Orthodontic treatment in the UK is not universally free of charge. The provision of treatment is primarily managed by the National Health Service (NHS) and is determined by a strict assessment of clinical need, not merely a desire for a straighter smile. To receive fully funded treatment, a patient must meet specific criteria that prioritize dental health over purely cosmetic adjustments. Understanding the system requires knowing the age limits, the required severity of the misalignment, and the formal assessment process.
Eligibility for Free NHS Braces
The most significant factor determining eligibility for free orthodontic treatment is age, as the NHS generally limits fully funded care to patients under 18 years old. This age restriction ensures that resources are directed toward individuals whose jaw and facial growth is still developing. However, being under 18 does not guarantee treatment; a clinical need must also be demonstrated.
Clinical necessity is formally assessed using a standardized measurement tool called the Index of Orthodontic Treatment Need (IOTN). The IOTN system evaluates dental health issues, such as severe crowding, protruding teeth, and bite problems, by assigning a grade from 1 to 5. Grades 1 and 2 indicate little or no need for treatment, meaning the patient will not qualify for NHS funding.
Patients who receive a Grade 4 or Grade 5 automatically qualify for free NHS treatment because their dental irregularities are severe enough to affect their long-term oral health. Grade 3 is considered a borderline case, and eligibility depends on a secondary, aesthetic component of the IOTN. This secondary assessment compares the appearance of the teeth to a set of photographs; if the patient scores 6 or higher on this aesthetic scale, they will be accepted for NHS treatment.
Adults over 18 are typically not eligible for free treatment unless they present with an exceptionally severe malocclusion requiring complex, multidisciplinary care. This level of care is usually only provided within the hospital orthodontic service.
The NHS Orthodontic Treatment Pathway
The journey to receiving NHS braces begins with a consultation with a general NHS dentist. The general dentist performs an initial assessment of the patient’s teeth and bite. If they suspect that the patient may meet the necessary IOTN criteria, they will issue a referral to a specialist orthodontist.
Once the referral is received, the patient is called for a specialist assessment appointment with the NHS orthodontist. During this appointment, the specialist applies the full IOTN to determine the patient’s precise grade. This confirms whether the patient has a severe enough malocclusion to receive free care.
If the patient is deemed eligible, they are placed on a waiting list. Due to high demand and limited NHS capacity, waiting times can be substantial, often ranging from one to two years. Treatment typically involves standard fixed metal braces, as the NHS does not generally fund more discreet appliance types.
Costs When NHS Treatment Isn’t Free
When a patient does not qualify for free NHS treatment, either because they are over 18 or their IOTN score is too low, they have two primary financial options: paying the fixed NHS adult charge or opting for private care. For adults receiving non-exempt NHS dental treatment, including orthodontics, the cost falls under the highest fee category, known as Band 3.
The current NHS Band 3 charge in England is a fixed cost of £326.70, which covers the entire course of treatment. This includes the fitting of the braces, all necessary adjustments, and the provision of retainers afterward. This fixed charge is a single payment regardless of the length or complexity of the treatment. Individuals who are eligible for certain benefits, or are under 18, are exempt from this charge.
For those seeking treatment that is not clinically necessary, such as purely cosmetic adjustments, or who want more discreet brace types, private treatment is the alternative. Private orthodontic costs vary significantly based on the type of appliance and the complexity of the case. Traditional fixed metal braces can cost in the range of £1,800 to over £4,000 for both upper and lower arches.
More advanced options include clear ceramic braces, lingual braces (fitted behind the teeth), or clear aligners like Invisalign. The cost for these discrete treatments can start at around £2,500 and frequently exceed £5,000, with complex cases reaching up to £8,000 or more. Many private practices offer payment plans to help patients manage the financial commitment of self-funded care.