Transcript Greater NY Dental Meeting November 29, 2004

Greater NY Dental Meeting
November 29, 2004
The Dental Profession’s Role in the
Control of Compulsive Overeating:
Orthodontic Jaw Wiring
(a kinder gentler way)
(OJW)
1
Hello my name is Dr. Steven Alden and I am a certified
clinical hypnotist who has spent 25 years using hypnosis for
the purpose of getting people to lose weight.
Although I strongly recommend using hypnosis for weight
loss, I certainly have no problem recommending other
approaches.
After speaking to Dr. Ted Rothstein, I am firmly convinced
that orthodontic jaw wiring is a worthwhile procedure for people
who are labeled obese and need to lose weight quickly and
safely.
It is my hope that other dentists will enjoy this presentation
and be motivated and stimulated to join with Dr. Rothstein in
recognizing that members of the dental profession are uniquely
empowered to offer the OJW service as part of a dentalmedical cooperative effort in concert with other providers of
services that enable the overweight and obese to modify their
compulsive overeating behavior before they reach that point
where they are no longer candidates for any other procedure
except bariatric procedure where the mortality rates render that
procedure anathema to compulsive overeaters. –Steven Alden,
PhD.
2
Dr. Steven Alden:
Chairman of the Social Science Department at NYC
College of Technology
Member- National Guild of Hypnotists
Producer of CD on Hypnosurgery
3
Greater NY Dental Meeting
November 29, 2004
The Dental Profession’s Role in the
Control of Compulsive Overeating:
Orthodontic Jaw Wiring
(a kinder gentler way)
(OJW)
4
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]
5
69 Slides
11 seconds/slide
View time:
13 min 25 sec
6
"All progress has
resulted from people
who took unpopular
positions."
-- Adlai E. Stevenson
7
Meet Dr. Ted 
• Dr. Ted and
grandsons Caleb and
Joshua
• Review Dr.
Rothstein’s CV
8
Meet OJW 
Orthodontic Jaw Wiring
9
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 register
form.html
BE ONE OF THE FIRST 25 AND BECOME A
FOUNDER/CHARTER MEMBER OF THE
DPOJW.
10
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.
11
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 State Board of Dentistry, given to Dr.
Rothstein on Thursday, October 14, 2004 in
answer to the question:
12
“Is Orthodontic Jaw Wiring
a service within
the scope of dentistry?”
13
"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.
14
How is overweight/obesity measured?
“Obesity itself has now been declared to be an illness in and of itself
Medicare and Medicaid have recently declared. As such, its treatment
care may will be covered by insurance.
Until now, Medicare has paid for weight-loss surgery, for example, only
if it was intended to treat a condition like diabetes that arose from obesity.
Dr. McClellan said he was expecting a deluge of requests that
Medicare pay for treatments like surgery, diets, behavioral therapy and
exercise therapy. The agency does not pay for drug treatments.
An estimated 18 percent of the Medicare population meets the official
definition of obese - a body mass index above 30, as would occur, for
example, in a woman who was 5-foot-5 and weighed more than 180
pounds or a 6-foot man weighing more than 221 pounds.
15
CONSIDER:
OVERWEIGHT / OBESITY
IS EPIDEMIC
IN THE UNITED STATES.
16
CONSIDER:
Normal life expectancy:
males 73 and females 80
But the life expectancy for
chronically overweight/obese is:
males 68 and females 75
17
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.
18
Who is overweight / obese?
That is defined by the
“Body Mass Index” (BMI)
BMI of 25.00-25.99= overweight
BMI = or>30.00 = obese
Do you want to
calculate your BMI?
http://nhlbisupport.com/bmi/bmicalc.htm
19
CONSIDER:
DENTAL PROFESSIONALS
ARE UNIQUELY EMPOWERED
TO PROVIDE OJW TO PROPERLY
SELECTED CANDIDATES.
20
CONSIDER:
THE MORTALITY RATE FROM
BARIATRIC SURGERY IS
3/1000. IT IS NOT SURPRISING
THAT THE OVERWEIGHT ON
THEIR WAY TO OBESITY
WOULD CHOOSE OJW WERE
IT MORE WIDELY AVAILABLE.
21
LITERATURE REVIEW
Bruch, Hilde, M.D., EATING DISORDERS
Obesity, Anorexia Nervosa and the Person
Within 1973, Harper Colophon Books
http://WWW.DRTED.COM/index.html.bak2/J
aw wiring for weight loss literature
references.htm
22
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.
