"My child needs braces. Can I get it free of charge with the SSN?"

"I have a 9-year-old boy who was recommended braces to correct a cross-bite problem. Turning to private individuals, the quotes are very high. Is it possible to get braces through the National Health Service? Is there an agreement or is everything charged for?'

Orthodontics for children can be guaranteed by the National Health Service, but not automatically. It is not a universal service: access depends on the clinical severity of the problem and, in many regions, also on the family's economic situation (ISEE). The regulation of public dental care is contained in the Prime Ministerial Decree of 12 January 2017, which defines the Essential Levels of Care (Livelli Essenziali di Assistenza - LEA). Even with the updating of the Nomenclator of outpatient specialisation (Tariff Decree), orthodontics remains a selective service: the guiding criterion is not aesthetic appearance, but functional impairment.

The National Health Service intervenes in cases of severe malocclusions or conditions that significantly affect masticatory or respiratory function or the harmonious development of the oral cavity. To determine the level of need, an international clinical index is used: the IOTN (Index of Orthodontic Treatment Need), which classifies cases according to severity. In particular, for grades 4 and 5, i.e. severe situations (e.g. cleft palate, impacted teeth, severe malocclusions), access to treatment under the public system is provided; for grades 1, 2 and 3, i.e. mild or moderate situations, there is normally no public coverage and the cost remains the responsibility of the family.

Generally, dental services are provided for children up to the age of 14 (in some Regions up to 16). However: ISEE may be provided for free access or with co-payment; the economic thresholds vary significantly in the territory (indicatively between 6,000 and 15,000 euros); some Regions also provide subsidised rates for ISEE above the total exemption thresholds. For this reason it is always advisable to check the health portal of one's own Region for the specific conditions applied locally.

To verify entitlement to the benefit, it is useful to follow these steps: A paediatrician's or family doctor's referral, with a request for a 'first dental examination' or 'orthodontic assessment'; booking via CUP at a public or university affiliated facility; specialist clinical assessment, during which the IOTN grade will be determined and any eligibility for regional criteria (including economic ones) verified. If the case falls within the prescribed parameters, the service will be provided free of charge or with payment of the co-payment only (if the requirements are met).