AAO OJW Scope of dentistry

Between September 8-16, 2009 I sent the letter below to the attention of the "Executive Director of Dentistry" and, or the committee comprising the members of the State Board of Dentistry in every state of the union.

  Below the letter you will find the responses from each state.

GA:Is orthdontic jaw wiring for weight control within the scope of Dentistry in Georgia
 
Ted Rothstein, DDS, PhD  
 Specialist in Cosmetic Orthodontics for Adults and Children
Specialist in Orthodontic Jaw Wiring
BCAT  film producer

American Association of Orthodontists
Founder DPOJW: www.drted.com/DPOJW.html
35 Remsen St., Brooklyn, NY 11201
718 852 1551      Fx 718 852 1894
www.drted.com    drted35@aol.com
 
 
Dear Executive Director of Dentistry and
Members of the State Board of Dentistry:
C/O Anita Martin
I was invited to present a paper at the AAO May 3, 2010 on the subject of OJW (Orthodontic Jaw Wiring), (see topic content below).
 
I know that OJW is within the scope of dentistry in NY State. However, I am uncertain about its status in other states (Washington, DC, Illinois, Texas, Florida, California ).  I find it hard to imagine it is expressly forbidden. However, since I am going to give a paper to the AAO I would like to verify my facts/beliefs.
Just in case you have doubts as to the nature of OJW please refer to:

Synopis of paper presented to the AAO in Washington on OJW

I understand that dental professionals may not make a diagnosis of obesity. However, if medical clearance is provided to begin a liquid diet than OJW would seem to be with the scope of dentistry as our responsibility would  be to insert the appliance and periodically check the health status of the teeth, gums and TMJ.  The weight loss would then be  the responsibility of the patient not the dental practitioner.

 

Would you please elaborate in so far as you are intimately familiar with your state's guidelines related to this question.  Cordially, Dr. Ted Rothstein

 

 and see below:

Orthodontic Jaw Wiring: The Dental Professional's Role in Weight Control for Compulsive Overeating Leading to Obesity

 

 

Given that we are the caretakers of the mouth and uniquely empowered with skills and mechano-therapy to provide services to the overweight, it is our obligation and responsibility as part of a health-care team to provide our expertise to the overweight heading towards obesity and those who have already reached that state.

OJW patients will applaud and praise your effort to help them; they will not begrudge you if they regain the weight post-treatment, a problem encountered with every weight-loss method without exception. Weight loss is not the OJW provider’s prime responsibility. OJW providers are primarily responsible for the maintenance of the health of the TMJ, dentition and gingiva during the period of being wired. If members of the dental profession step forward and recognize their right and responsibility to care for selected patients who meet the criteria of being overweight or obese, based on the diagnosis of the patient’s physician the leaders of the AAO and ADA will be obliged to clearly define the dental professional’s role in providing this service,  just as they did when problems of snoring and sleep apnea first came to the attention of dental professionals.

 

Bond bracketsCanines and premolars

Ligate w deadsoft wire .012-4

 

 
 

PROTOCOL: Jaws are wired APART 2.0 mm-4.0 mm and released every five weeks for five days to permit TMJ to recover from any loss of mobility.
recover from any loss of mobility.
 THE OJW POSITION OF PHYSIOLOGIC REST is a parted resting position of the mandible at which the muscles of mastication are in a minimally contracted position thereby allowing the lower jaw to be suspended from the maxillary teeth in a condition of "weightlessness". Inter-occlusal wiring permits the mandible to move  2.0 mm - 4.0 mm laterally, vertically and antero-posteriorly  thereby minimally impeding speech and minimizing the possibility of TMJ stiffening. This position is often congruent with an observable inter-occlusal space of 2.0 mm - 4.0 mm and closely approximates the position we know as the "physiologic jaw resting" position, the initial position  from which all jaw excursions begin. It is this condition of  jaw "weightlessness" that precludes the possibility that the upper/lower teeth are extruded during the time the OJW device is in place.

