ORTHODONTIC SERVICES in Scotland are set to be slashed, leaving thousands of children and adults in Scotland without free care on the NHS. Those with "borderline" orthodontic problems, such as slightly protruding teeth, could be ineligible for help and face typical private treatment bills of up to £5000 for braces. It is likely that only the most severe cases will be financed by the state.

Next year there will be a consultation process in Scotland to look at "prioritisation of need", which may cut funding and drastically reduce services, according to the British Orthodontic Society.

The cost of providing orthodontic treatment in the Scottish NHS general dental service in 2006-07 was £12.1 million, and 14,916 patients were fitted with at least one fixed brace or other device.

Swingeing cuts in services could severely impact on Scotland's already abysmal dental health record, which is one of the worst in western Europe. The prioritisation scheme will bring services into line with those in England, but English orthodontists warned that their waiting lists have grown to up to 10 years in some parts of the southeast.

There are fears this waiting time would be much worse in Scotland because there are far fewer consultants and orthodontists per head of population. There is already a crisis in some areas, such as Highland region, where there are no consultants to take up the empty posts, and so virtually no orthodontic care is provided.

Robbie Lawson, Scottish representative of the British Orthodontic Society, told the Sunday Herald: "It is in the pipeline that funding for orthodontic care will be drastically cut back. We can guess the outcome will be that a significant number who currently qualify for free care will not.

"The index of need will go from one to five, where one is low need and five is high need. We guess that a three or perhaps four will be considered borderline."

"For protruding or buck teeth, Ken Dodd would still qualify but the actor who plays Neville Longbottom in Harry Potter, Matthew Lewis, may well be borderline," he said. "This would also apply to post-restorative or dental accident orthodontic treatment. One of the problems with this is that the perception of need is often with the child.

"Some children with very misaligned or protruding teeth may not be bothered, while other children with what might be termed a low need may be very self-conscious about their teeth. Research shows that children can be bullied very badly about their appearance and teeth. It is psycho-social reasons that drive the need for orthodontic care.

"If this funding is drastically reduced, it will have a huge impact on Scotland's poor dental record."

Another orthodontist, who asked to remain anonymous, told the Sunday Herald: "It is on the cards that funding for orthodontic care will be slashed so that only those most in need will be able to access free orthodontic care in Scotland.

"I am advising all but my most-in-need patients, if they are considering treatment, to have it done now, since they may not qualify in the near future. As far as I am aware, this could come into effect by the end of 2008."

The 2006-07 annual report of the NHS's Scottish Dental Practice says the target for next year is to have an Index of Orthodontic Treatment Need consultation, "with a view to its adoption within the General Dental Services in Scotland".

John Cameron, senior dental adviser of NHS Dental Practitioner Services, told the Sunday Herald: "There is speculation among orthodontists that, as part of the new statement of dental remuneration, orthodontic services are going to be cut to bring orthodontic care in line with the position in England."

Under current government policy children and adults are eligible for NHS orthodontic treatment, although they should be dentally fit before the treatment commences. It is a dentist's clinical decision whether to refer a patient for such treatment.

Shona Robison, minister for public health, said: "The Scottish government has no current plans to withdraw NHS orthodontic treatment for children or to change the way it is provided."