1

Thank you for attending my presentation on this hitherto never-addressed, highly controversial subject: Orthodontic Jaw Wiring for the control of compulsive overeating--or simply O-J-W. OJW is treatment modality for carefully selected patients who are obese or heading toward obesity that can help them start regaining control over their compulsive eating habits with their potentially grave consequences. At the outset OJW may seem extreme. However, in my experience, I can say with confidence that it is a benign, non-invasive, alternative method for controlling weight. Having provided OJW for more than 10 year I can testify unequivocally that it is both safe and effective, especially when performed under the protocol I am presenting. Under this protocol, the DOCTOR is responsible for maintaining the health of the TMJ, Dentition and Gingiva. The PATIENT is responsible for losing weight by dint of their passionate dedication and adherence to a long-term, low-calorie, liquid diet. On the following page you will also find a hyperlink to an E-handout; it contains the documents I am going to refer to and other highly relevant information. .

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DrTed . ComDrTed . Com

E-Synopsis at:E-Synopsis at:

drted.com/AAO OJW drted.com/AAO OJW Synopsis.htmSynopsis.htm

Overview handout at entranceOverview handout at entrance

DrTed . ComDrTed . Com

E-Synopsis at:E-Synopsis at:

drted.com/AAO OJW drted.com/AAO OJW Synopsis.htmSynopsis.htm

Overview handout at entranceOverview handout at entrance

3

Presented at the 110th meetingPresented at the 110th meeting

American Association of American Association of OrthodontistsOrthodontists

Washington, DC May 3, 2010Washington, DC May 3, 2010

Presented at the 110th meetingPresented at the 110th meeting

American Association of American Association of OrthodontistsOrthodontists

Washington, DC May 3, 2010Washington, DC May 3, 2010

Ted Rothstein, DDS Ted Rothstein, DDS PhDPhD

Life-Active member Life-Active member AAOAAO

Brooklyn, New YorkBrooklyn, New YorkDrted35 @ aol . comDrted35 @ aol . com

Drted . comDrted . com

Ted Rothstein, DDS Ted Rothstein, DDS PhDPhD

Life-Active member Life-Active member AAOAAO

Brooklyn, New YorkBrooklyn, New YorkDrted35 @ aol . comDrted35 @ aol . com

Drted . comDrted . com

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A Protocol for Providing A Protocol for Providing Orthodontic Jaw Wiring for Control Orthodontic Jaw Wiring for Control

of Obesity:of Obesity:

A New Role for Dental A New Role for Dental ProfessionalsProfessionals

A Protocol for Providing A Protocol for Providing Orthodontic Jaw Wiring for Control Orthodontic Jaw Wiring for Control

of Obesity:of Obesity:

A New Role for Dental A New Role for Dental ProfessionalsProfessionals

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Orthodontic Jaw WiringOrthodontic Jaw WiringTable Clinics Presented:Table Clinics Presented:Orthodontic Jaw WiringOrthodontic Jaw WiringTable Clinics Presented:Table Clinics Presented:

AAO: Las Vegas, NV -- May 7, 2006AAO: Las Vegas, NV -- May 7, 2006

66thth International Orthodontic Congress: International Orthodontic Congress: Paris, France -- September 12, 2005Paris, France -- September 12, 2005

AAO: San Francisco, CA -- May 22, 2005AAO: San Francisco, CA -- May 22, 2005

ADA: Philadelphia, PA -- October 8, 2005ADA: Philadelphia, PA -- October 8, 2005

Greater NY Dental Meeting:Greater NY Dental Meeting: New York, NY -- November 29, 2004New York, NY -- November 29, 2004

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Write Your QuestionsWrite Your Questions

Thank you for attendingThank you for attending

Add an email addressAdd an email address

Pass them forwardPass them forward

Enjoy the show Enjoy the show

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"All progress has "All progress has resulted from resulted from

people who took people who took unpopular unpopular positions."positions."

-- Adlai E. Stevenson

"All progress has "All progress has resulted from resulted from

people who took people who took unpopular unpopular positions."positions."