23
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.
24
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.
26
What is Orthodontic Jaw Wiring?
ORTHODONTIC JAW WIRING refers to the entire domain of
the OJW provider's responsibility for selecting patients
according to a specified criteria, providing them with
informed consent so that they are aware of the risks and
limitations of OJW, then wiring their jaws together by
a prescribed, method, transmitting that know-how to the
patient (especially if they are not able to return to your
office and can not find a professional level provider) and
finally, reexamining them and rewiring them periodically
after examination has shown that their dentition, gingiva,
and TMJ have remained healthy during the period of time
that they have elected to receive OJW (usually about 6-9
months; representing a weight loss of 50-75 pounds).
27
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.
28
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.
29
Following are some comments from
people who had OJW
30
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 overeating? After all, doesn't obesity cause myriad health
problems also?
31
J.F. -- The positive feed-back I've received from the
weight loss is beyond belief. The response to my
decision to wire has been largely supportive (or at
least to my face). The most negative comment is
"will you be able to keep the weight off" -- to which I
now respond, "if I was an alcoholic, you'd support my
decision to not drink, even if I might fall off the wagon
in the future- right"? Of course, alcohol is not
necessary to live -- and food is -- but they both can
be powerful addictions -- and no one would say to
the alcoholic "just cut back on your intake..."
32
G.E.-- The OJW was a great spring board to get me back into
the gym. It's given me a great palette (my new body) to work
from. The hard part was going into your office to get this done,
the easiest part is going to be maintaining what I've started. Tell
your patients that life after the treatment is what they need to
prepare for.
T.S.-- Alright, it's been a complete month. What I realized is
that I have to do more than WANT to lose weight, but I have to
do and deal with what comes with loosing the weight. I have a
hard time with cravings and boredom. Although I am extremely
busy, when it comes to eating, there is always food around. My
house is stocked with protein shakes and diet shakes but I
don't want to drink them. I feel for the first time that I am able to
deal with the means to my end; losing weight.
33
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). The odds of dying 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
34
OJW in a Nutshell
• Brackets are bonded.
• Jaws are methodically
wired to allow 1.5 mm
of mandibular
movement in all
excursions.
35
1 minute to place wiring
• Voila!
36
Oops!
• Note error in placing
the wire according
to the “figure 8”
wiring pattern.
37
Why do you lose weight when your
jaws are wired together?
1/7. Heightens resolve: Wired jaws are tangible
evidence, and a persistent reminder that you have
decided and are determined to lose some if not all of
your excess weight.
2/7. Prevents eating solids: Wired jaws prevent/make
it difficult for you from eating all/most of the very worst
foods: bread and cake, candy, cookie and pastries,
pastas, pizza, French-fries, burgers and other meats,
that may contain excessive fat.
38
Why do you lose weight when your
jaws are wired together?
3/7. Minimizes snacking: Wired jaws minimize your
snacking because preparing a snack takes special
time and effort to prepare (liquefy/puree) the snack.
So jaw wired patients are less inclined to have the
snack.
4/7. Focuses you on nutrition: Wired jaws compel
you to think more about nutritional value of food
such as fat and salt content, vitamins and minerals,
and calories.
39
Why do you lose weight when your
jaws are wired together?
5/7. Helps control calories: Many people who are
limited to a liquid diet may well choose the
products offered by companies like Ensure and
Slim-Fast. The caloric values and contents are
exactly known;
consequently, dieters can know and more easily
control their daily caloric intake.
6/7. After 2-3 weeks your stomach shrinks and the
need/desire for food becomes less intense.
40
Why do you lose weight when your jaws
are wired together?
7/7. You see yourself losing weight...it gives you
pleasure...you see yourself as being in control...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.
41
CONSIDER:
DENTAL PROFESSIONALS ARE
UNIQUELY EMPOWERED TO
PROVIDE OJW TO PROPERLY
SELECTED CANDIDATES.
42
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.
43
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.
44
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.
45
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?
46
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.
47
CONSIDER:
THE MORTALITY RATE FROM
BARIATRIC SURGERY IS 3/1000.
IT IS NOT SURPRISING THAT
THE OVERWEIGHT ON THEIR
WAY TO OBESITY WOULD
CHOOSE OJW WERE IT MORE
WIDELY AVAILABLE.
48
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.
49
WHAT ARE THE LEGAL AND
LIABILITY ISSUES?
THEY HAVE YET TO BE DEFINED.
