NHS orthodontic treatment, like all other areas of NHS dental care, underwent changes with the introduction of the new NHS dental contract in 2006. Orthodontic treatment was restricted to those patients with the most severe malocclusions as defi ned by the Index of Orthodontic Treatment Need (IOTN). In order for the new system to work successfully, it follows that dentists referring patients for orthodontic treatment should be familiar with the IOTN and its use. This paper by Jackson et al. sets out to investigate whether this is the case among dentists in West Sussex. The test cases sent to the study dentists were designed to assess their ability to identify whether a case would benefi t from orthodontic work and the type of provider, if any, that would be appropriate, and their ability to assess the correct timing of orthodontic referrals. They were also asked if they used the IOTN when referring patients. The results of the study were salutary: just over half of the respondents made correct decisions for all the cases in the question asking whether an orthodontic referral was appropriate, and only 20% made the correct decision for all the cases in the questionnaire on timing of referral. The IOTN was not routinely used by 76% of respondents, and 5% had never heard of it. The results clearly suggest that West Sussex dentists require further training in the use of the IOTN and additional referral guidelines to assist them in making appropriate orthodontic referrals. It would be interesting to see if this was also the case for dentists nationwide. The authors mention in their answers to our questions (right) that orthodontic referral guidelines have now been developed locally and distributed to West Sussex dentists – a good illustration of how the results of targeted research can be used to improve the local situation. A similar study at a national level would show us whether UK-wide measures need to be taken to help familiarise dentists with the IOTN and help them refer orthodontic cases appropriately. The full paper can be accessed from the BDJ website (www.bdj.co.uk), under ‘Research’ in the table of contents for Volume 207 issue 9. Rowena Milan, Journal Editor DOI: 10.1038/sj.bdj.2009.991 FULL PAPER DETAILS 1*Specialist Registrar in Orthodontics, 4Consultant Orthodontist, Orthodontic Department, St. Richard’s Hospital, Spitalfi elds Lane, Chichester, West Sussex, PO19 6SE; 2Senior Lecturer/Honorary Consultant and MSc/MOrth Programme Director, Orthodontic Unit, UCL Eastman Dental Institute, 256 Gray’s Inn Road, London, WC1X 8LD; 3Professor of Oral Health Services Research, Director of Postgraduate Education and Research, Specialist in Dental Public Health, Peninsula Dental School, The John Bull Building, Research Way, Plymouth, PL6 8BU *Correspondence to: Miss Orla Aine Jackson Email: orlajackson1@yahoo.co.uk Online article number E18 Refereed Paper accepted 22 June 2009 DOI: 10.1038/sj.bdj.2009.979 ©British Dental Journal 2009; 207: E18