Referring to orthodontics

All referrals should be from a dentist only to avoid inappropriate referrals and avoid unnecessary delay for your patient.

To refer to this service please complete a referral form [docx] 39KB and send it to:

Please note that we no longer accept postal or fax referrals. All proformas must be electronically completed and hand written forms will be returned

  • Referrals will be accepted for advice, treatment planning and, for those patients meeting our acceptance criteria, they will be accepted for comprehensive treatment.
  • Patients who are not dentally fit will not be accepted and should not be referred in the first instance unless they are fit for treatment.
  • Those patients who are accepted for treatment will be expected to continue to be registered with a general dental practitioner.
  • Patients can only be accepted where we have capacity to care for them.
  • NHS England is committed to monitoring for the quality of referrals to secondary care. 

The following patients will be accepted for orthodontic assessment:

  • Patients under the age of 18 years with high treatment need requiring complex orthodontic or multidisciplinary treatment. This encompasses patients having ‘great’ (IOTN 4) or ‘very great’ (IOTN 5) need for treatment, only where the required treatment is complex.
  • Patients will not automatically be accepted for treatment based on IOTN score; and the complexity of treatment will first be assessed.
    • For example, where a patient has only crowding; or a patient has only an increased overjet; or a patient who has hypodontia with only one missing tooth per quadrant, or there is no need for the prosthetic replacement of any teeth, we may discharge them for and suggest onward referral to a specialist orthodontic practice.
  • Patients with significant skeletal discrepancy eligible for combined orthodontic-surgical (orthognathic) (Royal London or Whipps Cross) care.
  • Patients with developmental absence of teeth (hypodontia) (Royal London or Whipps Cross) meeting specific acceptance criteria.
  • Patients with cleft lip and palate (Royal London only) according to our eligibility criteria.

The table below allows quick reference to IOTN DHC with the most common features.









  • Cleft lip & Palate
  • Impacted/Ectopic teeth
  • Hypodontia > 4 missing teeth
  • > 9mm Overjet

  • > - 3.5mm reverse Overjet





  • Supernumaries
  • Hypodontia <4 missing teeth
  •  > 6mm Overjet
  •  -2mm to -3.5mm reverse Overjet

Crossbite with > 2mm displacement between RCP and ICP

> 4mm contact point displacement (adjacent teeth)

  • Deep Overbite + Trauma
  • > 4mm Anterior Open Bite



  • > 4mm Overjet
    < -2mm reverse Overjet

Crossbite with > 1mm <2mm displacement between RCP and ICP

< 4mm contact point displacement (adjacent teeth)

  • Deep Overbite (no trauma)
    < 4mm Anterior Open Bite



> 2mm Overjet


< 2mm contact point displacement (adjacent teeth)






Minimal irregularity