-- Adlai E. Stevenson

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We can provide a We can provide a service to help the obeseservice to help the obese

As caretakers of the mouth we are As caretakers of the mouth we are uniquely empowered with skills anduniquely empowered with skills and

mechano-therapies to provide services mechano-therapies to provide services to the overweight. Indeed, it isto the overweight. Indeed, it is

our responsibility our responsibility as part of a health as part of a health care teamcare team to provide our expertise to provide our expertise

to the overweight heading towards to the overweight heading towards obesity: obesity: Orthodontic Jaw Wiring (OJW)Orthodontic Jaw Wiring (OJW)

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OJW requires a careful selection of patients who are obese, OJW requires a careful selection of patients who are obese, (as diagnosed by their physician),(as diagnosed by their physician), and who will provide you and who will provide you with a medical-dental history and an Informed Consent with a medical-dental history and an Informed Consent (as well (as well as a release from their physician to begin a long-term, low-as a release from their physician to begin a long-term, low-calorie liquid diet)calorie liquid diet). . It requires the patient to choose a weight It requires the patient to choose a weight goal,goal, and that you and that you wire their jaws apartwire their jaws apart providing an providing an interocclusal laxity of about 2-3mm in all directions – a position interocclusal laxity of about 2-3mm in all directions – a position in which they will remain for 5 weeks -- until they release the in which they will remain for 5 weeks -- until they release the wiring for 5 dayswiring for 5 days and return to your office for examination, and and return to your office for examination, and rewiring. This rewiring. This alternating wiring-rest-rewiring methodalternating wiring-rest-rewiring method is is repeated until the patient achieves their weight goal, or repeated until the patient achieves their weight goal, or requests that you remove the appliance.requests that you remove the appliance.

What does OJW entail?What does OJW entail?

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Rationale for OJWRationale for OJW

When safety, effectiveness, side effects When safety, effectiveness, side effects and mortality rate are taken into and mortality rate are taken into consideration OJW will be seen as a consideration OJW will be seen as a non-invasive conservative approach to non-invasive conservative approach to weight control.weight control.

My experience providing OJW has My experience providing OJW has shown that it is a shown that it is a safe and effectivesafe and effective method to help selected patients regain method to help selected patients regain control of their weight.control of their weight.

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Evolution: Hyperphagimas CompulsivisEvolution: Hyperphagimas Compulsivis

Obesity is legion and epidemic and recognized as a precursor toObesity is legion and epidemic and recognized as a precursor toa host of serious illnesses and other co-morbidities which attend it,a host of serious illnesses and other co-morbidities which attend it,many of which have oral manifestations and grave consequences.many of which have oral manifestations and grave consequences.OJW is a fixed appliance and method we dental practitionersOJW is a fixed appliance and method we dental practitionerscan provide that can help selected patients regain control over can provide that can help selected patients regain control over their excessive eating habits.their excessive eating habits.

Obesity is legion and epidemic and recognized as a precursor toObesity is legion and epidemic and recognized as a precursor toa host of serious illnesses and other co-morbidities which attend it,a host of serious illnesses and other co-morbidities which attend it,many of which have oral manifestations and grave consequences.many of which have oral manifestations and grave consequences.OJW is a fixed appliance and method we dental practitionersOJW is a fixed appliance and method we dental practitionerscan provide that can help selected patients regain control over can provide that can help selected patients regain control over their excessive eating habits.their excessive eating habits.

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30 Diseases and Side Effects of Obesity30 Diseases and Side Effects of Obesity 30 Diseases and Side Effects of Obesity30 Diseases and Side Effects of Obesity

1.1. type 2 diabetes type 2 diabetes (afflicts one in three Americans)(afflicts one in three Americans)2.2. hypertensionhypertension3.3. depression depression 4.4. sleep apnea (snoring)sleep apnea (snoring) 5.5. strokestroke6.6. knee and hip joint dysfunctionknee and hip joint dysfunction7.7. coronary heart diseasecoronary heart disease8.8. gall bladder disease gall bladder disease 9.9. liver disease liver disease 10.10. osteoarthritis osteoarthritis 11.11. some cancers - colon, endometrial, some cancers - colon, endometrial,

post-menopausal breast cancer post-menopausal breast cancer 12.12. menstrual irregularities menstrual irregularities 13.13. polycystic ovary syndrome polycystic ovary syndrome 14.14. infertilityinfertility 15.15. pulmonary dysfunctionpulmonary dysfunction

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30 Diseases and Side Effects of Obesity30 Diseases and Side Effects of Obesity 30 Diseases and Side Effects of Obesity30 Diseases and Side Effects of Obesity 16. gestational diabetes 16. gestational diabetes 17. 17. Post-surgical mandibular advancementPost-surgical mandibular advancement18. low-back pain 18. low-back pain 19. increased risk of anesthetic complications 19. increased risk of anesthetic complications 20. carpal tunnel syndrome 20. carpal tunnel syndrome 21. venous insufficiency 21. venous insufficiency 22. deep vein thrombosis 22. deep vein thrombosis 23. poor wound healing 23. poor wound healing 24. 24. psychosocial problemspsychosocial problems 25. osteoporosis25. osteoporosis

 - obesity is protective  - obesity is protective 26. stress incontinence and leaking urine 26. stress incontinence and leaking urine 27. prolapse 27. prolapse 28. esophageal reflux 28. esophageal reflux 29. constipation 29. constipation 30. tiredness 30. tiredness

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How isHow is Overweight / ObesityOverweight / Obesity measured ?measured ?