RESPONSES:

Arkansas

Maine;

 

See http://www.mainedental.org/forms/September182009.pdf   Maine Against: Scroll document until you see "E-mail
from Dr. Rothstein"  Septemeber 18, 2009

Utah:  Sept 17, 2009

DISCUSSION ITEMS:

E-mail Question from Dr. Ted Rothstein

regarding the Practice of Dentistry

Ms. Taxin read Dr. Rothstein’s e-mail and explained

that Dr. Rothstein had called Ms. McCall regarding

Orthodontic Jaw Wiring for weight loss being the

practice of Dentistry. She stated he then talked with

her and requested she read the e-mail before she make

comments. Ms. Taxin requested Board members to

review the information and make a recommendation

regarding if the procedure is a Dental procedure or a

medical procedure.

Following discussion the Board determined if the

procedure is done by a Dentist it must be by the

request of a Physician and not the patient with the

Physician being responsible for the weight loss

program and the patient continues under the care

of the Physician. The Board determined there

should be medical records to support the procedure

and it should be physician driven. The Board

determined weight loss programs and the

procedure are not in the scope of practice for a

Dentist but wiring the mouth for TMJ, gingivitis

and other Dental issues would be in the scope of

practice for a Dentist.

OJW SCOPE OF DENTISTRY  RESPONSES

 

ARIZONE 091009
elaine.hugunin@azdentalboard.us

In response to your email advising me of your interpretation, please note that Staff, the Board and the Attorney General Office does not have  statutory authority to issue advisory opinions in this situation.  You may wish to consult with your attorney regarding your interpretation of the Arizona dental regulations.   

 

“Board staff do not give legal opinions about the statutes. “

Again, please reference ARS 32-1202 which defines the scope of the practice of dentistry

 

THANK YOU FOR YOUR RESPONSE

 

I WILL REPORT TO MY COLLEAGES THAT ACCORDING TO MY INTERPRETATION OF THE  ARIZONA DENTAL REGULATIONS REGARDING ORTHODONTIC JAW WIRING FOR WEIGHT CONTROL THE RULES ARE NEBULOUS AS SPECIFICALLY RELATE TO THE QUESTION. AND THERE WAS NO AUTHORITY WILLING TO TAKE A POSITION. CORDIALLY, DR. TED

PS: IF THERE IS SOME AUTHORITY THAT CAN TAKE POSITION ONE WAY OR THE OTHER PLEASE LET ME KNOW.

 

 

ARKANSAS
Donna.Cobb@arkansas.gov
I will put this on the Board’s agenda for discussion.Donna F. Cobb
Executive Director
Arkansas State Board of Dental Examiners
101 East Capitol Avenue, Suite 111
Little Rock, AR  72201
Ph:   (501) 682-2085
Fax: (501) 682-3543
www.asbde.org

 

KENTUCKY:

From our attorney…

briank.bishop@ky.gov

 

DEAR BRIAN:

 

THANK YOU FOR RESPONDING SO QUICKLY:

DOES THE RESPONSE MEAN THAT A PROVIDER OF ORTHODDONTIC JAW WIRNG IN KENTUCKY IF " "DISCOVERED" WOULD BE CENSORED, FINED, REPRIMANDE, LICENSE REVOKED ETC. OR NOT.

I REALIZE THE GREY AREA IS CONSIDERABLE, BUT IN YOUR HUMBLE OPINION WHAT DO YOU THINK WOULD BE AN OUTCOME.  SINCE THIS SERVICE IS NEWLY UNDER CONSIDERATION THE ANSERS ARE WITHOUT DOUBT GOING TO BE ALL OVER THE BOARD. I HAVE BEEN PROVIDING THE SERVICE FOR THE LAST 10 YEARS HERE IN NY. i HAVE NEVER BEEN NOTIFIED BY THE STATE BOARD OR REPRIMANDED ETC. WHAT DO YOU MAKE OF ALL THE INTERSTING WORDS YOU SENT ME? TED

