Treatment for those who need it most

The founding fathers of orthodontics as a specialty recognized that amongst all their patients, those with severe dentofacial discrepancies often experienced the greatest distress and were particularly deserving of their attention. From the outset, these early orthodontists made significant efforts to develop treatment modalities that would enable them to correct the more severe skeletal discrepancies that they encountered in many of their patients.

Until the late twentieth century, and despite the development of many successful orthodontic treatment techniques to address skeletal discrepancy, there remained a significant group of patients who could not be treated successfully with orthodontics alone. However, advances in anaesthetic, surgical and orthodontic techniques and increased collaborative teamworking between orthodontists and maxillofacial surgeons, has led to improved care for those patients not amenable to treatment with conventional orthodontic therapy. The significant focus on orthognathic treatment within the UK higher training programmes for all trainee consultant orthodontists and consultant maxillofacial surgeons, has ensured that the United Kingdom (UK) population now has access to well-trained clinicians who are both knowledgeable and skilled in providing this multidisciplinary treatment.

Since devolution there are now four publicly funded healthcare systems in the constituent countries of the UK, which are financed primarily through central taxation and provide a comprehensive range of health services. Common to all of these is the desire to ensure that finite resources are directed toward those with the greatest need. In some areas of the UK, orthognathic treatment has come under scrutiny, with suggestions being made on how to identify those with the greatest need for treatment. Orthodontists in the UK have always embraced the principle of effective use of health service resources, and it is important that we play a central role in leading and shaping the development of any method aimed at identifying those patients who should receive orthognathic treatment and those who should not.

In this issue of the Journal of Orthodontics an open access article has been published (Ireland et al. 2014), which proposes a new index to assist in prioritizing care for orthognathic patients, the Index of Orthognathic Functional Treatment Need or IOFTN. This article is timely within the current context of our healthcare system and once again, demonstrates the ability of the UK orthodontic community to respond positively to the challenges we all face in a resource-limited public health service. The IOFTN has been evolved from the widely used and accepted Index of Orthodontic Treatment Need (IOTN) and therefore has the significant advantage of familiarity to many orthodontists. This index will be a valuable new clinical tool, which will hopefully be accepted widely and quickly by both clinicians and those tasked with allocating valuable resources within our health service.