“ “Body Mass IndexBody Mass Index””

BMIBMI

Weight (Kgs) / Height Weight (Kgs) / Height (Mters)(Mters)22

How isHow is Overweight / ObesityOverweight / Obesity measured ?measured ?

“ “Body Mass IndexBody Mass Index””

BMIBMI

Weight (Kgs) / Height Weight (Kgs) / Height (Mters)(Mters)22

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BMI: 18-24 = NormalBMI: 18-24 = Normal BMI: 25-29 = BMI: 25-29 = OverweightOverweight

BMI: BMI: 30-35 = Obese 30-35 = Obese Class IClass I M5’10”/240; F5’4”/200 = M5’10”/240; F5’4”/200 = (BMI 34)(BMI 34)

BMI: BMI: 35-39 = Obese 35-39 = Obese Class 2Class 2

BMI: 40+ = Morbid BMI: 40+ = Morbid ObesityObesity

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CONSIDER:CONSIDER:

2009: Normal life 2009: Normal life expectancy USexpectancy US Males 75.4 -- Females Males 75.4 -- Females 80.780.7

The life expectancy for the The life expectancy for the chronically Overweight / chronically Overweight / Obese is: Obese is: three to five three to five years lessyears less

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WHY CHOOSE OJW?WHY CHOOSE OJW? COMPULSIVE OVER-EATERS BEGIN TO COMPULSIVE OVER-EATERS BEGIN TO

FEARFEAR they have lost all control of their ability to they have lost all control of their ability to eat sensibly. In their minds they have failed at all eat sensibly. In their minds they have failed at all the methods of losing weight they have tried, the methods of losing weight they have tried, and and they are depressedthey are depressed. They see OJW as an . They see OJW as an approach which is more aggressive than fad approach which is more aggressive than fad diets and diets and less menacing than weight control less menacing than weight control using pharmaceuticalsusing pharmaceuticals with their sometimes with their sometimes unknown and unknown and unpredictable side effectsunpredictable side effects. . Moreover, Moreover, the thought of surgical intervention-the thought of surgical intervention-- - be it liposuction, lap-band or bariatric surgery, be it liposuction, lap-band or bariatric surgery, horrifies themhorrifies them..

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THE ANTECEDENTS OF THE ANTECEDENTS OF ORTHODONTIC JAW WIRING:ORTHODONTIC JAW WIRING:

IVY LOOPS IVY LOOPS First used by oral surgeons for First used by oral surgeons for

inter-maxillary fixation inter-maxillary fixation The patient was placed under The patient was placed under general anesthesia since the wire general anesthesia since the wire had to be threaded between the had to be threaded between the teeth (and sometimes the gums as teeth (and sometimes the gums as well).well).

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Brackets are Brackets are bonded bilaterallybonded bilaterally

Jaws methodically Jaws methodically wired wired apartapart : : 2.0mm to 4.0mm 2.0mm to 4.0mm using .012” -.014” using .012” -.014” deadsoft wiredeadsoft wire

OJW: The applianceOJW: The appliance

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Note the interocclusal separation of 2-3mm-- approximating the physiologic rest position in which the mandible is “weightless”

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Is Orthodontic Jaw WiringIs Orthodontic Jaw Wiringa service withina service within

the scope of dentistry? the scope of dentistry?

See E-handoutSee E-handoutwww.drted.com/AAO OJW Scope of www.drted.com/AAO OJW Scope of

dentistry.htmdentistry.htm

Is Orthodontic Jaw WiringIs Orthodontic Jaw Wiringa service withina service within

the scope of dentistry? the scope of dentistry?

See E-handoutSee E-handoutwww.drted.com/AAO OJW Scope of www.drted.com/AAO OJW Scope of

dentistry.htmdentistry.htm

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Following is a direct quote Following is a direct quote provided by Dr. Milton Lawney, provided by Dr. Milton Lawney, the Executive Secretary of the the Executive Secretary of the State Board of DentistryState Board of Dentistry, , given given to Dr. Rothstein on Thursday, to Dr. Rothstein on Thursday, October 14, 2004 in answer to October 14, 2004 in answer to the preceding question:the preceding question:

[[Interpretation of NY State Article Interpretation of NY State Article 133, § 6601133, § 6601 as it relates to the as it relates to the practice of dentistry, and to the practice of dentistry, and to the dentist who chooses to provide OJW dentist who chooses to provide OJW to patients who meet the selection to patients who meet the selection criteria.criteria.]]