 

I don’t conclude having one’s jaw wired shut for the sole purpose of weight loss is within the definition of dentistry per KRS 313.010(2).   Oh yeah, wiring the jaw shut is dentistry by itself, but the end result has to be for a dental purpose.  See statute, below.  Ohio once had a dental anesthesiologist who could put patients totally to sleep, that is, in full sedation/general anesthesia for an operation, such as to perform dental surgery, but that same Ohio dentist was stopped from putting people to sleep, that is, full anesthesia, so a surgeon could do an appendectomy.  Also, this Board has said that a dentist or RDH could numb the lips and gums, etc., in order to perform a dental procedure, but not so the “patient” can walk across the street for a painful facial tattoo.  Again, numbing the mouth, lips, etc., is dentistry all right, but not doing a tattoo. Mark

Any person shall be regarded as "practicing dentistry" who, for a fee, salary or other reward paid, or to be paid either to himself, or to another person, performs or advertises to perform, dental operations of any kind, or who diagnoses or treats diseases or lesions of human teeth or jaws, or attempts to correct malpositions thereof, or who diagnoses or treats disorders, or deficiencies of the oral cavity and adjacent associated structures, or who takes impressions of the human teeth or jaws to be used directly in the fabrication of any intraoral appliance, or shall construct, supply, reproduce or repair any prosthetic denture, bridge, artificial restoration, appliance or other structure to be used or worn as a substitute for natural teeth, except upon the written laboratory procedure work order of a licensed dentist and constructed upon or by the use of casts or models made from an impression taken by a licensed dentist, or who shall advertise, offer, sell or deliver any such substitute or the services rendered in the construction, reproduction, supply or repair thereof to any person other than a licensed dentist, or who places or adjusts such substitute in the oral cavity of another, or who uses the words "dentist," "dental surgeon," the letters "D.D.S.," "D.M.D.," or other letters or title in connection with his name, which in any way represents him as being engaged in the practice of dentistry.

 

FLORIDA

Dear Dr. Rothstein, 

 

        Section 466.017, Florida Statutes states that a dentist shall have the right to perform surgical operations within the scope of his or her practice and training.  We do not have any specific laws or rules related to orthodontic jaw wiring.  It would seem logical to me that the orthodontist would need to  work with the medical practitioner as far as the obesity diagnosis and patient diagnosis/health conditions.  

 

    Unfortunately, we, as staff, are unable to provide a legal interpretation of the statutes.  I have contacted our board counsel concerning this matter and am sending you the attached.  If you need more specific information than that found in the statutes, you may wish to prepare a petition for declaratory statement to be presented for the board's review at a regularly scheduled meeting.  The next meeting is October 30 and the agenda deadline is September 25.  I have attached the statute and rule concerning declaratory statements for your information.  If you file a petition for review at the October meeting, your petition must be filed prior to September 25.

        Sincerely,

     Susan J. Foster, Executive Director 
    Department of Health-Medical Quality Assurance 
    850/245-4474-telephone 
    850/921-5389-fax
www.doh.state.fl.us/mqa
sue_foster@doh.state.fl.us

 

 

RESPONSE: I WOULD VERY MUCH LIKE TO HAVE AN OPINION RE MY SUBJECT

VIZ. ORTHODONTIC JAW WIRING FOR WEIGHT CONTROL.   IF A PROFESSIONAL WERE TO PROVIDE SUCH A SERVICE AS I DESCRIBE IN MY PREVIOUS LETTER WOULD THAT PROFESSIONAL BE REPRIMANDED, CENSURED, FINED OR HAVE HAVE THEIR LICENSED REVOKED?  CORDIALLY, DR. TED ROTHSTEIN

Ps: I REALIZE THAT THIS QUESTION IS DIFFICULT. BUT WHEN I PRESENT MY RESULTS TO MY COLLEAGUES I WOULD HAVE NO IDEA HOW FLORIDA FEELS ABOUT THIS SUBJECT.

