The potential for iatrogenic damage following fixed orthodontic treatment has been well documented for many years. Enamel decalcification and gingival inflammation are preventable if good practice is followed. Patients with gingivitis or active caries should not be considered for fixed orthodontics until the disease is controlled. Diet advice, oral hygiene, and topical fluorides are the basic elements of any preventive regime, and while they need to be individually tailored for each patient, fluoride mouthrinses should be routinely used by all patients with fixed appliances. The susceptibility of enamel adjacent to an orthodontic attachment remains a problem which future improvements in adhesive materials may help to address.