NHS Braces Cost: Free Under 18, IOTN Threshold Applies
NHS braces are free for patients under 18 whose clinical need meets the Index of Orthodontic Treatment Need (IOTN) threshold. Adult NHS orthodontics is restricted to severe clinical cases referred through hospital secondary care. Private fees are practice-set: published lists checked October 2026 start at £1,525 (mydentist teeth straightening) and £1,999 per arch (Dentistry for You fixed braces). This page covers the IOTN eligibility framework, the NHS orthodontic pathway, what to expect during treatment, and the private alternatives for cases that fall outside NHS funding.
Quick answer: NHS braces cost
NHS braces are free for under-18s meeting IOTN grade 4 or 5, or grade 3 with significant aesthetic impact. Treatment typically takes 18 to 24 months. Adult NHS orthodontics is restricted to severe clinical cases. Private treatment for those not eligible is priced by each practice: mydentist lists teeth straightening from £1,525, Dentistry for You lists fixed braces from £1,999 per arch and Invisalign from £2,199 per arch, and Finsbury Dental Care lists Invisalign from £4,100 (checked October 2026). Per-arch fees apply to each arch treated.
IOTN: the NHS eligibility assessment
The Index of Orthodontic Treatment Need is the formal assessment tool used by NHS England to determine clinical eligibility for funded orthodontic treatment. The IOTN has two components:
- Dental Health Component (DHC): graded 1 (no need) to 5 (extreme need). Based on the clinical features of the bite (overjet, overbite, crossbite, impacted teeth, missing teeth, crowding).
- Aesthetic Component (AC): graded 1 (most attractive) to 10 (least attractive). Based on photographic comparison to a standard scale.
NHS funding criteria as of 2026 are:
- DHC grade 5: severe cases, automatic NHS funding.
- DHC grade 4: severe cases, automatic NHS funding.
- DHC grade 3 with AC grade 6 or above: borderline cases with significant aesthetic impact, NHS-funded.
- DHC grade 3 with AC grade 5 or below: not generally NHS-funded.
- DHC grade 1 or 2: not NHS-funded.
The assessment is carried out by a specialist orthodontist (or a dentist trained in orthodontic case assessment) following a referral from the patient's general dentist. The assessment is free for under-18s and produces an IOTN score that determines whether NHS funding is available. If the score does not meet criteria, the orthodontist will discuss private treatment options or alternative referrals.
The NHS orthodontic pathway
For under-18s meeting IOTN criteria, the NHS orthodontic pathway is:
- Referral from general dentist to specialist orthodontist (typically aged 11 to 13).
- Initial consultation and IOTN assessment.
- Treatment planning if NHS-eligible: type of appliance, duration, anticipated extractions if needed.
- Records appointment: photographs, impressions or digital scans, X-rays.
- Any extractions or preliminary work (NHS-funded).
- Fitting of appliances: typically fixed metal braces, sometimes with functional appliances first.
- Active treatment: 18 to 24 months, with monthly or 6-weekly review appointments.
- Removal of braces and fitting of retainers.
- Retention phase: 12 months of nightly retainer wear, then long-term reduced wear.
The entire pathway is free of charge for under-18s meeting IOTN criteria. Treatment can extend to age 19 if the patient is still in full-time education when treatment is in progress. Treatment that starts before 18 and continues past 18 remains NHS-funded; treatment that starts after 18 is generally not NHS-funded except for severe clinical cases referred through hospital secondary care.
Adult NHS orthodontics
Adult orthodontics is restricted on the NHS to severe clinical cases. The threshold is higher than for under-18s and the assessment is more selective. Cases that may qualify for adult NHS orthodontics include:
- Cleft lip and palate cases requiring orthodontic preparation for surgery.
- Severe skeletal discrepancies requiring orthognathic surgery, where orthodontics is part of the multi-disciplinary surgical treatment.
- Pathological tooth positions causing functional problems beyond cosmetic concern.
