Sir, we would like to expand on J. Winston's query about whether there is a the need to give additional warnings of choking hazard during a patient's initial period of adaptation to fixed appliances.1 It is fortunate that J. Winston's prompt actions managed to clear the Malteser from his daughter's airway. However, he reported that his daughter 'had been sucking a Malteser for comfort and played with it at the back of her mouth to avoid contacting the hypersensitive molars, when it slipped back'. Patients are expected to experience mild discomfort with fixed appliances, especially following an archwire change. This is expected to peak in the first 24 hours with a gradual decrease to negligible levels after three days.2 This discomfort is usually classified as immediate (following a clinical manipulation of the appliances) and delayed (due to tooth movement).3 The activity of sucking a Malteser is unlikely to provide adequate oral comfort nor justifiable as a habit to improve patients' experience of pain caused by fixed orthodontic appliances. A study has found that complaints of fixed appliances included altered speech and swallowing4 and it would be wise to warn patients regarding this. Fixed orthodontic appliances are not known to inhibit the function of the soft tissues during the oral phase of swallowing or the gag reflex. In this case the unusual activity with the Malteser would have put the airway at risk, whether fixed appliances were present or otherwise. In our combined orthodontic experience this is a very unusual case, but serves to highlight the importance of parents being competent in basic first aid.

Further information for patients about fixed appliances can be found at: http://www.bos.org.uk/index/patientinformationleaflets/fixedappliances.