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HSE Orthodontic Eligibility Guidelines

In Ireland one of  the most confusing aspects of deciding Orthodontic treatment for your Children is wondering if treatment is covered by the HSE, because nobody wants to pay for private Orthodontic treatment if the the State is going to provide the same treatment for free. I do not work for the HSE so the following are my observations over the years and if you want definitive answers contact the HSE directly.

As with all State schemes,resources are limited so therefore orthodontic care is rationed through the use of waiting lists and priority groups. In general HSE will provide treatment if you fall in to Grade 4 or Grade 5 category.

Grade 5 Treatment Requirements

  1. Increased overjet greater than 9 mm.
  2. Extensive missing teeth or major dental anomalies such as amelogenisis imperferfecta.
  3. Impeded eruption of teeth apart from wisdom teeth due to crowding, displacement,presence of suppernumerary teeth,retained deciduous teeth,and any patholigical cause.
  4. Reverse overjet greater than 3.5,, with speech or eating problems.
  5. Defects of cleft lip and palate.

Grade 4 Treatment Requirements

  1. Reverse overjet greater tha 3.5mm.
  2. Anterior or posterior crossbites greater than 2mm .
  3. Severe displacement of anterior teeth.
  4. Extreme lateral or anterior open bite.
  5. Increased and complete overbite with gingival or palatal trauma.
  6. Posterior lingual crossbite.
  7. Reverse overjet greater than 1mm but less than 3.5mm with recorded masticatory and speech difficulities.

You may not fully understand all of it but I think you get the idea that only the most severe cases are accepted for treatment.I would say that 80% os cases are refused treatment.

So what are the practical implications?

  1. Congratulations! you are accepted for treatment due to severity but HSE will not start treatment for 2 to 3 years if you are lucky! Any body who is in Grade 4 or 5 need to be treated as a matter of urgency, a two year wait time will only make a severe case even more difficult.
  2. 80% of Patients are eventually declined treatment ,attend private Orthodontist at 14 to 15 years instead of 11 to 12  and are not happy to have braces at 15 when thier friends are just finished not to mind the increased difficulty.

What you need to know from the HSE

  1. Ask when your child will be formally assessed for Orthodontic treatment,and ask are they likely to be in Grade4 or 5.  The sooner you know the sooner you can plan.
  2. Ask HSE will they provide retainer care  post treatment,I have seen quite a few HSE treated cases that relapse because no retainer care was provided.
  3. Most private orthodontists want to see the child at 8 years to start planning treatment so treatment can start at the right time for the individual patient
  4. HSE tend to formally assess children at 12 years of age which in my opinion is to late.

If you are in any doubt please consult your local private orthodontist, as you can be advised what is best for your child and when is best time to start treatment.