   

Following is a direct quote Following is a direct quote provided by Dr. Milton Lawney, provided by Dr. Milton Lawney, the Executive Secretary of the the Executive Secretary of the State Board of DentistryState Board of Dentistry, , given given to Dr. Rothstein on Thursday, to Dr. Rothstein on Thursday, October 14, 2004 in answer to October 14, 2004 in answer to the preceding question:the preceding question:

[[Interpretation of NY State Article Interpretation of NY State Article 133, § 6601133, § 6601 as it relates to the as it relates to the practice of dentistry, and to the practice of dentistry, and to the dentist who chooses to provide OJW dentist who chooses to provide OJW to patients who meet the selection to patients who meet the selection criteria.criteria.]]

   

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“…“…It is not within the scope It is not within the scope of dentistry to diagnose and of dentistry to diagnose and treat independently the treat independently the condition of obesity. Dental condition of obesity. Dental appliances aimed at weight appliances aimed at weight loss may be prescribed if the loss may be prescribed if the condition is diagnosed by the condition is diagnosed by the proper authority.” --proper authority.” -- Interpretation of Article 133  § 6601 – Dr. ML. 

………………………………………………………………………………………………………………………………………………………………………………………………….

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The Diagnosis of ObesityThe Diagnosis of Obesity

Can be made only by the Can be made only by the patient’s physician.patient’s physician. Moreover, Moreover, the provider must include in the the provider must include in the OJW patient’s record a note from OJW patient’s record a note from their physician stating that the their physician stating that the patient may begin a long-term, patient may begin a long-term, low-calorie liquid diet.low-calorie liquid diet.

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JAW WIRING: THE PASTJAW WIRING: THE PASTJAW WIRING: THE PASTJAW WIRING: THE PAST1.1. Weight loss was an accidental by-product of Weight loss was an accidental by-product of

inter-maxillary fixation inter-maxillary fixation

2.2. No protocol for providing the service was extant No protocol for providing the service was extant

3.3. Jaws were wired tightly together with no thought to Jaws were wired tightly together with no thought to TMJ stiffening or clarity of speech TMJ stiffening or clarity of speech

4.4. The inter-maxillary wiring process was primitive The inter-maxillary wiring process was primitive

5.5. The dental professional’s role was nebulous The dental professional’s role was nebulous

6.6. The concept of the dental professional as The concept of the dental professional as part of apart of a health care team health care team in controlling overweight was in controlling overweight was non-existent non-existent

oooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooo

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OJW TODAYOJW TODAYOJW TODAYOJW TODAY1.1. The jaws are wired The jaws are wired apartapart via via orthodontic bracketsorthodontic brackets bonded to the premolars and canines in a bonded to the premolars and canines in a “weightless”“weightless” position (the physiologic rest position)position (the physiologic rest position)

2.2. A robust A robust informed consentinformed consent was developed was developed

3.3. Criteria for patient selectionCriteria for patient selection were established were established

4.4. A A protocolprotocol to address the possibility of TMJ stiffening to address the possibility of TMJ stiffening over time was developed and applied to 100+ patientsover time was developed and applied to 100+ patients

5.5. A A research surveyresearch survey to assess to assess safety and effectiveness safety and effectiveness was carried out was carried out

cont.cont.

6. 6. … And that the… And that the provider’s responsibility provider’s responsibility is limited to maintaining the health of the is limited to maintaining the health of the TMJ, dentition and gingiva.TMJ, dentition and gingiva.

7. 7. While the patient is solely responsible for While the patient is solely responsible for losing weight by dint of their passionate losing weight by dint of their passionate dedication and adherence to a long-term, dedication and adherence to a long-term, low-calorie liquid diet.low-calorie liquid diet.

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Choosing patients to provide OJW Choosing patients to provide OJW begins with information obtained begins with information obtained primarily from the Informed Consent primarily from the Informed Consent and the patient’s medical – dental and the patient’s medical – dental history.history. It allows the provider to It allows the provider to have a profile of all the important have a profile of all the important information needed to know about a information needed to know about a would-be patient’s health, would-be patient’s health, present present weightweight, their , their weight goalsweight goals and and the the time they would “dedicate time they would “dedicate passionately” to being wired.passionately” to being wired.

