Free NHS Dentist for Under 18 (and Under 19 in Education)

All children under 18 in the UK receive free NHS dental treatment regardless of family income or benefit status. The exemption is the most generous in the NHS dental framework and is intended to support early dental care habits and avoid cost as a barrier to attendance. The exemption extends to under-19s in qualifying full-time education. This page covers what is included (essentially everything clinical), the separate IOTN clinical-need test that applies to orthodontic treatment, what proof children need at the appointment, and how to find an NHS dentist accepting paediatric patients.

What free NHS dental treatment for children covers

The under-18 NHS dental exemption is comprehensive. It covers all NHS-funded procedures regardless of band:

• Band 1: routine examinations (typically annually), X-rays where clinically needed, fluoride varnish application, oral health advice, treatment planning.
• Band 2: fillings (composite is standard for children; amalgam is restricted under UK rules), extractions of milk teeth and adult teeth, root canal treatment, gum treatment.
• Band 3: crowns where clinically indicated (rare in children but funded where needed, e.g. after trauma to a permanent tooth).
• Fissure sealants (preventive resin applied to molars to reduce decay risk).
• Orthodontic treatment for cases meeting IOTN clinical-need criteria.
• Urgent treatment for dental pain, trauma, or infection.
• Referral to NHS hospital secondary care if required (e.g. for surgical extractions, sedation, complex orthodontics).

What is not covered: cosmetic treatment of clinically sound teeth (whitening, cosmetic veneers on healthy teeth), and clear aligner orthodontic treatment (NHS uses fixed metal braces). These are private only and incur private fees if the parent chooses to pursue them.

Children's dental development and NHS pathway

NHS dental advice for children follows a developmental timeline:

• Birth to 12 months: parents should attend their own dentist with the baby to introduce the environment. Brush emerging teeth with a smear of fluoride toothpaste twice daily.
• 12 to 24 months: first NHS dental check-up (Band 1, free). Focus on prevention, diet advice, and toothbrushing technique.
• 2 to 6 years: continued routine check-ups, typically annually. Fluoride varnish applied if appropriate. Fissure sealants on permanent molars as they erupt around age 6.
• 6 to 12 years: continued routine care. Permanent dentition fully establishing around age 12. Orthodontic screening at age 11 to 13 for IOTN assessment.
• 12 to 18 years: continued routine care, orthodontic treatment if IOTN qualifies, management of any decay or developmental issues. Wisdom tooth monitoring as adulthood approaches.

NICE recall guidance recommends recall intervals based on risk: low-risk children typically attend every 12 months; higher-risk children attend more frequently. All recall examinations are free under the under-18 exemption.

Orthodontic treatment for under-18s: the IOTN test

Although routine and restorative NHS dental treatment is unconditionally free for under-18s, orthodontic treatment is subject to the Index of Orthodontic Treatment Need (IOTN). The IOTN is a clinical assessment of how much orthodontic intervention the patient needs:

• Grade 5 (most severe): automatic NHS funding.
• Grade 4 (severe): automatic NHS funding.
• Grade 3 (moderate) with significant aesthetic impact: NHS funding.
• Grade 3 without significant aesthetic impact: not NHS-funded.
• Grades 1 to 2 (mild or no need): not NHS-funded.

The IOTN assessment is carried out by a specialist orthodontist following referral from the child's general dentist. Referrals are typically made around age 11 to 13 when the permanent dentition is established. If the IOTN grade qualifies, NHS treatment is free (the patient is under 18). If not, the parent can pursue private orthodontic treatment at typical fees of £2,000 to £4,000 for fixed braces.

A second opinion at another NHS orthodontist is possible if the parent disagrees with the initial IOTN grading. The IOTN is a structured assessment but does involve clinical judgement, so different practitioners can occasionally reach slightly different grades.

Under-19s in full-time education: the extension

The exemption continues beyond age 18 if the patient is under 19 and in qualifying full-time education. The rule recognises that 18 and 19 year-olds in college or sixth form are typically still dependent on parental finances and should not face an abrupt cost transition when they turn 18 mid-course of education.

Qualifying full-time education includes sixth form, college, and equivalent secondary education. University students (typically aged 18 to 21) are not generally exempt under this rule because university is higher education, not the qualifying secondary route. University students with low income can apply for the NHS Low Income Scheme HC2 certificate.

At the dental appointment, the patient or parent confirms the education status verbally or with a student ID card. A formal education certificate is not usually required. The exemption ends on the patient's 19th birthday or on leaving full-time education, whichever is sooner.

Frequently asked questions

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