BOS response to Newcastle University RAINDROP project


The British Orthodontic Society gives its response to the RAINDROP project study on the NHS dental budget and how it is being utilised

Last week saw the release of the RAINDROP Project study, led by Newcastle University, which posited that the NHS dental budget is not being spent in the most efficient way and must be better allocated to avoid oral health inequality and meet patients’ needs.

It argued that public money used for NHS dentistry in England is based on historical demands rather than evolving with the needs of patients.

Peter McCallum, director of external relations for the BOS, commented: ‘The British Orthodontic Society is supportive of all measures which could improve the oral health of the nation.

‘We are concerned however, with the proposals in this report that suggests that lower IOTN 3 (Index of Orthodontic Treatment Need) (Brook and Shaw 1989) cases and the very small number of adult orthodontic cases carried out on the NHS, should cease to receive funding.

‘If this funding was redistributed to improve access for other orthodontic patients, there could be a case to be made.

‘However, it is a wholly different situation with the proposal that the money is lost from orthodontics altogether, further compounding the well-documented pressures and access challenges within existing services.

‘Willingness to pay (WTP) as a measure of health utility and cost benefit analysis assesses intrinsic value rather than monetary and uses additional taxation per household as a measure.

‘The outcomes of the RAINDROP Project study highlighted that moderate and severe, as well as orthognathic aspects of orthodontics were consistently valued in the higher brackets of all the oral healthcare interventions put to the population sample.

‘The RAINDROP Project study therefore affirms the intrinsic value that the public place on orthodontics.

‘At this stage this is purely a study with recommendations.

‘We understand that the RAINDROP team are embarking on a series of engagements with key stakeholders to explain and explore the project and its findings. We trust that the BOS will be consulted for our input and expertise before any subsequent decisions may be taken.

‘The benefits of orthodontic treatment include an improvement in dental health, function, appearance, as well as social and emotional well-being.

‘Prospective patients (and their parents) seem to be confident of the gains that they expect to achieve by undergoing a course of orthodontic treatment. The benefits of orthodontic treatment often go beyond improving a person’s dental health.

‘People may feel they look better, which can contribute to an improved overall sense of well-being and quality of life (Turpin 2007).

‘The longevity of treatment gain (QALYS – quality adjusted life years) when correcting malocclusions in teenagers also needs to be highlighted.

‘Orthognathic treatment seems to provide good outcomes at relatively low cost. Even allowing for the uncertainty in mean costs and QALYs, there is a high probability of treatment being cost-effective (Cunningham et al 2003).

Peter McCallum added, ‘It is important that we consider the social, emotional and functional handicaps that produce a significant need for orthodontic treatment in addition to purely dental health benefits.

‘The WHO definition of health is as ‘a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity’. Orthodontic treatment can allow individuals to cope more effectively in social situations, without concern for the appearance of their teeth.’ (Benson et al 2015).


  1. Benson PE, Javidi H, DiBiase A. What is the value of orthodontic treatment? British Dental Journal, 2015; 218; 185-190
  2. Brook PH, Shaw WC. The development of an index of orthodontic treatment priority. European Journal of Orthodontics, 1989; 11: 309-320.
  3. Cunningham SJ1, Sculpher M, Sassi F, Manca A. A cost-utility analysis of patients undergoing orthognathic treatment for the management of dentofacial disharmony. 2003
  4. Turpin DL. Orthodontic treatment and self-esteem (Editorial). American Journal of Orthodontics & Dentofacial Orthopedics, 2007; 131: 571-572

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The RAINDROP (Resource Allocation iNHS Dentistry: Recognition of societal Preference) Study is a NIHR funded research project working with dental commissioners in NHS England to embed economics based tools in their priority setting activities, studying how commissioners adopt these tools. See

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