 

susan_angel@doh.state.fl.us
 sue_foster@doh.state.fl.us

466.003 Definitions.—As used in this chapter:(1) “Board” means the Board of Dentistry.

(2) “Dentist” means a person licensed to practicedentistry pursuant to this chapter.

(3) “Dentistry” means the healing art which is concerned

with the examination, diagnosis, treatment

planning, and care of conditions within the human oral

cavity and its adjacent tissues and structures. It

includes the performance or attempted performance of

any dental operation, or oral or oral-maxillofacial surgery

and any procedures adjunct thereto, including

physical evaluation directly related to such operation or

surgery pursuant to hospital rules and regulations. It

also includes dental service of any kind gratuitously or

for any remuneration paid, or to be paid, directly or indirectly,

to any person or agency. The term “dentistry”

shall also include the following:

(a) The taking of an impression of the human tooth,

teeth, or jaws directly or indirectly and by any means or

method.

(b) Supplying artificial substitutes for the natural

teeth or furnishing, supplying, constructing, reproducing,

or repairing any prosthetic denture, bridge, appliance,

or any other structure designed to be worn in the

human mouth except on the written work order of a duly

licensed dentist.

(c) The placing of an appliance or structure in the

human mouth or the adjusting or attempting to adjust

the same.

(d) Delivering the same to any person other than

the dentist upon whose work order the work was performed.

(e) Professing to the public by any method to furnish,

supply, construct, reproduce, or repair any prosthetic

denture, bridge, appliance, or other structure

designed to be worn in the human mouth.

(f) Diagnosing, prescribing, or treating or professing

to diagnose, prescribe, or treat disease, pain, deformity,

deficiency, injury, or physical condition of the

human teeth or jaws or oral-maxillofacial region.

(g) Extracting or attempting to extract human teeth.

(h) Correcting or attempting to correct malformations

of teeth or of jaws.

(i) Repairing or attempting to repair cavities in the

human teeth.

Sincerely,

Susan J. Foster, Executive Director
Department of Health-Medical Quality Assurance
850/245-4474-telephone
850/921-5389-fax
www.doh.state.fl.us/mqa
sue_foster@doh.state.fl.us

GEORGIA

Dr. Rothstein – At its 10/09 meeting, the Georgia Board of Dentistry reviewed the attached.  At that time, the Board requested that you be notified that its current policy from 2004 is still applicable in this case.  For your convenience, the following is a link to the policies
http://www.sos.ga.gov/plb/dentistry/Dental Policy Manual.pdf
((OJW is not within the scope of Dentistry)
Anita O. Martin, Executive Director
Healthcare Section
Office of the Secretary of State
Professional Licensing Boards Division
237 Coliseum Dr.
Macon,  GA  31217
(478) 207-2440

MAINE
dental.board@maine.gov

Dr. Rothstein:We will take your question to the members of the Board.

Lynn

Lynn A. Warner, AS
Board Assistant
Board of Dental Examiners
SHS # 143
Augusta, ME  04333-0143
Physical Address:  161 Capitol Street
Telephone:  287-3333
Fax:            287-8140
E-Mail:  lynn.warner@maine.gov
www.mainedental.org

MAINE

 

STATE OF MAINE

BOARD OF DENTAL EXAMINERS

143 STATE HOUSE STATION

AUGUSTA MAINE, 0433-0144

October 1, 2009

“RE: Orthodontic Jaw Wiring for Weight Control

Regarding your email dated September 8, 2009

At a recent meeting, the State of Maine Board of Dental examiners reviewed your email dated September 8, 2009…The board determined that this procedure doe not fall within the scope of practice for  licensed dentist practicing in Maine.