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The Informed ConsentThe Informed Consent is reproduced at: is reproduced at:

drted.com/AAO OJW Synopsis.htmdrted.com/AAO OJW Synopsis.htm

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OJW SAFETY AND OJW SAFETY AND EFFECTIVENESS EFFECTIVENESS

QUESTIONNAIRE SURVEY QUESTIONNAIRE SURVEY COMPLETED IN 2009: COMPLETED IN 2009: 

Refer to your E-SynopsisRefer to your E-Synopsis

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OJW SAFETY AND OJW SAFETY AND EFFECTIVENESSEFFECTIVENESS

OJW SAFETY AND OJW SAFETY AND EFFECTIVENESSEFFECTIVENESS

Responses to questions: 21, 58, 63, 66Responses to questions: 21, 58, 63, 66

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Question 21Question 21My choice below represents how I feel My choice below represents how I feel

about OJW for the control of weight in about OJW for the control of weight in compulsive overeating:compulsive overeating:

OJW is both safe and effective. 70%OJW is both safe and effective. 70%

OJW is safe but not effective. 5%OJW is safe but not effective. 5%

OJW is neither safe nor effective. 10%OJW is neither safe nor effective. 10% OJW is effective but not safe. 15%OJW is effective but not safe. 15%

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Question 58Question 58

Given that vomiting could lead to the Given that vomiting could lead to the taking of vomit back into your airway taking of vomit back into your airway leading to effects ranging from choking leading to effects ranging from choking and possibly to death, please state and possibly to death, please state your position(s) from the list below.your position(s) from the list below.

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Response to 58Response to 58 55.6% The Informed Consent I filled out told 55.6% The Informed Consent I filled out told

me all I needed to know.me all I needed to know. 44.4% I was warned of that so I carried my wire 44.4% I was warned of that so I carried my wire

clippers with me at all times.clippers with me at all times. 38.9% It's possible but highly unlikely.38.9% It's possible but highly unlikely. 27.8% I carefully researched that possibility 27.8% I carefully researched that possibility

and found no instance of its occurrence.and found no instance of its occurrence. 22.2% The risk of death from surgery bothers me more.22.2% The risk of death from surgery bothers me more. 22.2% You can die from some diet pills as well.22.2% You can die from some diet pills as well. 50.0% All of the above.50.0% All of the above.

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Safety of Jaw wiring / Safety of Jaw wiring / OJWOJW

Safety of Jaw wiring / Safety of Jaw wiring / OJWOJW

Conservatively speaking more than Conservatively speaking more than 35,000 people have their jaws wired for 35,000 people have their jaws wired for trauma or pathology annually. trauma or pathology annually. I have I have not been able to unearth a single case not been able to unearth a single case of grave harm coming to any patient of grave harm coming to any patient whose jaws were wired by an oral whose jaws were wired by an oral surgeon.surgeon. The protocol I formulated for The protocol I formulated for OJW, further enhances the safety of OJW, further enhances the safety of providing this service.providing this service.

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Question 63Question 63

Why did you choose the OJW method to begin with?

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Response to 63Response to 6378.9% 78.9% My being overweight was causing me to be My being overweight was causing me to be

depressed.depressed.68.4% I felt this approach might help me bring my 68.4% I felt this approach might help me bring my

compulsive overeating under control.compulsive overeating under control.63.2% I realized that my excessive weight could have 63.2% I realized that my excessive weight could have

serious health-related consequences. serious health-related consequences. 57.9% I was finally able to locate a dental professional who 57.9% I was finally able to locate a dental professional who

would provide the service.would provide the service.52.6% Previous methods were ineffective for me.52.6% Previous methods were ineffective for me.52.6% I just didn't like the way I looked.52.6% I just didn't like the way I looked.31.6% I dreaded the thought of gastric-bypass surgery31.6% I dreaded the thought of gastric-bypass surgery31.6% Taking over-the-counter pharmaceuticals seemed 31.6% Taking over-the-counter pharmaceuticals seemed

too risky (side effects).too risky (side effects).26.3% My physician recommended I lose weight. 26.3% My physician recommended I lose weight. 21.1% All or most of the above.21.1% All or most of the above.15.8% I heard about it from a friend.15.8% I heard about it from a friend.

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Question 66Question 66

Do you believe that it is the right and Do you believe that it is the right and responsibility for dental professionals to responsibility for dental professionals to provide this service to compulsive provide this service to compulsive overeaters?overeaters?

YES 85%YES 85%

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CONSIDER:CONSIDER:

OVERWEIGHT / OBESITYOVERWEIGHT / OBESITY IS EPIDEMIC IS EPIDEMIC

IN THE UNITED STATES. IN THE UNITED STATES.

