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Orthodontic Jaw Wiring ’ The Dental Profes s ion s Role in the Control of Compuls ive

Overeating This MS power point pres entation is an

. abridged vers ion of the orig inal The (72 ) complete pres entation s lides is available gratis on the CD prepared for the

GNYDMand the American As s oc iation of.Orthodontis ts

8 . 30 . min s ec to view

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’ The Dental Profes s ion s Role in the Contro l :of Compuls ive Overeating

Orthodontic Jaw Wiring( )a kinder gentler way

( )OJW

Pres ented at The Greater NY Dental Meeting

29, 2004 November and to the

American As s oc iation of Orthodontis ts 22, 2005May

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:Pres ented by

, Ted Roths te in DDS PhD Member of the AAO

1973 - Present Founder DPOJW

Dentis t Providers of Orthodontic JawWiring

Specialis t in Orthodontics for Adults andChildren

35 , 11201Rems en Brooklyn NY 718 852 1551 718 852 1894     Fax

: Web s ite . .www drted com :     Email35 .drted @aol com

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. Meet Dr Ted

• Dr. Ted and grandsons Caleb and Joshua

• . ’ Review Dr Roths te in s CV

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Meet OJW

Orthodontic Jaw Wiring

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JOIN THE DPOJW JOIN THE DPOJW (Dentist Providers of Orthodontic Jaw Wiring)(Dentist Providers of Orthodontic Jaw Wiring)

/ REGISTER FOR PART I IV OF THE ONLINE / REGISTER FOR PART I IV OF THE ONLINE 30 :COURSE TO BEGIN JANUARY AT 30 :COURSE TO BEGIN JANUARY AT

:// . . / http www drted com OJWDPOJW:// . . / http www drted com OJWDPOJW.Cours e htm.Cours e htm

BE ONE OF THE FIRST 25 AND BECOME A BE ONE OF THE FIRST 25 AND BECOME A

FOUNDER/CHARTER MEMBER OF THE FOUNDER/CHARTER MEMBER OF THE DPOJW.DPOJW.

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:// . . . / 133. #http www op nys ed gov artic le htm def

: 133NY State Artic le 6601. .§ Definition of practice of dentis try

The practice of the profession of dentistry is defined as diagnosing, treating, operating, or prescribing for any disease,

pain, injury, deformity, or physical condition of the oral and maxillofacial area related to restoring and maintaining dental health. The practice of dentistry includes the prescribing and

fabrication of dental prostheses and appliances. The practice of dentistry may include performing physical evaluations in

conjunction with the provision of dental treatment.

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Interpretation of NY 133, 6601State Artic le § , as it re lates to the practice of dentis try and to the dentis t who choos es to provide OJW .to patients who meet the s e lec tion criteria

. Following is a direct quote provided by Dr , Milton Lawney the Executive Secre tary of

the NY State Board of Dentis try, . given to Dr , 14, 2004 Roths te in on Thurs day October in

:answer to the ques tion

       

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“Is Orthodontic Jaw Wiringa service within

the scope of dentistry?”

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  . , Dr Milton Lawney the Executive Secretary of :the State Board of Dentis try res ponds

"If the condition is prope rly diagnose d and a lawful tre atme nt plan is pre scribe d by a profe ss ional authoriz e d to do so, the fitting and attaching of appliance s could v e ry we ll have de ntal he alth implications and a de ntis t may be involv e d in those se rv ice s .”

 

“It is not within the scope of de ntis try to diagnose and tre at inde pe nde ntly the condition of obe s ity . De ntal appliance s aime d at we ight loss may be pre scribe d if the condition is diagnose d by the prope r authority .” -- Inte rpre tation of Artic le 133  § 6601 – Dr. ML.

