Sir, there appears to be confusion about the use of the aesthetic component of IOTN which of course has recently become more important with respect to the prioritisation of NHS orthodontic treatment. Whilst examining for the intercollegiate M.Orth exam in London last summer I was informed by one candidate that 'It is not up to me to award the IOTN aesthetic component grade, this is the patient's job'. Having discussed this with some of my colleagues, it seems that this is a fairly widespread view and is apparently being taught as such in some units.

Whilst the aesthetic component is an invaluable tool for patient counselling with respect to treatment need, it is NOT correct for the patient to award the grade. This must be done by an appropriately trained dental professional. If it were the patient's job than obviously any 'informed' parent or patient would be able to qualify for treatment regardless of the malocclusion!