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Health care: $ 2.3 trillion industry Health care: $ 2.3 trillion industry in the USin the US

14% of the health care budget14% of the health care budgetis allotted to controlling obesity…is allotted to controlling obesity…

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CONSIDER:CONSIDER:

…THE OJW SERVICE OFFERS …THE OJW SERVICE OFFERS DENTAL PROFESSIONALS DENTAL PROFESSIONALS

THE OPPORTUNITY TO THE OPPORTUNITY TO PARTICIPATE SEAMLESSLY PARTICIPATE SEAMLESSLY IN THIS SEGMENT OF THE IN THIS SEGMENT OF THE

HEALTH INDUSTRY.HEALTH INDUSTRY.

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CONSIDER:CONSIDER:

DENTAL PROFESSIONALSDENTAL PROFESSIONALS ARE UNIQUELY ARE UNIQUELY

EMPOWERED TO PROVIDE EMPOWERED TO PROVIDE OJW TO PROPERLY OJW TO PROPERLY

SELECTED CANDIDATES.SELECTED CANDIDATES.

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CONSIDER:CONSIDER:

THE MORTALITY RATE THE MORTALITY RATE FROM BARIATRIC SURGERY FROM BARIATRIC SURGERY

IS 3/1000. IT IS NOT IS 3/1000. IT IS NOT SURPRISING THAT THE SURPRISING THAT THE OVERWEIGHT ON THEIR OVERWEIGHT ON THEIR

WAY TO OBESITY WOULD WAY TO OBESITY WOULD CHOOSE OJW WERE IT CHOOSE OJW WERE IT

MORE WIDELY AVAILABLE.MORE WIDELY AVAILABLE.

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PREVENT SURGICAL MORTALITY?PREVENT SURGICAL MORTALITY?

““If the ultimate effect of my work If the ultimate effect of my work was to help just one person avoid was to help just one person avoid having to undergo gastric bypass having to undergo gastric bypass surgery there is the possibility, surgery there is the possibility, that is one in three-hundred that is one in three-hundred indeed, that this person did not indeed, that this person did not die.”die.”

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OJW: TWO CASES OJW: TWO CASES drted.com/OJW Two Cases.htm

OJW: TWO CASES OJW: TWO CASES drted.com/OJW Two Cases.htm

1.1. ALONE ALONE

2. WITH ORTHO TXWITH ORTHO TX

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OJW protocol in brief OJW protocol in brief 1.1. Provider receives an inquiry requesting OJW Provider receives an inquiry requesting OJW2.2. Provider requests Informed Consent and Medical- Provider requests Informed Consent and Medical-

Dental formsDental forms3.3. Provider agrees / Provider agrees / declines declines to provide OJWto provide OJW4.4. Provider establishes doctor-patient relationship by Provider establishes doctor-patient relationship by

telephonetelephone5.5. At OJW appointment provider examines patient, takes At OJW appointment provider examines patient, takes

records and applies OJW and…records and applies OJW and…6.6. Gives patient the Reminders / Precautions NoticeGives patient the Reminders / Precautions Notice7.7. Patient removes wiring every 5 weeks for 5 daysPatient removes wiring every 5 weeks for 5 days and and

returns to office for examination and rewiring, etc.returns to office for examination and rewiring, etc.8.8. Upon achieving goal weight, or patient's request, the Upon achieving goal weight, or patient's request, the

appliance is removed appliance is removed

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Implementation of the ProtocolImplementation of the Protocol www. drted . com / OJW Two Cases . www. drted . com / OJW Two Cases .

htmhtm

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1.1. Provider receives an email Provider receives an email inquiry requesting OJWinquiry requesting OJW

2.2. Provider responds with email Provider responds with email requesting a completed Informed requesting a completed Informed Consent and Medical-Dental formConsent and Medical-Dental form

drted.com/AAO OJW Synopsis.htmdrted.com/AAO OJW Synopsis.htm

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PROVIDER’S RESPONSE TO A WOULD-PROVIDER’S RESPONSE TO A WOULD-BE OJW PATIENT’S INQUIRY:BE OJW PATIENT’S INQUIRY:

• Dear would-be OJW patient:Dear would-be OJW patient:• IN BRIEF:  Jaws are wired APART about this much |--| . Wires are to be

released every 5 weeks for  5 days to permit jaw joints to move fully• The number of OJW providers is small indeed: List of providers.  I provide this I provide this

service with pleasure, and truly believe in it,service with pleasure, and truly believe in it, having provided it to many patients. I endeavor to constantly improve it.  Here is the follow-up study I did to see how my patients fared with their OJW: http://www.drted.com/ojw_questionnaire_survey.htm . When you examine the responses to the queries you will find by and large the respondees were most pleased by their experience with OJW service I provided.