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:CONSIDER

/ OVERWEIGHT OBESITY IS EPIDEMIC

.IN THE UNITED STATES

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:CONSIDER

:Normal life expectancy 73 80males and females

But the life expectancy for / :chronically overweight obes e is

68 75males and females

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Overweight / Obesity is defined by the

“Body Mass Index” (BMI)

BMI 25.00-25.99= OverweightBMI≥30.00 = Obese

CALCULATE YOUR BMI NOW:http://nhlbisupport.com/bmi/bmicalc.htm

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: 2000 - 2065. The Progres s of Man Born Died . “He ate hims e lf into the grave”

OJW provided by dental profes s ionals in cooperation with ' the patient s phys ic ian offers hope of increas ed life

.expectancy to s ome compuls ive overeaters

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:CONSIDER

DENTAL PROFESSIONALS ARE UNIQUELY EMPOWERED

TO PROVIDE OJW TO PROPERLY SELECTED

.CANDIDATES

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:CONSIDER

IT IS NOT SURPRISING THAT THE OVERWEIGHT ON THEIR WAY TO OBESITY

WOULD CHOOSE OJW WERE ITMORE WIDELY

.AVAILABLE

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  General Conclus ions of the Literature Review

1/5. Jaw wiring is generally accepted by the medical community as a therapeutically effective method to lose weight.

2/5. The only study of jaw wiring on teeth, gums and jaw joints per se shows that this procedure has no permanent harmful effects.

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3/5. Behavior modification that results in maintenance of weight lost is extremely important.

4/5. There are no studies specifically aimed at the harmful effects on the Temporo-mandibular joint of  a long-term "immobilization-rest/exercise TMJ-immobilization" protocol as utilized by Dr. Rothstein. 

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5/5  Research on jaw wiring has been sadly neglected by dentists and Orthodontists for lack of a protocol and an Informed Consent leading to serious concern about medico-dental and liability issues. I suggest it is time to catch up on that research.

Dentists and orthodontists are uniquely capable to provide a service that no other professional can deliver as safely, efficiently and competently.  

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?What is Compuls ive Overeating

COMPULSIVE OVEREATING: REFERS TO A MULTI-FACTORIAL "EATING DISORDER" characterized by the unintentional, excessive and uncontrolled ingestion of food at mealtime and between meals which results in the patient experiencing depression, spiraling overweight and loss of self-esteem frequently accompanied by systemic problems such as high blood pressure, diabetes, cardiac disease and various pathologies of the knee and hips. Indeed the mortality rate for such people is considerably higher than those whose weight is closer to normal for their height and skeletal type.

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Is jaw wiring for weight control something new?

Not at all. Oral surgeons have been doing it since it was first noticed that when they wired their patients closed to facilitate healing in trauma or pathology cases and placed the patients on a liquid diet the patients lost weight.

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So what is new about jaw wiring for controlling weight?

1. The jaws are wired together via orthodontic brackets bonded to the premolars and canines.

2. Until now the delivery of jaw wiring had no protocol and no informed consent.

3. Until now no one had addressed the problem of how to choose patients (who to exclude as a candidate).

4. Until now no one had addressed the issue of possible TMJ stiffening over time.

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Following are some comments from people who had OJW

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. .--G S First, I want to say how very important it is that Dr. Ted provide this service.  For some people it is the only way to lose weight and conquer uncontrollable eating habits.  Detractors really need to gain a little more insight into the problem of compulsive eating before being judgmental.  I feel that the considerable and growing problem of obesity and overweight in this country will not be solved until food addiction is recognized as a valid condition the same as alcoholism, smoking and  gambling.  Any amount of help is available for addicts with those problems and one wouldn't dream of telling an alcoholic to just stop drinking without any help, it is almost impossible so why then is it expected that people with eating problems are told to just  stop overeating?  After all, doesn't obesity cause myriad health problems also?

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. . --J G I needed to do something also as my health was going down hill.  I do not enter into things lightly.  I researched all of my options for quite some time.  I did not want to gamble with my life and to me bariatric surgery is a BIG, BIG gamble.  (The death rate is 3/1000). Those odds are very high and besides they cut you open like a tuna.  And later: I am down 31lbs. and can’t tell you enough how excited I am about this program.  Now this procedure is not without its ups and downs, but it works! I am almost half way to my goal.

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• Brackets are bonded.

• Jaws are methodically wired to allow 1.5 mm of mandibular movement in all excursions.

