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    • 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)
    • 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 dental-medical 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.
    • Dr. Steven Alden: Chairman of the Social Science Department at NYC College of Technology Member- National Guild of Hypnotists Producer of CD on Hypnosurgery
    • 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)
          • 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_address]
    • 69 Slides 11 seconds/slide View time: 13 min 25 sec
    • "All progress has resulted from people who took unpopular positions." -- Adlai E. Stevenson
    • Meet Dr. Ted 
      • Dr. Ted and grandsons Caleb and Joshua
      • Review Dr. Rothstein’s CV
    • Meet OJW 
      • Orthodontic Jaw Wiring
    • 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.
    • 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.
    • 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:    
    • “ Is Orthodontic Jaw Wiring a service within the scope of dentistry?”
    • "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.  
    • 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.
    • CONSIDER: OVERWEIGHT / OBESITY IS EPIDEMIC IN THE UNITED STATES.
    • CONSIDER: Normal life expectancy: males 73 and females 80 But the life expectancy for chronically overweight/obese is: males 68 and females 75
    • 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.
    • 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
    • CONSIDER: DENTAL PROFESSIONALS ARE UNIQUELY EMPOWERED TO PROVIDE OJW TO PROPERLY SELECTED CANDIDATES.
    • 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.
    • 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/Jaw wiring for weight loss literature references.htm
    •   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.
    • 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.  
    • 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.  
    • 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.
    • 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).
    • 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.
    • 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 .
    • Following are some comments from people who had OJW
    • 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?
    • 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..."
    • 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.
    • 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
      • Brackets are bonded.
      • Jaws are methodically wired to allow 1.5 mm of mandibular movement in all excursions.
      OJW in a Nutshell
    • 1 minute to place wiring
      • Voila!
    • Oops!
      • Note error in placing the wire according to the “figure 8” wiring pattern.
    • 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.
    • 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.
    • 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.
    • 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.
    • CONSIDER: DENTAL PROFESSIONALS ARE UNIQUELY EMPOWERED TO PROVIDE OJW TO PROPERLY SELECTED CANDIDATES.
    • 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.
    • 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.
    • 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.
    • 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?
    • 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.
    • 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.
    • 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 .
    • 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.
    • 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:
    • BELOW YOU WILL FIND A LIST OF CONSULTANTS WHO CAN PROVIDE INFORMATION CONCERNING THE MEDICO-LEGAL AND LIABILITY ISSUES:
    • NYSDA (New York State Dental Association) Sandy DiNoto 518 465 0044  [email_address] MMLIC (Medical Malpractice Liability Insurance Company) GNYDM Booth 2308 or David White, 800 683 7769, [email_address] 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, [email_address] Dr. Mlton Lawney: Executive Secretary of NY State Board of Dentistry 518 474 3817 x550 [email_address]
    • The Informed Consent for OJW The complete Informed Consent can be viewed at www.drted.com (Choose “Orthodontic Jaw Wiring” )
    • 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:
    • 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 low-calorie liquid diet. Important Message: Read Carefully
    • 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_address] 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_address] and  [email_address] . 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…
    • * 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…
    • 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
    • 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:
    • 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:
    • 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:
    • 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:
    • 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:
    • 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).
    • 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.
    • 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.
    • 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_address] , Fax 718 852 1894.
    • Credits Jon Rothstein Len Ross Campbell Foster Dr. Steven Alden Fran Zeman V. C. Hardison Christine Collazo Dr. John Sheridan Brian Millard Asaad Case
    •  
    • THE END