Last updated: February 2026. Verified information from NHS and UK dental sources.
NHS braces are completely free for children under 18 who have a clinical need for treatment. But how do you know if your child qualifies? This guide explains the IOTN assessment system, what types of braces are available on the NHS, waiting times, and how to get your child referred.
Is My Child Eligible for Free NHS Braces?
NHS orthodontic treatment is free for children under 18, but only if there is a clinical need. This is assessed using the Index of Orthodontic Treatment Need (IOTN).
Understanding the IOTN Assessment
The IOTN has two components:
| Component | What It Measures | Scale |
|---|---|---|
| Dental Health Component (DHC) | How teeth problems affect oral health | Grade 1-5 |
| Aesthetic Component (AC) | Visual impact of teeth alignment | Scale 1-10 |
Your child's orthodontist will assess both components to determine NHS eligibility.
IOTN Grades Explained
| Grade | Description | NHS Eligibility |
|---|---|---|
| Grade 5 | Severe dental health need (e.g., impacted teeth, extensive hypodontia) | Automatic |
| Grade 4 | Significant need (e.g., large overjet >6mm, severe crowding) | Automatic |
| Grade 3.6+ | Moderate need with aesthetic score of 6 or above | Usually eligible |
| Grade 3 | Moderate need with aesthetic score below 6 | Not eligible |
| Grade 2 | Minor irregularities | Not eligible |
| Grade 1 | Almost perfect alignment | Not eligible |
"NHS funded orthodontic treatment is normally restricted to individuals with a DHC of 5, 4 or 3 with an AC of 6 or more." — NHSBSA
What Dental Issues Qualify for NHS Braces?
Grade 5 (Automatic eligibility):
- Impacted teeth (other than wisdom teeth)
- More than one tooth missing from birth (hypodontia)
- Teeth that cannot erupt due to crowding
- Cleft lip and palate cases
Grade 4 (Automatic eligibility):
- Overjet (protruding front teeth) greater than 6mm
- Reverse overjet (underbite) greater than 3.5mm
- Severe contact point displacement (crowding over 4mm)
- Open bite greater than 4mm
- Crossbite with more than 2mm displacement
Grade 3 (May qualify if aesthetic score is 6+):
- Overjet between 3.5mm and 6mm
- Reverse overjet between 1mm and 3.5mm
- Moderate crowding (contact displacement 2-4mm)
- Deep overbite with gum trauma
Beyond the IOTN Score
Even if your child meets the IOTN threshold, they must also demonstrate:
- Excellent oral hygiene — No active decay, healthy gums
- Genuine motivation — Child wants the treatment
- Commitment — Willing to attend all appointments and follow instructions
"Beyond meeting IOTN score, patients must have excellent oral hygiene and a genuine desire for treatment." — NHS England Clinical Standard for Orthodontics
What Age Can Children Get NHS Braces?
When Treatment Typically Starts
Orthodontic treatment usually begins around age 12, once most permanent teeth have erupted.
"This is usually when they're about 12 years old, but it depends on how many of their adult teeth have come through and the growth of their face and jaws." — NHS
Age Requirements Summary
| Age | NHS Braces Eligibility |
|---|---|
| Under 10 | Rarely - only for specific issues like crossbite affecting jaw growth |
| 10-12 | Sometimes - if permanent teeth are through and treatment is needed |
| 12-17 | Most common age range for NHS orthodontic treatment |
| 18+ | NOT free on NHS (unless started before 18 or exceptional circumstances) |
Important: Treatment must be completed before turning 18 to remain free. If treatment extends beyond your child's 18th birthday, it continues free as long as it was started under 18.
How to Get Your Child Referred for NHS Braces
Step 1: Regular Dental Check-ups
Your child's general dentist monitors their teeth development at routine appointments. They will identify if orthodontic assessment is needed.
Step 2: Dentist Referral
If your dentist believes your child may benefit from braces, they will refer them to an orthodontist. You cannot self-refer for NHS orthodontic treatment.