OJW in a Nuts he ll

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1 minute to place wiring

• Voila!

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Oops!

• Note error in plac ing the wire according

8 to the “figure ” . wiring pattern

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Why do you los e weight when your jaws ?are wired together

7/7. You see yourself losing weight, maybe for the first time, and it gives you pleasure. You see yourself as being in control, maybe for the first time, and it gives you more pleasure and a sense of success. You recognize you can modify your behavior and you begin to take small steps to do so on a more permanent basis. Your aspirations to regain self-control are renewed.

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:CONSIDER

DENTAL PROFESSIONALS ARE UNIQUELY EMPOWERED TO

PROVIDE OJW TO PROPERLY .SELECTED CANDIDATES

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RATIONALE FOR MEMBERS OF THE PROFESSION TO PROVIDE OJW: OJW for weight loss is a treatment modality for a serious "social, psychological and physiological" problem that can help some people to get a start on treating a problem with potentially grave consequences. Obesity is legion and epidemic and recognized as a precursor to a host of serious illnesses. I am exploring the “orthodontic” approach to help alleviate this epidemic in those cases where it may be applicable. I think orthodontists, or for that matter, any member of the dental profession, can deliver this service with compassion and intelligence. My experience to date is that it is safe, and reasonably effective when performed with proper protocols that are presented herein.

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10 REAS ONS TO PROVIDE OJW TO THE OVERWEIGHT / OBES E

1.  You are a dentist who believes the "risk / benefit" ratio of OJW would be inside your "comfort zone.“

2.  You strongly believe dentists are guardians of the mouth and the TM joint and are well positioned in helping the overweight.

3. You are not overweight or obese, nor are your staff members, and therefore offering OJW in your office would not bring undesirable and embarrassing attention to you or your staff members.

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4.  You believe that providing this service would enhance your image in the community in which you practice. 5. You are a dentist who is quite capable of bonding a bracket to a tooth.

6. You believe that OJW is effective and safe.

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7.  You believe dentists are professional health providers who should be helping the overweight.

8.   You feel strongly that OJW is relatively safe to provide and puts you at no greater risk liability-wise than you are already.

9. You know your dental license is not in jeopardy. Why should it be?

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AND FINALLY

10.  You believe that the new DDS Sys tem c lears the way for

dentis ts to provide s ervices to , the overweight and providing

OJW s till further implements .your armamentarium

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RATIONAL FOR OJW: SOME COMPULSIVE OVER-EATERS BEGIN TO FEAR they have lost almost all control of their ability to eat sensibly. In their minds they have failed at all the methods of losing weight they have tried. They see in OJW an approach which is more aggressive than fad diets and less menacing than the weight control pharmaceuticals with their sometimes unpredictable side effects, Moreover, the thought of surgical intervention be it liposuction, lap-band or bariatric surgery has been deemed anathema by them.

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IF DENTISTS STEP FORWARD AND RECOGNIZE THEIR RESPONSIBILITY TO

CARE FOR SELECTED PATIENTS WHO MEET THE CRITERIA OF BEING

/ , OVERWEIGHT OBESE THE LEADERS OF THE ADA AND AAO WILL BE OBLIGED TO

CLEARLY DEFINE THE DENTAL’ PROFESSION S ROLE IN PROVIDING

.SERVICES TO THE OVERWEIGHT

:CONSIDER

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BELOWYOU WILL FIND A LIST OF CONSULTANTS WHO CAN PROVIDE

INFORMATION CONCERNING THE- MEDICO LEGAL AND LIABILITY

:ISSUES

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NYSDA (New York State Dental Association) Sandy DiNoto 518 465 0044  sdinoto@ nysdental.org

MMLIC (Medical Malpractice Liability Insurance Company) GNYDM Booth 2308 or David White, 800 683 7769, dwhite@ mlmc.com

ADA (Insurance Dept.) http://www.ada.org/prof/prac/insure/index.asp

AAO (Insurance Dept.) http://www.aaomembers.org/aaortho/aaortho- member/insurance/index.cfm

