Criteria For Cosmetic Dentistry On NHS

Getting Cosmetic Dentistry Through The NHS

Cosmetic Dentistry is generally regarded as any treatment that aesthetically improves the appearance of the mouth and teeth but is not a clinical necessity. Essentially, this means that if your dentist decides that a particular course of treatment is beneficial to improve the health of your mouth, teeth or gums, then it is available on the NHS. But if it is deemed as only a visual enhancement, then it can only be done privately. To this end, the Index for Orthodontic Treatment Need (IOTN) has been developed to enable the industry to make an objective judgement over who needs treatment for the benefit of dental health and who is seeking enhancement of their general dental attractiveness.

Qualifying Criteria

The criteria for the Dental Health Component (DHC) of the IOTN has been split into 5 grades, as follows:
  • Grade 1 - Close to Perfection.
  • Grade 2 - Minor Irregularities, (including slight protrusions.)
  • Grade 3 - Greater Irregularities that Do Not need treatment on Health Grounds, (irregularities of less than 4mm.)
  • Grade 4 - More Severe Irregularities that Do need treatment on Health Grounds, (irregularities of more than 4mm, too many teeth causing overcrowding or too few teeth leaving gaps that require closing.)
  • Grade 5 - Severe, (large irregularities, severe overcrowding and other facial irregularities such as Hare Lip and Cleft Palate.)

Cost Of Treatment On The NHS

The cost of treatment on the NHS has now been categorised into 3 bands reflecting the level of treatment required. These bands include the following general treatments:
  • Band 1 - £16.50: Includes examinations, assessments, advice and reports, dental hygiene and disease prevention instruction, cleaning, extraction of material requiring examination, and adjustments of fittings such as dentures or retainers.
  • Band 2 - £45.60: Includes everything in Band 1, plus more intensive scaling, gingivectomy, permanent fillings, tooth extraction, cyst removal and dental splints.
  • Band 3 - £198.00: Includes everything in Bands 1 & 2, plus veneers and inlays, caps, crowns and bridges, dentures and general orthodontic fittings.
This list is not exhaustive, but covers the most common types of treatment. Consideration should also be made for the fact that any treatment may require two payments per band, depending on whether your dentist refers you to a specialist for further treatment. (In the case of treatments in Band 3, this could mean incurring two separate charges of £198 if it is a completely new course of treatment, but only one charge of £198 if it is all part of the initial course of treatment.) It should also be understood that you may be required to pay part or all of any course of treatment before the treatment is carried out, (particularly in the case of any fixtures or fittings such as dentures, crowns, veneers, etc.)

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What's Available On The NHS

NHS dental treatment doesn't usually cover cosmetic enhancement

The NHS will provide any treatment that is needed to maintain oral health and keep your mouth, teeth and gums free of disease.

Your NHS dentist will be able to assess what course of treatment is needed, and offer you the appropriate care. They will give you the option of having care provided under the NHS, and also make you aware of cosmetic treatment options such as whitening that can only be accessed on a private basis, enabling you to make the best decision for you. Wherever alternative private options are being considered, your treatment plan should go over these options in detail. Once you have decided on your treatment plan, you will be asked to sign a copy to commit to it.

If you are receiving a treatment in Band 2 or Band 3, or a mix of NHS and private treatment, your dentist is obligated to provide you with a written treatment plan. These plans are not necessary for Band 1 treatments, but can be obtained if you would like one based on personal preference. You should be informed of any changes to your proposed treatment plan, which can arise as a result of changes to your oral health in the time between your initial assessment and the beginning of treatment.

When Treatment Is Available On The NHS

All of this treatment may be available on the NHS free in exceptional circumstances, such as:
  • Those under 18 years of age.
  • Those over 18 years of age still in full time education.
  • Pregnant women or women who have been pregnant in the 12 months prior to the start of treatment.
  • An NHS inpatient being treated by the hospital dentist.
  • If you (or your partner) are in receipt of Income Support, (including Jobseekers Allowance.)
As with the types of treatment available within each band, this eligibility list is not exhaustive.


If you are unsatisfied or unhappy with any aspect of the dental care you have received on the NHS, you will need to make a formal complaint.

To initiate this process, you should begin by speaking to your dental practice. It is normally the case that most issues can be resolved through this course of action, without having to go through the process of lodging a formal complaint. Often an honest, informal discussion with your dentist can alleviate any issues, and this is ideal especially if you are dealing with a minor compliant or grievance.

If you are not satisfied with how your local dentist has handled your complaint however, it may be necessary to take further action and submit your complaint to the independent Parliamentary and Health Service Ombudsman. For more serious cases, you can contact the NHS directly, or speak to the General Dental Council (GDC) to obtain advice. The GDC exists to protect patients who have obtained dental treatment both privately and through the NHS, and they are there to act on your behalf if you feel your dentist is acting unethically or below standard. The GDC can take action to investigate complaints regarding poor treatment and malpractice, a practice not having professional indemnity insurance, cross-infection issues, fraudulent activity or theft, or dentists practicing whilst under the influence of drugs or alcohol.

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