Select Committee on Health Appendices to the Minutes of Evidence


Memorandum by British Orthodontic Society (D 11)

  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 Dentistry—Implementing 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 inadequate resources.

  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 Service).

9 January 2001

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