Denise M. Theriault, DMD

Board President

207 287 3333

Fx: 207 287 8140

 

MISSOURI:

dental@pr.mo.gov

nicole.reinkemeyer@pr.mo.gov

THANK YOU NICOLE:

 

JAW WIRING FOR WEIGHT CONTROL:

THIS QUESTION IS NOT EASY FOR IT CONSIDERS A NEW TREATMENT MODE HITHERTO NOT PROVIDED WIDELY BY DENTAL PRACTITIONERS.  I LOOK FORWARD TO  YOUR CONSIDERED RESPONSE FOR INCLUSION IN MY REPORT TO MEMBERS FO THE AAO. DR. TED ROTHSTEIN

 

In a message dated 09/08/2009 5:30:42 P.M. Eastern Daylight Time, nicole.reinkemeyer@pr.mo.gov writes:

Sorry about that.  I accidentally responded to the wrong email.  I am currently researching that information for you.  I will email you with the information you are requesting. Again, sorry about the mix-upNicole ReinkemeyerOffice Support AssistantMissouri Dental BoardMissouri State Board of Optometry3605 Missouri Blvd.Jefferson City, MO  65109Phone: (573) 751-0040Fax: (573) 751-821

MONTANA
Dear Dr. Rothstein,

The Montana Board of Dentistry reviewed your request “ Is orthodontic jaw wiring for weight control within the scope of Dentistry in Montana ?” at its September 25, 2009 Full Board meeting. While the Board did not specifically indicate yes or no, it directed me to refer you to the state statute definition of “dentistry”:

37-4-101. Definitions -- practice of dentistry. (1) Unless the context requires otherwise, in this chapter, the following definitions apply:

(a) "Board" means the board of dentistry provided for in 2-15-1732.
     (b) "Conscious sedation" means a minimally depressed level of consciousness in which the patient breathes normally without assistance, retains protective reflexes, and responds to physical stimulation or verbal command in a manner appropriate to the patient's cognitive level. Conscious sedation is not a form of general anesthesia, and brief interludes of unconsciousness during conscious sedation do not bring conscious sedation within the scope of general anesthesia.
     (c) "Department" means the department of labor and industry provided for in Title 2, chapter 15, part 17.
     (d) "General anesthesia" means a state of unconsciousness intentionally produced by anesthetic agents, with absence of pain sensation over the entire body and a greater or lesser degree of muscular relaxation. The drugs producing this state can be administered by inhalation, intravenously, intramuscularly, or via the gastrointestinal tract. General anesthesia is divided into:
     (i) full general anesthesia, which means a level of consciousness in which the patient is without intact protective reflexes, is unable to maintain an airway, and is incapable of rational response to query or command; and
     (ii) light general anesthesia, which means a level of consciousness in which the patient breathes normally without assistance and retains protective reflexes throughout most of the procedure.
     (e) (i) "General anesthetic" means any recognized anesthetic agent, sedative, hypnotic, tranquilizer, or narcotic used in sufficient prescribed dosages for the purpose of inducing general anesthesia.
     (ii) The term does not include a nitrous oxide and oxygen mixture or any other anesthetic administered to produce conscious sedation.
     (2) Except for the provisions of 37-4-104, a person is practicing dentistry under this chapter if the person:
     (a) performs, attempts, advertises to perform, causes to be performed by the patient or any other person, or instructs in the performance of dental operations, oral surgery, or dental service of any kind gratuitously or for a salary, fee, money, or other remuneration paid or to be paid, directly or indirectly, to the person, any other person, or any agency;
     (b) is a manager, proprietor, operator, or conductor of a place where dental operations, oral surgery, or dental services are performed, unless the person is the personal representative of the estate of a deceased dentist or the personal representative of a disabled dentist, as provided in 37-4-104;
     (c) directly or indirectly, by any means or method, furnishes, supplies, constructs, reproduces, or repairs a prosthetic denture, bridge, appliance, or other structure to be worn in the human mouth;
     (d) places the appliance or structure in the human mouth or attempts to adjust it;
     (e) advertises to the public, by any method, to furnish, supply, construct, reproduce, or repair a prosthetic denture, bridge, appliance, or other structure to be worn in the human mouth;
     (f) diagnoses, professes to diagnose, prescribes for, professes to prescribe for, treats, or professes to treat disease, pain, deformity, deficiency, injury, or physical condition of human teeth, jaws, or adjacent structures;
     (g) extracts or attempts to extract human teeth or corrects, attempts, or professes to correct malpositions of teeth or of the jaw;
     (h) gives or professes to give interpretations or readings of dental roentgenograms;
     (i) administers an anesthetic of any nature, subject to the limitations provided in 37-4-511, in connection with a dental operation;
     (j) uses the words "dentist", "dental surgeon", or "oral surgeon", the letters "D.D.S." or "D.M.D.", or any other words, letters, title, or descriptive matter that in any way represents the person as being able to diagnose, treat, prescribe, or operate for any disease, pain, deformity, deficiency, injury, or physical condition of human teeth, jaws, or adjacent structures;
     (k) states, advertises, or permits to be stated or advertised, by sign, card, circular, handbill, newspaper, radio, or otherwise, that the person can perform or will attempt to perform dental operations or render a diagnosis in connection with dental operations; or
     (l) engages in any of the practices included in the curricula of recognized dental colleges.

