I get a lot of patients asking about their IOTN, so I thought I should explain it a bit and why it’s important in Ireland.
It stands for Index of Orthodontic Treatment Need. It was developed in the late 80s in the UK, based on a Swedish model from the early 70s with the intention of having an objective comparison of orthodontic situations to decide what would be a reasonable use of public healthcare to provide dental treatment to correct the problem.
The most commonly part of the Index is known as the Dental Health Component (DHC).
There’s a 1 to 5 scale, with 1 being low need for treatment and 5 being a high need. Grade 5 IOTN would include things like impacted front teeth (not wisdom teeth which are impacted in loads of people are rarely are treated with orthodontics) or very prominent upper teeth that are a trauma risk or naturally absent teeth (which happens more often than you think). Quite often these are dental problems combined with problems in the development of the skeleton of the face and they stop teeth meeting correctly.
In the middle, the IOTN Grade 3, then the need might be smaller, but the problem might be enough for it to be obvious enough to patients to want it.
The system is laid out so that equipped with a ruler and a mirror and straightforward dental training you can get a reasonable agreement with where a patient falls on the scales and then maybe some X-ray pictures can be used to help work out the position on the index more accurately (particularly for missing teeth)
Sometimes the Dental Health Component is combined with an Aesthetic Component (AC). This is a standardised set of 10 photographs of teeth in varying states of mis-alignment that can be used to give an idea of how bad a dentition looks – not because of decay or gum disease, but because of orthodontically fixable tooth position problems.
One aspect of the Index – both Dental Health Component and Aesthetic Comonent – is that you can get a group of orthodontists and train them to be “calibrated” on the Index so that they will have a roughly standard agreement of the Index position between orthodontists for any given patient and their teeth.
I was calibrated in 2007, along with a couple of future OSI Presidents, one of whom got her car clamped later that afternoon.
The upshot of IOTN in Ireland is that the IOTN can be used for deciding what children have a big enough need for orthodontic treatment for the HSE to offer to treat them. It's reasonable to expect that a patient in Kerry, a patient in Galway and a patient in Dublin with the same degree of orthodontic problems will get the same consideration from whatever orthodontist examines them and each will have the same decision as to whether the HSE will treat them, and they'll usually go on a waiting list for treatment. So some children can have orthodontic treatment provided by the state and others – if they want it – can seek it privately with an orthodontist in practice outside of the HSE system.
What’s not widely known is that it has an additional use in orthodontics outside of the HSE because it's often required by insurance policies that contribute to orthodontic treatment and that’s why, years after leaving the NHS and HSE, I still find myself getting out a patient’s models and x-rays and a ruler or digitiser and measuring overjets and contact point displacements to fill in their forms.
Swords Orthodontics does not charge a fee to fill in these forms, but we will need to be satisfied that these are being filled at the patient’s request not the insurer’s request. (I once had an insurance company chasing me for information that the patient hadn’t consented to give them and I can’t pass on the information.)
