Dental complications during electroconvulsive therapy (ECT) are uncommon. Nevertheless, dental complications are often cited in ECT-related malpractice litigation. Choice of dental protection during ECT should be based on dental pathology prior to ECT. We describe the results of formal dental examinations of 82 patients prior to ECT and 82 matched psychiatric controls. Dental pathology was frequent in both groups without intergroup differences. The decision to pursue a formal dental consultation prior to ECT should be based upon questions raised on inspection of the oral cavity by the treating psychiatrist. The type of dental protection during ECT should be chosen according to the patient's pre-ECT dental status.