James Bowlin, 800 424 2841 x223, jbowlin@ aaortho.org

. : Dr Mlton Lawney Executive Secre tary of NY State 518 474 3817 550Board of Dentis try x . .optombd@mail nys ed gov

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The Informed Cons ent for OJW

The complete Informed Cons ent can be viewed at

. .www drted com ( Choos e “Orthodontic Jaw Wiring”)

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You will note that your s ole res pons ibility is to provide the OJW jaw wiring

, mechanics and to s ubs equently evaluate 5 , every weeks the health of tee th gingiva

.and TMJ as well as to c lean the teeth

In no way does the provider guarantee that . the OJW recipient will los e we ight It notes -the need for the patient to be on a low

.calorie liquid die t

: Important Mes s age Read Carefully

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: Ques tion Who is not a good ?candidate for OJW

:Answer Your mouth has many functions ( ) both obvious talking and not s o obvious

( ) s neezing and is therefore the s ource of . many pleas urable activities The los s of

. any of them may provoke anxie ty Therefore one s hould think carefully about

. undertaking this method of weight control

A partial lis t of poor candidates for OJW :would inc lude

:Continued

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a. Persons who need to floss their teeth due to gum problems or other compulsive reasons.

b. Persons who speak abundantly for business or other reasons whose speech might be rendered less than perfectly clear because of being wired closed.

c. Persons whose sex life would be rendered intolerable if intimate oral functions were impaired… even a little. Continued:

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d. Persons with multiple-missing, loose or decayed teeth

e. Those with psychological or emotional disorders who might feel powerless/ panicky with their mouths wired closed.

f. Those whose work functions might be impaired such as an actor, singer, waiter, teacher etc.

g. Persons with systemic diseases such as diabetics whose diets could not accommodate a liquid diet. Continued:

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h. Persons who cannot breathe through their nose and whose breathing might be compromised by being held continuously in a closed bite teeth position.

i. Those who are highly allergic are more at risk.

j. Persons who have respiratory ailments such as snoring and/or sleep apnea as well as those who must use a broncho-dilator spray such as asthmatics.

k. Persons who have a history of Temporo-Mandibular Joint dysfunction (TMJ). Continued:

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l. Persons who are taking oral pill/capsule form medications could encounter some difficulties trying to pass a large capsule into the mouth behind the last teeth. It would be virtually impossible if the wisdom teeth were fully in place.

m. Persons who compulsively clench/brux/gnash their teeth.

n. Persons who have, or are suspected of having, anorexia or bulimia to begin with.

o. Persons with frank unresolved periodontal (gum-tooth socket) problems. Continued:

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p. Persons who drink alcoholic beverages excessively. In the event of alcoholic intoxication, vomiting can occur. (Alcohol suppresses the gag reflex, vomiting can lead to aspiration of vomitus).

q. Persons who 1. will not provide a telephone number 2. do not have an Email address. 3. below the age of 21 unless accompanied by a parent. 4. are MORE than 110 pounds overweight or LESS than 25 pounds overweight (i.e. moderately obese and obese, but not "morbidly" obese).

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CONCLUSIONS

Members of the dental profession are uniquely positioned to work as part of a team with other health care providers to help the overweight/obese to achieve a healthier weight by providing orthodontic jaw wiring using the protocol and Informed Consent presented herein.

The health-care team includes: Weight control hospital clinics, GP physicians, bariatric surgeons, nurses, registered dieticians and psychotherapeutic counselors.

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POST SCRIPT

I take pleasure in noting that my table clinic on the subject of Orthodontic Jaw Wiring was selected for presentation at the annual international meeting of the American Association of Orthodontists (May 21-24, 2005) being held in San Francisco.

There I will demonstrate how orthodontists are able to make the transition from active treatment in braces to passive treatment (retention of the corrected teeth) using OJW for those of their patients who elect to control weight by the OJW approach, and who meet the criteria for selection.

My grateful appreciation to those who took the time to view this presentation. You are cordially invited to share your comments, suggestions and criticisms. Cordially, Dr. Ted Rothstein, drted35@ aol.com, Fax 718 852 1894.

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THE END