The scientific content related to the cytotoxicty of components in fixed appliances in the September issue of the AJO-DO made interesting reading indeed! As clinicians, we have always been aware of the cytotoxic potential of the intraoral appliances that we place during treatment. With improving technology, there is an increasing body of data that suggests the possible mutagenic nature and carcinogenic potential of the materials we use clinically, and these facts raise several serious outstanding legal issues.

In this litigious day and age, would we be held liable for failing to inform a prospective patient regarding the material safety facts? How well informed is the average practitioner on the safety aspects of the materials we use? Do we even bother to refer to the material safety data sheet provided by manufacturers?

Although in light of present knowledge, there is no evidence that short-term use of fixed appliances for orthodontic treatment has an impact on the systemic and general well being of the patient, could it be possible that in the future we might have to leave the ultimate choice of the material of braces to our patients?

With a broader array of materials and the clinician often choosing among titanium, low-nickel stainless steel, or ceramic brackets, or Invisalign, would we be ethically wrong by deciding or helping to decide what might be best suited for a patient? Should economics primarily dictate the choice of material for our patient? We all insist on recording a clear medical history, but which patients are at greater risk from the metallic ions leached out from appliances?

For one, I do not have clear-cut answers to these questions. But these legal issues might have to be addressed, if not from the discerning patient’s perspective, then at least to placate the average clinician’s psyche. It would be good to know Dr Larry Jerrold’s legal views on this matter in a forthcoming issue.

In the meantime, we can be optimistic and hope that tomorrow’s technology will either vindicate the clinical use of current materials or otherwise come up with better clinical alternatives, all ultimately to serve the better interests of our patients.