The provision of orthodontic services to eligible children is the statutory responsibility of the health boards. Because of the high cost of providing orthodontic treatment it is important that resources be used to best advantage and for those most severely affected or handicapped. Patients are, therefore, assessed for treatment on both a medical needs criteria and on dental fitness in accordance with guidelines issued by my Department for the provision of secondary care orthodontic treatment and placed on waiting lists in descending order of severity or handicap.
In relation to the dental health status of the patient, the guidelines state that "patients should be free from untreated dental caries with all lesions satisfactorily restored and they should be free from active gingivitis and-or peridontitis". The guidelines also provide that prior to commencing appliance therapy all patients and parents should be assessed to ensure their understanding of the need to comply with the instructions of the orthodontist and to co-operate fully in preventive measures for the entire period of treatment.
I appreciate there is great disappointment if a patient is refused orthodontic treatment due to a low level of oral hygiene when treatment is due to be carried out. Accordingly, my Department has advised health boards that patients on waiting lists and their parents should be routinely circulated with a standard letter advising them of the necessity to maintain their oral health to the highest possible standard while awaiting treatment and highlighting the possibility of the refusal of treatment if oral hygiene is not of the highest standard and the reasons the highest standard of oral hygiene is required before orthodontic treatment is commenced. Teeth overcrowding is not an obstacle to maintaining a high standard of oral hygiene. I am not aware that these guidelines are being misused by health boards as suggested by the Deputy.