Step 3: Orthodontic Assessment
The orthodontist will:
- Examine your child's teeth, jaws, and bite
- Take X-rays and photographs
- Make impressions or digital scans
- Calculate the IOTN score
- Explain whether NHS treatment is available
Step 4: Treatment Decision
| Assessment Outcome | What Happens Next |
|---|---|
| IOTN qualifies for NHS | Treatment plan created, added to waiting list |
| IOTN does not qualify | Private treatment options discussed |
| Borderline case | May be reviewed again in 6-12 months |
What If Your Dentist Won't Refer?
If you believe your child needs orthodontic assessment but your dentist disagrees:
- Ask for a clear explanation of why referral isn't recommended
- Request a second opinion from another NHS dentist
- Contact NHS England on 0300 311 2233 for advice
NHS Braces Waiting Times
How Long Is the Wait?
The NHS standard is to begin treatment within 18 weeks of eligibility being confirmed. However, actual waiting times vary significantly by region.
"Because of high demand, there can be a long waiting list for NHS orthodontic treatment." — NHS
Typical Timeline
| Stage | Expected Duration |
|---|---|
| GP dentist to orthodontist referral | 2-6 weeks |
| Assessment appointment | Within 18 weeks of referral |
| Assessment to treatment start | Varies (weeks to months) |
| Total treatment duration | 18 months - 3 years |
What Affects Waiting Times?
- Regional demand — Urban areas often have longer waits
- Complexity — Severe cases may be prioritised
- Orthodontist availability — Shortage in some areas
- Your child's readiness — Oral hygiene must be excellent
If the Wait Is Too Long
If you believe the waiting time is unreasonably long:
- Contact the orthodontic practice for an update
- Speak to your local NHS England area team
- Consider private treatment if you can afford it (costs £2,000-£6,000+)
What Types of Braces Are Available on the NHS?
Free on NHS
| Type | Description | Suitable For |
|---|---|---|
| Metal braces | Traditional fixed braces with metal brackets and wires | Most cases, very effective |
| Removable braces | Plastic plates with clips and springs | Simple cases, younger children |
| Functional appliances | Removable braces that use jaw muscle power | Correcting bite problems |
| Headgear | External appliance worn at night | Severe overjet, jaw positioning |
| Retainers | Worn after treatment to maintain results | All patients post-treatment |
Metal braces are the most common type used on the NHS and are highly effective for correcting most orthodontic problems.
NOT Available on NHS
| Type | Why Not Covered | Private Cost |
|---|---|---|
| Ceramic/clear braces | Aesthetic preference, not clinical need | £2,500-£5,500 |
| Lingual braces | Behind teeth, purely cosmetic choice | £5,000-£10,000 |
| Invisalign/clear aligners | Usually cosmetic preference | £2,500-£5,500 |
Exception: Clear aligners may occasionally be available on the NHS if there is a specific clinical reason (e.g., nickel allergy preventing metal braces), but this is rare.
"If orthodontic treatment is recommended, it will usually involve wearing a brace." — NHS
What Happens During NHS Orthodontic Treatment?
Initial Appointment
- Fitting of braces (takes 1-2 hours)
- Instructions on cleaning and care
- Dietary advice (foods to avoid)
- Pain management guidance (discomfort is normal for first few days)
Regular Adjustments
| Frequency | What Happens |
|---|---|
| Every 4-8 weeks | Braces adjusted, wires tightened or changed |
| Every 3-6 months | X-rays or photographs to monitor progress |
| As needed | Repairs if brackets break |
After Treatment: Retainers
Once braces are removed, your child will need to wear retainers to prevent teeth moving back:
- Fixed retainer — Thin wire bonded behind front teeth (permanent)
- Removable retainer — Clear or plastic retainer worn at night
"After the braces are removed, most people need to wear a retainer." — NHS
Retainers are included free as part of NHS treatment.
Looking After Braces
Daily Care
| Task | How Often | Why It Matters |
|---|---|---|
| Brushing | After every meal + before bed | Prevents decay around brackets |
| Interdental brushes | Daily | Cleans between brackets and wires |
| Mouthwash | Daily | Reduces bacteria |
| Check for damage | Daily | Report loose brackets promptly |
Foods to Avoid
Hard foods (can break brackets):
- Nuts, hard sweets, ice
- Crusty bread, raw carrots, apples (cut into pieces instead)
Sticky foods (can pull off brackets):
- Chewing gum, toffee, caramel
- Chewy sweets
Sugary foods (increase decay risk):
- Limit fizzy drinks, sweets, chocolate
- Rinse mouth with water after sugary foods
What If Braces Break?