• The OJW fee at present is $2685. It is a one-time non-refundable feeThe OJW fee at present is $2685. It is a one-time non-refundable fee.  This all-inclusive fee includes maintenance of the appliance from placement to removal, rewiring every 5 weeks until goals are met or patient requests theOJW be removed; and  24/7 support and contact with the Dr. Rothstein. An initial fee $685 twenty four hours in advance confirms the appointment and the balance is due when the OJW is placed. Lacking the initial payment the appointment will be cancelled.

1. If you are considering coming to my office in Brooklyn, New York then please familiarize yourself with the information provided at:

• http://www.drted.com/index.html.bak2/jaw_wiring.htm .  If you are still interested complete: The Informed Consent for OJW  and email it to mecomplete: The Informed Consent for OJW  and email it to me, and then download, complete and fax to me the two other documents requested on it. When I receive all three I will call you.  Complete the Informed Consent and be sure to sign/initial it in all four places requested. 

• Please read below: "Who is NOT a good candidate for OJW". CONTINUEDCONTINUED

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DIRECTIONS: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 Consentemail the Informed Consent to drted35@aol.com. 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 FORMSALL THREE FORMS  I will call you without further delay. With care, Dr. Ted Rothstein.

• Date:    /    / 20102010       * Name:                         * Age:     Date of birth:     * • Height:Height:           * Present Weight:Present Weight:                               * Goal Goal

Weight:Weight:          (click on link)--->*Present Body Mass Index (BMI):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 Number of months you are initially willing to dedicate passionately to the jaw wiring (OJW) approach to weight lossjaw wiring (OJW) approach to weight loss:  2 3 4 5 6 92 3 4 5 6 9 (3 months/ 21 pounds, assuming 5 pounds first week then 1.5 pounds each week thereafter)*Address:                        *City:              *State:       * Zip:*Occupation:*Home Telephone:                 *and Work Telephone (Other):                 * and Cell/ Mobile Telephone: *Email Address: Dr. Ted will not contact you if you do not provide this item. * Your dentist's name:Your dentist's name:    Address:  * Telephone number:

• CONTINUEDCONTINUED

Patient completes informed Consent requestedPatient completes informed Consent requested

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3.3. Provider agrees / Provider agrees / declines declines to provide to provide OJW based on OJW based on informationinformationnoted in the Informed Consent and the noted in the Informed Consent and the Medical-Dental formsMedical-Dental forms

4.4. Provider establishes the doctor- Provider establishes the doctor-patient relationship by telephone or at patient relationship by telephone or at consultation exam, and appoints consultation exam, and appoints patient for OJWpatient for OJW

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5.5. Provider examines patient, Provider examines patient, takes panoramic and photos and takes panoramic and photos and applies OJWapplies OJW

drted . Com / OJW Two Cases . htmdrted . Com / OJW Two Cases . htm

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OJW AloneOJW Alone

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6.6. Patient is given Patient is given ““RemindersReminders

and Precautions and Precautions Notice”Notice”

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Reminders and PrecautionsReminders and Precautions

• Reminder 1.  It is highly recommended to have your jaws wired properly, i.e., to have the lower jaw  placed and wired in  the "semi-mobile rest position called "Rothstein’s OJW rest position"©, which allows the jaw to move 2.5 millimeters in all directions.

• R2. When wired properly your upper and lower teeth do not touch.When wired properly your upper and lower teeth do not touch.• R3. It is highly recommended to remain wired the entire 4-6 weeks and then

remain unwired for 4-6 days to allow your joint to recover from any stiffening it may have suffered. METHODS AND INSTRUMENTS TO REMOVE THE WIRESMETHODS AND INSTRUMENTS TO REMOVE THE WIRES

• R4. The jaws must be exercised for at least 5 days.• R5. If the jaw joint feels stiff (pain on opening with 3 fingers inserted 1” into

mouth) wiring should be left off 5 more days or until the jaw joint no longer feels stiff.

• R6. Have your teeth, gums and jaw joint examined for any possible problems that could be developing as result of the jaw wiring, ex. night grinding.

• R7. Always carry your wire cutterAlways carry your wire cutter and be aware of other instruments (a fork) that could be useful to remove the wiring if an emergency suddenly developed.

• R8. The first 10 days may be very difficult so read A.T.’s story (OJW directory: item #2).

• CONTINUED etc., etc

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7.7. Patient removes wiring Patient removes wiring every every 5 weeks for 5 days5 weeks for 5 days and returns and returns to office for examination and to office for examination and rewiring rewiring

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PROTOCOL FOR MAINTENANCE PROTOCOL FOR MAINTENANCE OF TMJ HEALTHOF TMJ HEALTH

JAWS ARE WIRED JAWS ARE WIRED APARTAPART 2.0 mm-4.0 2.0 mm-4.0 mm and mm and released every five weeks for released every five weeks for five daysfive days to permit TMJ to recover from to permit TMJ to recover from any loss of mobility and rewired if any loss of mobility and rewired if mobility is within normal limits.mobility is within normal limits.

