March 11, 2004

Clinical Notes: Tiffanie Shelton.. St. Paul MN,  Occ.: Student/Mother, Age 24, 5'6'' 200 lbs:  Goal 130 pounds, Mildly active, willing to commit 6 months passionately to OJW. Expected weight loss: 45 pounds Email address: tiffyshelton@yahoo.com

 Examination of teeth, gums, all soft tissues, extent of movement of jaws, and TMJ (Temporo-Mandibular Joint) reveals that T is in good health. Her medical and dental history indicated that she had no problems or issues contraindicating  treatment for compulsive overeating using OJW.  A routine panoramic X-ray was taken, which further showed that her teeth and TM joint were normal. She has  had braces as an adolescent and her first premolars (5, 12, 28 and 21)  had been removed. Her occlusion was tested with articulating paper in order to test for/locate any possible traumatic occlusion. None was noted. (The Temporo-Mandibular Joint (TMJ)) is a "ball and socket" joint. The "ball" is the top part of your lower jaw and is called the "condyle". You can feel them by putting your fingers just in front of your ears when opening and closing your mouth. T was advised that in OJW the jaws are wired together but the teeth of the upper and lower jaw touch just barely, thus allowing about 1.0 mm of lower jaw movement in every direction. Consequently, no pressure is placed on the TM joint. She signed the informed consent for jaw wiring . She was provide an overview of the entire procedure and  was advised of the dangers she might encounter and how to avoid them. The informed consent and the FAQ's were reviewed and she signed the OJW Telephone memo indicating that she was aware of all aspects of the OJW treatment method for the control of compulsive overeating. "Begg" brackets were bonded on upper teeth 3,4,6  and 11, 13,14 and lower teeth 30, 29, 27 and 22,20, 19 (canines and first premolars and first molars).  The brackets were micro etched. The brackets were "double bonded", in that a second layer of adhesive was place on the flanges of the bracket. All excessive and unsightly adhesives was removed and the space between the teeth was checked for unimpeded passage of dental floss. The bracket slot was tested for blockage that might have occurred from stray adhesive. Finally, she was asked to put her teeth gently together and the wiring was done with "dead soft" .014 inch diameter stainless steel round wire.  T observed the wiring technique and then cut out the wire as a practice procedure which she did with ease in about 5 seconds. She was then wired closed on the right and left sides so that she felt equally comfortable on both sides with about 1.0 mm of freedom to move in all directions.  After 5 weeks of being wired she would remove the wires for 5 days to exercise her TM joints. She was advised not to rewire if there was still any stiffness until the TM stiffness disappeared.  She was given a kit of supplies including a wire cutter and a wire twisting instrument. (Mathieu needle holder) She was given instructions on how to exercise her jaws  during the 5 days she would be released from the wires and advised re the possibility of the joint becoming more limited in motion over time (two fingers of opening rather than 3 fingers).  She was counseled to adhere to a 1350 calorie  low/no salt liquid diet.  She was advised to always carry the wire-cutter with him. Lacking a wire cutter a simple fork could accomplish the emergency removal of the wire. She was provided with instruments to assist in the removal and replacement of the wires including and (Mathieu needle holder). knowing that she would not be returning every five weeks to be rewired my staff and I taught her how to rewire himself, a task she was able to accomplish with remarkable ease.  Herein I advise her to weigh himself EVERYDAY and even better keep a graph of her weight loss 18"wide (each day) by 9" high (weight) and make an entry every day/week.  I encourage you both to read:the letter A.T. wrote  who spells out for you what her experience was like warts and all.

March 13,
T called me at home Saturday morning (no patient care hours this Sat) to tell me she had a detached bracket (#3).  Fortunately she had not left for St. Paul and was able to return to the office that morning where I rebonded and rewired her and gave 6 spare brackets to take back home in case another bracket became detached and a different orthodontist had to rebond it.

Ps.  The brackets were bonded on to the teeth differently than in all previous patients in that they "more inclined" rather than vertically placed on the surface of the teeth.  It seemed that this innovation was more suitably matched to the direction of the path of the wiring...see pics below: