Experiences of the challenges of undertaking an orthodontic needs assessment within the National Health Service in England

The purpose of undertaking Orthodontic (Oral Health) Needs Assessment is to identify unmet healthcare need in a systematic way. The NHS Five Year Forward View set out a clear direction for the NHS in 2014, showing why change is needed and what it will look like. It has been recognised that the health needs and personal preferences of individuals are continuously adapting; therefore, orthodontic services are required to meet this changing environment. Here, we describe some of the challenges for orthodontic needs assessment. Current methods used to assess normative, perceived and expressed need are reviewed, highlighting how these may fail to accurately identify current orthodontic need. Currently, there is no index assessing either psychological need or psychological benefit from orthodontic treatment, despite evidence to suggest that there is a moderate improvement in the emotional and social wellbeing dimensions of the oral health-related quality of life of adolescents following orthodontic treatment. Commissioning of NHS orthodontic services should be guided by the best available evidence of need. As such, a number of recommendations are made which include establishment of comprehensive and comparable datasets for both primary and secondary care providers; review of the instruments used for measuring normative need in view of a changing society influenced by social media developments; and electronic referral management systems should be established which accurately monitor treatment provision. Moreover, further research is required to understand the health inequalities associated with orthodontic care and determine how social deprivation impacts on orthodontic treatment needs and uptake in local populations