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Normal TMJ MobilityNormal TMJ Mobility

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OJW with OrthodonticsOJW with Orthodontics

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OJW using Unitek SmartClip OJW using Unitek SmartClip brackets and a variant of the brackets and a variant of the wiring patternwiring pattern

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Methods patients can use toMethods patients can use toremove the intermaxillary wiringremove the intermaxillary wiring

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WHAT ARE THE LEGAL AND WHAT ARE THE LEGAL AND LIABILITY ISSUES?LIABILITY ISSUES?

THEY HAVE YET TO BE THEY HAVE YET TO BE DEFINED. YOU WILL NEED TO DEFINED. YOU WILL NEED TO SPEAK TO YOUR LIABILITY SPEAK TO YOUR LIABILITY CARRIER AND HAVE THEM CARRIER AND HAVE THEM ADDRESS THE RISK ISSUES ADDRESS THE RISK ISSUES FROM THEIR POINT OF VIEW.FROM THEIR POINT OF VIEW.

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Why provide OJW?Why provide OJW?1. You believe that OJW is safe and effectiveYou believe that OJW is safe and effective

2.  You believe dentists are professional health You believe dentists are professional health providers who can / should be helping the providers who can / should be helping the overweightoverweight

3.   You feel strongly that OJW puts you at no You feel strongly that OJW puts you at no greater risk liability-wise than you are alreadygreater risk liability-wise than you are already

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Post ScriptPost Script

I have provided OJW to I have provided OJW to more than one hundred more than one hundred patients many of whom patients many of whom expressed their gratitude expressed their gratitude in no small terms…in no small terms…

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… …Most of the Most of the compulsively overweight compulsively overweight will applaud your efforts will applaud your efforts to help them, and they will to help them, and they will not hold it against you if not hold it against you if they regain the weight.they regain the weight.

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CONCLUSIONSCONCLUSIONSWe are uniquely positioned We are uniquely positioned as part of a as part of a health care teamhealth care team to help the to help the overweight / obese to achieve a healthier overweight / obese to achieve a healthier weight by providing weight by providing the OJW servicethe OJW service using the protocol and Informed Consent using the protocol and Informed Consent presented herein. presented herein.

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

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If we step forward and recognize our If we step forward and recognize our right and responsibility to care for right and responsibility to care for selected patients who meet the criteria selected patients who meet the criteria of being overweight or obese,of being overweight or obese, based on based on the diagnosis of the patient’s physicianthe diagnosis of the patient’s physician,, the leaders of the AAO and ADA will be the leaders of the AAO and ADA will be obliged to clearly define the dental obliged to clearly define the dental professional’s role in providing this professional’s role in providing this service, just as they did when problems service, just as they did when problems of snoring and sleep apnea first came to of snoring and sleep apnea first came to the attention of dental professionals. the attention of dental professionals.

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TO MY COLLEAGUESTO MY COLLEAGUESSelect your patients carefully. Do the OJW Select your patients carefully. Do the OJW methodically and be responsive to your methodically and be responsive to your patient’s needs. It is my fondest hopes that patient’s needs. It is my fondest hopes that OJW patients will reach the goals they set out OJW patients will reach the goals they set out for themselves when they signed the for themselves when they signed the Informed Consent. If they do, they can expect Informed Consent. If they do, they can expect to lose 1.5 – 2.0 pounds each week and even to lose 1.5 – 2.0 pounds each week and even more if they exercise. Providers your sole more if they exercise. Providers your sole responsibility is to maintain the health of their responsibility is to maintain the health of their TMJ, dentition and gingiva.TMJ, dentition and gingiva.

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The evolution of Homo SapiensThe evolution of Homo SapiensSubspecies: Hyperphagimas CompulsivisSubspecies: Hyperphagimas Compulsivis

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Note the interocclusal separation of 2-3mm: (approximately the physiologic rest position in which the mandible is “weightless”)

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OJW: The Skill NeededOJW: The Skill Needed

Almost as easyAlmost as easy

as tying youras tying your

shoelacesshoelaces

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THANK YOUTHANK YOU A Protocol for Providing A Protocol for Providing

Orthodontic Jaw Wiring for Orthodontic Jaw Wiring for Control of Obesity: A New Role Control of Obesity: A New Role

for Dental Professionalsfor Dental Professionals

THE ENDTHE ENDwww. drted. com/AAO OJW www. drted. com/AAO OJW

Synopsis . htmSynopsis . htm

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