Aim: To detect the prevalence of anatomic anomalies and pathologic findings that could be screened from pretreatment orthodontic radio-graphs. Methods: A thorough screening was conducted of the pretreatment orthodontic radiographs of a sample of 1,354 patients, collected by the author during the last 15 years from 4 locations, 3 in the Kingdom of Saudi Arabia and 1 in Egypt. Results: A total of 154 significant anomalies and pathologic findings were recorded among the total sample group of 1,354 orthodontic patients (11.4%). Among these, 22 could have a serious effect on the general health of the patient. The findings included fractured odontoid process of the axis vertebra, os odontoideum, spondylolisthesis, fractured surgical needle in the oropharynx, fractured transpalatal archwire swallowed and stuck in patient’s throat, unrecognized carotid artery stenosis, cystic lesions, and calcified stylohyoid ligaments. Conclusion: Medicolegal litigation is a main priority for the clinician, requiring cautiousness through screening of the pretreatment orthodontic radiographs beyond orthodontic purposes to exclude patients with significant anomalies and pathological findings. If not done from the medicolegal prospective, such screening should at least take place from an ethical perspective. The orthodontic clinician needs to know when to consult other medical specialties. World J Orthod 2008;9:14–20.