The use of the Index of Orthodontic Treatment Need in dental primary care

Key Points Examines the extent to which the IOTN is used in general and specialist orthodontic dental practice in Scotland. Identifies variations in the clinical practice of these two groups of dental practitioners. Considers the barriers which might impede the implementation process.Makes recommendations for the implementation of the IOTN into clinical practice. Objectives The primary objective of this survey was to assess the use of the Index of Orthodontic Treatment Need (IOTN) in dental primary care (Scottish general dental services – SGDS), and to compare orthodontic specialists (OS) and general dental practitioners (GDPs). The secondary objective was to explore the attitudes to mandatory introduction of the IOTN into the SGDS. Design Postal, self completed questionnaire. Setting Dental primary care, Scotland. Subjects Randomly selected sample of general dental practitioners (GDPs), n = 315, and all orthodontic specialist practitioners (OS), n = 49, identified as working in the SGDS. Main outcome measures Prevalence and experience of using the IOTN in the SGDS. Results Response rate was 46% (n = 169). Eighty-four percent of respondents did not use the IOTN. Thirty-five percent of respondent GDPs had never heard of the IOTN. Respondents reported using the IOTN as an inter-colleague communication tool and to grade case complexity. GDPs perceived the IOTN as beneficial in setting national standards of practice; OS saw it as a tool to justify the allocation of NHS resources to patients. Responses indicate concerns that IOTN introduction will restrict access to orthodontic care. Conclusions The IOTN is not widely used in the SGDS but is perceived as standardising treatment need assessment by GDPs and justifying the allocation of NHS orthodontic resources to patients amongst OS. Introduction of mandatory IOTN grading is likely to be contentious – the following needs to be considered: the index profile should be raised; its advantages highlighted; concerns about restricted access to orthodontic care addressed; and perceived need for locally accessed training met.