- Contact your orthodontist promptly
- Keep any pieces that come off
- Use orthodontic wax to cover sharp edges temporarily
- Attend repair appointment as soon as offered
Frequent breakages may delay treatment and could affect your child's NHS eligibility if caused by not following care instructions.
What If My Child Doesn't Qualify for NHS Braces?
Understanding the Decision
If your child's IOTN score is below the threshold, it means their orthodontic need is classified as mild or cosmetic. This doesn't mean their teeth are perfect — just that the NHS prioritises more severe cases.
Options If NHS Treatment Isn't Available
| Option | Details |
|---|---|
| Wait and reassess | Teeth can change; reassessment in 6-12 months may give different result |
| Private orthodontic treatment | Full cost, but more options (clear braces, Invisalign) |
| Dental schools | Some offer reduced-cost treatment by supervised students |
Private Orthodontic Costs
| Treatment Type | Typical Cost |
|---|---|
| Metal braces (private) | £2,000-£3,500 |
| Ceramic braces | £2,500-£5,500 |
| Invisalign/clear aligners | £2,500-£5,500 |
| Lingual braces | £5,000-£10,000 |
Many private orthodontists offer payment plans to spread the cost.
Appealing an NHS Braces Decision
If you believe your child has been unfairly refused NHS treatment:
Step 1: Ask for Explanation
Request a clear written explanation of:
- Your child's IOTN dental health grade
- Your child's IOTN aesthetic score
- Why these scores don't meet the threshold
Step 2: Get a Second Opinion
You can request a second assessment from a different NHS orthodontist. Your dentist can arrange this referral.
Step 3: Contact NHS England
If you're still unhappy:
- Phone: 0300 311 2233
- Explain your concerns
- Ask about the complaints process
Step 4: Formal Complaint
You can make a formal complaint through:
- The orthodontic practice
- Your local Integrated Care Board (ICB)
- The NHS complaints procedure
Frequently Asked Questions
How do I know if my child needs braces?
Signs your child may benefit from orthodontic assessment include: crowded or crooked teeth, gaps between teeth, protruding front teeth, difficulty biting or chewing, mouth breathing, or teeth that don't meet properly when biting. Your dentist will advise if a referral is appropriate.
Are NHS braces as good as private braces?
Yes. NHS metal braces are highly effective and use the same techniques as private treatment. The main difference is that private treatment offers more aesthetic options (clear or invisible braces) and potentially shorter waiting times.
Can my child choose the colour of their NHS braces?
Yes. The elastic bands that hold the wire to the brackets come in many colours. Your child can choose their favourite colours and change them at each adjustment appointment.
How long will my child wear braces?
Treatment typically lasts 18 months to 3 years, depending on complexity. Most children wear braces for about 2 years. After braces are removed, retainers must be worn to maintain results.
What if my child turns 18 during treatment?
Treatment continues free if it started before your child turned 18. The NHS won't stop mid-treatment due to age.
Can adults get NHS braces?
Generally no. NHS orthodontic treatment is only available to adults in exceptional circumstances, such as severe cases that affect function or as part of other NHS treatment (e.g., jaw surgery). Adults typically need to pay privately.
Do NHS braces hurt?
Braces can cause discomfort for the first few days after fitting and after each adjustment. This is normal and can be managed with over-the-counter painkillers. The discomfort usually settles within a week.
What happens if my child doesn't wear their retainer?
Teeth can gradually move back towards their original position. This is called relapse and can undo the benefits of treatment. Retainers should be worn as instructed — typically every night at first, then reducing over time.
Key Takeaways
- NHS braces are free for under 18s with clinical need (IOTN grade 3.6+)
- IOTN assessment determines eligibility based on dental health need and aesthetic impact
- Metal braces are most common on NHS and highly effective
- Clear/invisible braces are generally private only
- Treatment takes 18 months to 3 years plus retainer wear afterwards
- Waiting times vary — NHS target is 18 weeks but demand is high
- Good oral hygiene is essential for eligibility and treatment success
- Referral comes from your dentist — regular check-ups are important
Think your child might need braces? Find an NHS dentist near you to discuss whether an orthodontic referral is appropriate.
