Updated May 2026
NHS Braces and Orthodontics: Free for Under-18s if IOTN 3.6+
NHS orthodontic treatment is free for under-18s who score 3.6 or higher on the Index of Orthodontic Treatment Need (IOTN). Adult NHS orthodontics is theoretically Band 3 (£332.10) but rarely available in practice. Private braces and aligners cost £1,500-6,000.
UNDER-18, IOTN 3.6+
£0
Free NHS orthodontic treatment, typically metal fixed braces, with retainers included.
ADULT NHS (RARELY APPROVED)
£332.10
Band 3 charge if NHS commissioning supports adult treatment in your area. Almost always private in practice.
The IOTN threshold explained
The Index of Orthodontic Treatment Need (IOTN) is the clinical assessment that decides whether an under-18 qualifies for free NHS orthodontic treatment. It has two components:
Dental Health Component (DHC)
Grade 1 (no need) to grade 5 (very great need). Considers misalignment severity, overbite, underbite, crossbite, impacted teeth, and bite function. Grade 4 and grade 5 cases automatically qualify for free NHS treatment.
Aesthetic Component (AC)
Photographic scale grading visible appearance from 1 (most attractive) to 10 (least attractive). Used to assess borderline grade 3 DHC cases.
The 3.6 threshold means: DHC grade 3 plus AC grade 6 or above. Below that, NHS orthodontic treatment is not provided as the treatment is considered to be primarily for cosmetic reasons rather than dental health.
| IOTN score | NHS treatment available? |
|---|---|
| DHC 5 (very great need) | Yes, free for under-18s |
| DHC 4 (great need) | Yes, free for under-18s |
| DHC 3 plus AC 6+ (borderline, 3.6) | Yes, free for under-18s |
| DHC 3 plus AC 5 or lower | No, considered cosmetic |
| DHC 1-2 (little/no need) | No, cosmetic only |
Why NHS adult orthodontics is so limited
In principle, NHS adult orthodontic treatment is available at the Band 3 charge of £332.10 where there is clear clinical need. In practice, almost all NHS adult orthodontic budget is allocated to under-18 cases and complex hospital-based adult treatment (post-jaw surgery, cleft palate). NHS adult orthodontic commissioning varies by Integrated Care Board and is not available to most adults wishing to straighten their teeth.
If you are an adult and want orthodontic treatment, you may be able to:
- Ask your dentist for an NHS orthodontic assessment to check whether you might qualify for the rare adult-need exception (usually severe functional issues).
- Go private with a high street practice or a clear aligner brand.
- Consider treatment at a UK dental school under student-led care at reduced cost (typically £500-1,500 for a full course of fixed braces, where available).
Private orthodontic options and costs
| Treatment type | Typical duration | Private cost (UK 2026) |
|---|---|---|
| Traditional metal fixed braces | 12-24 months | £1,500-3,000 |
| Ceramic (tooth-coloured) fixed braces | 12-24 months | £2,000-4,000 |
| Clear aligners (Invisalign, ClearCorrect) | 6-18 months | £2,000-5,500 |
| Lingual (behind-teeth) braces | 12-24 months | £4,000-8,000 |
| Six Month Smiles / short-term cosmetic | 6 months | £1,800-3,500 |
| Retainers after treatment | Lifetime use | Often included; £100-300 if separate |
Private ranges sourced from Which? UK orthodontic cost guides and Bupa Dental Care published price tiers. London is typically 30-50% higher.
What is included in free NHS under-18 orthodontics
If your child qualifies (IOTN 3.6 or above), free NHS orthodontic treatment typically includes:
- Initial orthodontic assessment and IOTN scoring.
- Treatment planning and impressions or scans.
- Fitting of fixed braces (metal brackets are standard NHS; ceramic typically not NHS).
- All routine adjustment appointments during treatment, typically every 6-8 weeks.
- Removal of braces at end of treatment.
- Retainers and retainer-fitting appointment.
- Initial retention review appointments.
Lost or broken retainers replaced later may be charged separately. The dentist or orthodontist will explain what is included before treatment starts.