YOU WILL NEED TO SPEAK TO
YOUR LIABILITY CARRIER AND
HAVE THEM ADDRESS THE RISK
ISSUES FROM THEIR POINT OF
VIEW.
50
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.
51
BELOW YOU WILL FIND A LIST OF
CONSULTANTS WHO CAN PROVIDE
INFORMATION CONCERNING THE
MEDICO-LEGAL AND LIABILITY
ISSUES:
52
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]
53
The Informed Consent
for OJW
The complete Informed
Consent can be viewed at
www.drted.com
(Choose “Orthodontic Jaw Wiring”)
54
Informed Consent
Choosing patients to provide OJW begins
with information obtained primarily from
the Informed Consent. It was created to
allow the provider to have a profile of all
the important information a would-be
provider would need to know about a
would-be patient’s present condition, their
goals and length of treatment they would
commit passionately to having their jaws
wire together. Part of it is reproduced
below:
55
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.
56
Ted Rothstein DDS, PhD
Specialist in Orthodontics for Adults and Children
35 Remsen, Brooklyn NY 11201
718 852 1551 Fax 718 852 1894
www.drted.com Email: [email protected]
Home Phone: Furnished on commencement of (OJW)
Orthodontic Jaw Wiring for Weight Loss (OJW)***
Informed Consent
[See Entire Directory for Orthodontic Jaw wiring]
DIRECTIONS:
Carefully read the Informed Consent then fill in the data requested (*
information requested is mandatory). Place your initials/name in all places
requested and email the Informed Consent to [email protected]
and [email protected] . Then just below see hyperlinks to the "Adult
Acquaintance" and "Adult Medical History" forms. Download and
complete BOTH forms and mail or fax them to the office (fax 718 852
1894 evening best). When I have received ALL THREE FORMS I will call you
without further delay. With care, Dr. Ted Rothstein. Continued…
57
* Date: / / 2004
* Name:
* Age: Date of birth: * Height:
* Present Weight:
* Goal Weight:
(click on link)--->*Present Body
Mass Index (BMI):
* Activity Level (Life style): (Circle one) inactive, mildly a., moderately a., very active
* Number of months you are initially willing to dedicate passionately to the jaw wiring (OJW)
approach to weight loss: 2 3 4 5 6 (3 months/ 21 pounds, assuming 5 pounds first week
then 1.5 pounds each week thereafter)
* Address:
*City:
*State:
* Zip:
* Occupation:
* Home Telephone:
*Work Telephone (Other):
* Email Address: Dr. Ted will not contact you if you do not provide this item.
* Your dentist's name:
Address:
* Telephone number:
I give Dr. Ted my permission to call my dentist by placing my initials here_______.
* You physician's name:
Address:
* Telephone number:
Please complete both forms indicated below and mail to my office:
(DOWNLOAD ADULT ACQUAINTANCE FORM)
(DOWNLOAD THE ADULT MEDICAL HISTORY FORM)
I give Dr. Ted my permission to call my physician by placing my initials here_______.
Continued…
58
I, _________________________, authorize Dr. Rothstein to wire my
jaws closed. I realize that I will need to be on a low calorie liquid
diet to achieve my weight loss goal.* I know I can have
the orthodontic jaw wiring (brackets and wire) removed at any time
I request. I have read and I understand all the material on Dr.
Rothstein’s web site related to the orthodontic jaw wiring
procedure. I also recognize that even if I achieve my weight loss
goal, I may well regain the weight. I have been advised that the best
way to maintain the weight loss is be means of life style changes,
which include a low calorie, balanced diet matched to an
appropriate exercise regime for my life style.
Dr. Rothstein’s work shall be largely limited to placement and
removal of the orthodontic jaw wiring appliance as a whole,
periodic rewiring and tooth cleaning of the inside of my teeth,
replacement of any accidentally detached brackets and finally,
warning me if he thinks that continued use of the orthodontic jaw
wiring may cause harm to me. Continued…
URL:
http://drted.com/index.html.bak2/Jaw wiring Informed
Cconsent.htm
59
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:
60
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:
61
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:
62
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:
63
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:
64
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).
65
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.
66
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 register
form.html
BE ONE OF THE FIRST 25 AND BECOME A
FOUNDER/CHARTER MEMBER OF THE
DPOJW.
67
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.
68
Credits
Jon Rothstein
Len Ross
Campbell Foster
Dr. Steven Alden
Fran Zeman
V. C. Hardison
Christine Collazo
Dr. John Sheridan
Brian Millard
Asaad Case
69
70
THE END
71