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IOTN dental health component high need — ORE Part 1 MCQ

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ModerateOrthodonticsIOTN dental health component high needORE Part 1

A 13-year-old has a 10 mm overjet, incompetent lips and a history of trauma to the upper incisors. The molar relationship is Class II and oral hygiene is adequate. The parent asks whether NHS orthodontic referral is justified. What is the most likely diagnosis of this case on the Index of Orthodontic Treatment Need (IOTN) dental health component?

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Correct answer: B — High orthodontic treatment need due to the increased overjet and incompetent lips

The patient presents with a 10 mm overjet and incompetent lips, which are primary dental health component (DHC) criteria for IOTN grade 5 (5a), indicating 'very great need for treatment'. This meets NHS eligibility thresholds for referral. The Class II molar relationship alone does not determine IOTN grade 5; the decisive factor is the overjet magnitude and associated functional consequence (incompetent lips). Previous trauma is historical and does not negate current orthodontic need. While some IOTN 5 cases may eventually require orthognathic surgery, this is determined after specialist assessment, not at initial referral. Cosmetic concern alone would not qualify; however, the overjet is a dental health component criterion, not merely aesthetic. NHS referral is justified based on high treatment need.

Reference: NHS Scotland Right Decisions (Borders Orthodontics referral criteria); Royal College of Surgeons England Faculty Dental Journal (2015) – IOTN classification and NHS commissioning standards. https://publishing.rcseng.ac.uk/doi/10.1308/rcsfdj.2015.6.2.58