- Pre-prosthetic orthodontics where tooth positioning is required for subsequent NHS restorative work.
The referral pathway for adult NHS orthodontics goes through hospital consultant orthodontists or consultant maxillofacial surgeons. Waiting times for assessment can be several months. The majority of adults seeking orthodontic treatment for mild to moderate alignment problems do not meet the NHS clinical threshold and pay privately.
Private orthodontic cost
| Published price list | Treatment | Fee (checked Oct 2026) |
|---|---|---|
| mydentist (national price list) | Teeth straightening | From £1,525 |
| Dentistry for You (multi-practice group) | Fixed braces (brackets) | From £1,999 per arch |
| Dentistry for You | Non-Invisalign aligners | From £1,999 per arch |
| Dentistry for You | Invisalign aligners | From £2,199 per arch |
| Dentistry for You | Retainer: removable (Essix) / bonded | £199 / £399 per arch |
| Finsbury Dental Care (City of London) | Invisalign Light / Go / Advance | From £4,100 / £4,500 / £5,100 |
| Finsbury Dental Care | Invisalign consultation | £120 (non-refundable) |
Orthodontic fees are set by each practice and depend on case complexity; "from" prices are starting points, not quotes. Per-arch fees apply to each arch treated, so both arches at Dentistry for You start at 2 x £1,999 = £3,998 for fixed braces or 2 x £2,199 = £4,398 for Invisalign. Links are in the Sources section below.
Frequently asked questions
Are clear aligners as effective as fixed braces?
For mild to moderate cases, clear aligners produce clinically comparable results to fixed braces. For complex cases (severe crowding, large overjets, skeletal discrepancies, impacted teeth), fixed braces and combined orthodontic-surgical treatment generally produce better outcomes. The clinical decision depends on case complexity, patient compliance with aligner wear (22 hours per day required), and the orthodontist's assessment.
Can I have NHS braces twice?
Generally no. NHS orthodontic funding is for a single course of treatment. Retreatment for relapse (teeth moving back after the original treatment) is usually not NHS-funded except in severe cases. Wearing the prescribed retainers reliably after the original treatment is the best protection against relapse.
What is the best age for NHS braces?
NHS orthodontic assessment is typically at age 11 to 13, when the permanent dentition is established but growth is still active and able to assist tooth movement. Treatment starts at age 12 to 14 most commonly. Earlier intervention (interceptive treatment in mixed dentition, age 8 to 10) is offered for specific clinical cases such as crossbites or impacted teeth.
Will I need extractions for NHS braces?
Depending on the case, yes. Severe crowding sometimes requires extraction of premolars to create space. The extractions are NHS-funded as part of the orthodontic course. The decision is clinical; some orthodontists favour non-extraction approaches with arch expansion where possible.
Can adults get clear aligners on the NHS?
No. The NHS does not fund clear aligners for any age group. NHS orthodontic treatment uses fixed metal braces and removable functional or retention appliances. Patients wanting clear aligners pay privately.
Related pages on this site
- British Orthodontic Society on NHS orthodontic eligibility: bos.org.uk
- NHS on dental costs and orthodontics: nhs.uk/conditions/braces-and-orthodontics
- Index of Orthodontic Treatment Need (IOTN) reference: bos.org.uk
- mydentist national private price list, checked October 2026: mydentist.co.uk private dental care prices
- Dentistry for You private treatment fees, checked October 2026: dentistryforyou.co.uk/private-treatment-fees
- Finsbury Dental Care (Portman Dental Care group) fees, checked October 2026: finsburydentalcare.co.uk/about/fees-pricing
- Royal College of Surgeons, Faculty of Dental Surgery: rcseng.ac.uk/fds
This page is information only and is not clinical advice. IOTN assessment is carried out by a specialist orthodontist or trained dentist following referral. NHS orthodontic funding criteria are subject to periodic review by NHS England. Always confirm eligibility at the assessment consultation.