Transcript Slide 1

Orthodontic Jaw Wiring
The Dental Profession’s Role in
the Control of Compulsive
Overeating
This MS power point presentation is an
abridged version of the original. The
complete presentation (72 slides) is
available gratis on the CD prepared for the
GNYDM and the American Association of
Orthodontists.
8 min. 30 sec. to view
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The Dental Profession’s Role in the Control
of Compulsive Overeating:
Orthodontic Jaw Wiring
(a kinder gentler way)
(OJW)
Presented at
The Greater NY Dental Meeting
November 29, 2004
and to the
American Association of Orthodontists
May 22, 2005
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Presented by:
Ted Rothstein DDS, PhD
Member of the AAO
1973 - Present
Founder DPOJW
Dentist Providers of Orthodontic Jaw
Wiring
Specialist in Orthodontics for Adults and
Children
35 Remsen, Brooklyn NY 11201
718 852 1551 Fax 718 852 1894
Web site: www.drted.com Email:
[email protected]
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Meet Dr. Ted 
• Dr. Ted and
grandsons Caleb and
Joshua
• Review Dr.
Rothstein’s CV
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Meet OJW 
Orthodontic Jaw Wiring
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JOIN THE DPOJW
(Dentist Providers of Orthodontic Jaw Wiring)
REGISTER FOR PART I/IV OF THE ONLINE
COURSE TO BEGIN JANUARY 30 AT:
http://www.drted.com/OJW DPOJW
Course.htm
BE ONE OF THE FIRST 25 AND BECOME A
FOUNDER/CHARTER MEMBER OF THE
DPOJW.
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http://www.op.nysed.gov/article133.htm#def
NY State: Article 133
§ 6601. Definition of practice of dentistry.
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 State Article 133, § 6601
as it relates to the practice of dentistry, and
to the dentist who chooses to provide OJW
to patients who meet the selection criteria.
Following is a direct quote provided by Dr.
Milton Lawney, the Executive Secretary of
the NY State Board of Dentistry, given to Dr.
Rothstein on Thursday, October 14, 2004 in
answer to the question:
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“Is Orthodontic Jaw Wiring
a service within
the scope of dentistry?”
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Dr. Milton Lawney, the Executive Secretary of
the State Board of Dentistry responds:
"If the condition is properly diagnosed and a lawful
treatment plan is prescribed by a professional authorized
to do so, the fitting and attaching of appliances could
very well have dental health implications and a dentist
may be involved in those services.”
“It is not within the scope of dentistry to diagnose and
treat independently the condition of obesity. Dental
appliances aimed at weight loss may be prescribed if the
condition is diagnosed by the proper authority.” -Interpretation of Article 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:
males 73 and females 80
But the life expectancy for
chronically overweight/obese is:
males 68 and females 75
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Overweight / Obesity
is defined by the
“Body Mass Index” (BMI)
BMI 25.00-25.99= Overweight
BMI≥30.00 = Obese
CALCULATE YOUR BMI NOW:
http://nhlbisupport.com/bmi/bmicalc.htm
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The Progress of Man: Born 2000 - Died 2065.
“He ate himself into the grave”.
OJW provided by dental professionals in cooperation with
the patient's physician offers hope of increased life
expectancy to some compulsive 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 IT MORE WIDELY
AVAILABLE.
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General Conclusions
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 "immobilizationrest/exercise TMJ-immobilization" protocol as
utilized by Dr. Rothstein.
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What is Compulsive 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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OJW in a Nutshell
• Brackets are bonded.
• Jaws are methodically
wired to allow 1.5 mm
of mandibular
movement in all
excursions.
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1 minute to place wiring
•
Voila!
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Oops!
• Note error in placing
the wire according
to the “figure 8”
wiring pattern.
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Why do you lose 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 selfcontrol 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 REASONS TO PROVIDE OJW TO THE
OVERWEIGHT / OBESE
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
System clears the way for
dentists to provide services to
the overweight, and providing
OJW still 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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CONSIDER:
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.
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BELOW YOU 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 [email protected]
MMLIC (Medical Malpractice Liability Insurance
Company)
GNYDM Booth 2308 or David White, 800 683 7769,
[email protected]
ADA (Insurance Dept.)
http://www.ada.org/prof/prac/insure/index.asp
AAO (Insurance Dept.)
http://www.aaomembers.org/aaortho/aaorthomember/insurance/index.cfm
James Bowlin, 800 424 2841 x223,
[email protected]
Dr. Mlton Lawney: Executive Secretary of NY State
Board of Dentistry 518 474 3817 x550
[email protected]
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The Informed Consent
for OJW
The complete Informed
Consent can be viewed at
www.drted.com
(Choose “Orthodontic Jaw Wiring”)
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Important Message: Read Carefully
You will note that your sole responsibility
is to provide the OJW jaw wiring
mechanics, and to subsequently evaluate
every 5 weeks the health of teeth, gingiva
and TMJ as well as to clean the teeth.
In no way does the provider guarantee that
the OJW recipient will lose weight. It notes
the need for the patient to be on a lowcalorie liquid diet.
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Question: Who is not a good
candidate for OJW?
Answer: Your mouth has many functions
both obvious (talking) and not so obvious
(sneezing) and is therefore the source of
many pleasurable activities. The loss of
any of them may provoke anxiety.
Therefore one should think carefully about
undertaking this method of weight control.
A partial list of poor candidates for OJW
would include:
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 TemporoMandibular 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,
[email protected], Fax 718 852 1894.
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THE END
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