Memorandum by British Orthodontic Society
1. Orthodontics is that branch of dentistry
concerned with treatment of deformities of the jaws and irregularities
of the teeth and dental occlusion and is mainly undertaken on
children between the age of nine to 14. Some simple treatments
are provided by general dental practitioners but most is delivered
by approximately 800 specialists working in the Hospital, Community
and General Dental Services (GDS).
2. The British Orthodontic Society (BOS)
is the national representative body for all orthodontists in the
United Kingdom. Membership includes Specialist Orthodontists working
in the Hospital and Community services and Specialists working
in the GDS. Many non-specialist General Dental Practitioners who
provide some orthodontic services are also members.
3. Recommendations specific to orthodontics
are contained within the Government's strategy "Modernising
NHS Dentistry" (paragraphs 4.32-4.36) and in a subsequent
more detailed document entitled "Modernising NHS DentistryImplementing
the NHS Plan, Modernising Orthodontic Services" written by
the Department of Health on 30 September 2000 and sent to the
General Dental Services Committee of the BDA which specifies their
proposals for changes to the provision of orthodontics and the
related fee scale structure in the GDS. The BOS does not oppose
these recommendations for orthodontics but is very concerned about
their likely success in improving access to specialist services
and treatment within the NHS.
4. The Department of Health believes that
there is a significant amount of unnecessary orthodontic treatment
being carried out in the General Dental Services (GDS), and that
by the introduction of an Index of Orthodontic Treatment Need
(IOTN), existing resources will be targeted at those in greatest
need in terms of health gain and aesthetic improvement. This measure
would remove altogether the right of patients to receive NHS treatment
in milder cases.
5. It should be noted that this is the first
example of national formal "rationing" of treatment
in any of the medical or dental services. The BOS does not oppose
this measure in principle, but the effect on the public perception
of NHS dentistry should be carefully considered.
6. It is incorrect to describe the treatment
of mild malocclusion as "unnecessary". In the minds
of many patients and their parents such treatment is perceived
as providing valuable improvements in self esteem and confidence.
Many patients in receipt of such treatment are well motivated
towards its success.
7. It should be understood that many parents
whose children may be denied NHS treatment in the future will,
after much protest, seek it under private contract, so occupying
valuable manpower resources which could otherwise be available
to the NHS. Furthermore the inevitable increased demand for second
opinions and re-assessment of treatment need will extend the already
8. All orthodontic services are seriously
undermanned at the present time. Many Hospital Consultant posts
lie vacant and more Specialist Orthodontic Practitioners in the
GDS are now retiring than are being replaced from post-graduate
specialist training programmes. Almost everywhere there are long
waiting lists. Annex 1 demonstrates our comparative situation
with those of other Western European countries and the USA.
9. It is the considered judgement of the
BOS that the factors mentioned will have the unfortunate effect
of reducing access to NHS orthodontics rather than improving it,
and that the Government, in consultation with the profession should
give urgent consideration to a fundamental restructuring of the
primary care orthodontic services (GDS and Community) including
a much closer integration with secondary care services (Hospital
9 January 2001