Let me know if you have any additional questions.Regards,DennisDennis R. ClarkBoard Administrator  406-841-2390 Fax: 406-841-2305 Board of Dentistry:E-Mail: dlibsdden@mt.gov  www.dentistry.mt.gov

 

RHODE ISLAND:

 

 Dear Dr. Rothstein

The RI Board of Examiners in Dentistry reviewed your e-mail seeking its opinion as to whether the wiring of jaws for the purpose of weight control is considered to be within the scope of dentistry.

Be advised, wiring jaws for the sole purpose of weight control, is not within the scope of dental practice in Rhode Island.

Gail Giuliano
Board Administrator
RI Board of Examiners in Dentistry.

 

TENNESSEE:

Dr. Rothstein,

 

The Tennessee Board of Dentistry has not specifically addressed orthodontic jaw wiring but there is a policy regarding Appliances Used for Weight Loss.  That policy is available online at http://health.state.tn.us/Downloads/Den_Weight_Loss.pdf.Sincerely,

Dea Smith

Executive Director

Tennessee Board of Dentistry

The mission of the Department of Health is to promote, protect, and improve the health of people living in, working in, or visiting the State of Tennessee.

 

TEXAS

In a message dated 10/01/2009 11:12:16 A.M. Eastern Daylight Time, cwetherbee@tsbde.state.tx.us writes:

cwetherbee@tsbde.state.tx.us

Dear Dr. Rothstein:

 After reviewing your question with our staff dentist, it is our concern that orthodontic jaw wiring for weight control does not come within the practice of dentistry because weight control is not within the practice of dentistry.  That would make jaw wiring for weight control a violation of our statutes and rules as treating a patient for a non-dental purpose.

 Cordially,

Charles F. Wetherbee, General Counsel 

From: Drted35@aol.com [mailto:Drted35@aol.com]
Sent: Tuesday, September 08, 2009 3:27 PM
To: information
Subject: TX: Is orthdontic jaw wiring for weight control within the scope of Dentistry

 

WASHINGTON:

091109

 jennifer.santiago@doh.wa.gov   <jennifer.santiago@doh.wa.gov>

The definition of dentistry is defined in our law RCW 18.32.020 http://apps.leg.wa.gov/RCW/default.aspx?cite=18.32.020

 

I included the 5 definitions of dentistry. The complete law can be located at the link provided.

 

1) represents himself as being able to diagnose, treat, remove stains and concretions from teeth, operate or prescribe for any disease, pain, injury, deficiency, deformity, or physical condition of the human teeth, alveolar process, gums, or jaw, or

(2) offers or undertakes by any means or methods to diagnose, treat, remove stains or concretions from teeth, operate or prescribe for any disease, pain, injury, deficiency, deformity, or physical condition of the same, or take impressions of the teeth or jaw, or