Well-documented present-day distributions of stable water isotopes (HDO and H218O) show the existence, in middle and high latitudes, of a linear relationship between the mean annual isotope content of precipitation (δD and δ18O) and the mean annual temperature at the precipitation site. Paleoclimatologists have used this relationship, which is particularly well obeyed over Greenland and Antarctica, to infer paleotemperatures from ice core data. There is, however, growing evidence that spatial and temporal isotope/surface temperature slopes differ, thus complicating the use of stable water isotopes as paleothermometers. In this paper we review empirical estimates of temporal slopes in polar regions and relevant information that can be inferred from isotope models: simple, Rayleigh-type distillation models and (particularly over Greenland) general circulation models (GCMs) fitted with isotope tracer diagnostics. Empirical estimates of temporal slopes appear consistently lower than present-day spatial slopes and are dependent on the timescale considered. This difference is most probably due to changes in the evaporative origins of moisture, changes in the seasonality of the precipitation, changes in the strength of the inversion layer, or some combination of these changes. Isotope models have not yet been used to evaluate the relative influences of these different factors. The apparent disagreement in the temporal and spatial slopes clearly makes calibrating the isotope paleothermometer difficult. Nevertheless, the use of a (calibrated) isotope paleothermometer appears justified; empirical estimates and most (though not all) GCM results support the practice of interpreting ice core isotope records in terms of local temperature changes.