have a definite clinical need for treatment. NHS orthodontic treatment is not usually available for patients over 18, but may be approved by local NHS commissioners on a case-by-case basis if the functional needs are great.
NHSBSA guidance for practices in England says that since 1 April 2019, if a patient is 18 or over on the date of referral, commissioner approval is needed before orthodontic treatment starts.
BOS says most children begin treatment around the age of 12 or 13, once all their adult teeth have come through, although in a few instances treatment is better started early.
Is there a waiting list for NHS orthodontic treatment?
NHS guidance says there may be a long waiting list to be seen after a dentist refers a child for an orthodontic assessment.
For private treatment, ask the practice you choose when it can see you.
To ask about private orthodontic treatment, book online or call 0114 288 2121.
Which brace does the NHS usually provide?
NHS guidance says that if you are eligible for braces on the NHS, you will usually be offered a fixed brace. The NHS commonly uses fixed metal braces, and other types may be offered depending on the problems you have with your teeth.
What does paying privately for braces involve?
NHS guidance says the cost of private braces can vary depending on how complicated the dental problems are and the type of braces fitted.
BOS says that, provided the teeth and gums are healthy, teeth can be moved at any age. Because adults are not usually eligible for NHS treatment, it says, they most commonly pay for treatment.
BOS says private fees vary widely, with the complexity of the problem, the locality and the clinician's experience. It suggests asking how much treatment will cost in total, including any breakages and retainers.
Does Deepcar Dental Care provide NHS orthodontic treatment?
Deepcar Dental Care provides private treatment only and does not offer NHS treatment, including NHS orthodontics.
For how NHS and private dental care differ beyond orthodontics, see the NHS or private dental care guide.
Who is orthodontic treatment at Deepcar Dental Care for?
Orthodontic treatment at Deepcar Dental Care is for adults only.
The treatments offered are set out on the orthodontics at Deepcar Dental Care page, and our guide to adult orthodontic treatment answers questions about straightening teeth later in life.
What does the practice's fee list say about orthodontic treatment?
The current fee list at the practice prices clear aligners from £1,495 per arch.
The fee list does not say whether the £1,495 per arch line covers fixed metal, ceramic or lingual braces.
Frequently asked questions
Is NHS orthodontic treatment ever available for adults?
Sometimes. BOS says adult treatment can in principle be provided on the NHS where the need is sufficient, but as a general rule most NHS orthodontic contracts exclude adults. For the most severe problems, notably those needing jaw surgery, adults may be treated through the NHS hospital service after a referral, though hospitals do not normally accept routine cases.
Can every child have an NHS orthodontic assessment?
BOS says all children under 18 are able to have an orthodontic assessment under the NHS. It adds that the NHS pays for treatment of the more severe cases only, and minor problems are not covered. Treatment for children who qualify is free of charge, and the IOTN sets out who qualifies.
Is the IOTN grade the only thing that decides NHS treatment?
Not according to a 2015 NHS England guide for commissioners. It said that, alongside the IOTN threshold for NHS eligibility, a patient having excellent oral hygiene, wanting care and being prepared to commit to the demands of treatment are as important. The guide was written for the commissioners who plan NHS services.
Do NHS and private braces both need a retainer afterwards?
Yes. NHS guidance says that once braces come off you will need to wear a retainer, which stops your teeth moving back, and you will be told how long to wear it. BOS says retainers, and the likely need for lifelong wear if the teeth are to stay in their new place, should be explained at the start of treatment.
Do you pay to replace a lost or broken NHS brace?
Yes. NHSBSA says your dental practice will charge you for replacing a lost or broken NHS orthodontic appliance, even if you usually qualify for free or reduced-cost NHS dental services. A refund may be claimed if paying the charge caused you undue financial hardship or you took reasonable care of the appliance.
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Deepcar, Sheffield S36 2RH
0114 288 2121
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