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SPECIAL NOTE

February 1, 2009

                          The article below, written for the AJODO  (American Journal of Orthodontics and Dentofacial Orthopedics) was presented recently as a "resubmit" 
                           to the publisher. In it are in included the revisions and deficiencies  suggested by three of my peers ("jurors") after I presented the manuscript  in October 29, 2007.
                          The most important deficiency addressed was the need for "scientific research study" to address The Safety and Effectiveness of, and the Problems
                          Associated with, OJW--a weight-control method. This study was completed and the results posted to the site in January, 2009  The publisher has now
                          declined to accept the revised manuscript for review declaring that dental professionals/orthodontists would be less interested than other medical
                          venues to present the material on the subject of OJW 
 Read the publishers letter and my response to him just above that 

Perhaps the publisher  is right. Nevertheless, my experience providing this service for the past ten years indicates that his opinion is deeply flawed, and his vision is shortsighted. I believe he speaks only for himself and certainly neither for dentists nor for orthodontists at large. The French would say "tant pis"
I will continue to strive to make my colleagues aware of my work through my free course on the subject  so that they may have the option to  provide their services to the overweight and obese struggling to help themselves gain a measure of control over compulsive overeating.  Moreover, I will revise the article and submit it to JADA  the nation's best-read dental journal., (Journal of the American Dental Association).

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

ARTICLE UNDERGOING SUBMISSION TO JADA BEGINNING FEBRUARY 5, 2009
SEE WORK IN PROGRESS:

 

 

COVER LETTER

Dear members of the Manuscript Central Review Committee:
"Orthodontic Jaw Wiring: The Dental Professional’s Role in Weight Control for Compulsive Overeating Leading to Obesity" is an article concerning a new service that dentists should consider providing to obese patients who seek them out. As the sole developer of Orthodontic Jaw Wiring for weight control and provider of the service since 1998 I feel confident that this service will improve the image of dentists and dentistry, albeit a discipline seemingly on the fringe of the usual and customary work that members of our profession typically provide.
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 our efforts to help them; they will not begrudge us 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.
I am confident that in time OJW will become a service that members of the dental community will provide with pleasure in their own communities. I have no doubt that there will never cease to be members of the dental and medical community who look upon OJW with a jaundiced eye. I say offer the service, choose our patients carefully, do the OJW methodically and be responsive our patient's needs. Most of the compulsively overweight will applaud our efforts to help them and they will not hold it against us if they regain the weight. Yours truly,
Ted Rothstein, DDS, PhD

JADA Copyright Transfer Agreement: Transmitted

JADA Conflict of Interest Statement: Transmitted

ABSTRACT:

Introduction: Obesity is legion and epidemic in our country, if not worldwide in developed countries, and recognized as a precursor to a host of serious illnesses. Indeed, Medicaid and Medicare have classified obesity per se as a disease.  Method: Orthodontic Jaw Wiring (OJW) using brackets on the canines and premolars and inter-occlusal wiring to control weight by limiting jaw opening in conjunction with a liquid diet is new more gentle approach to the problem of obesity that can help some people avert its potentially grave consequences. OJW is applicable to those carefully selected individuals whose Body Mass Index (BMI)* indicates they are overweight or obese as diagnosed by their physician. Twenty-four former OJW patients out of seventy-seven invitees responded to a lengthy in-depth survey. Results: Their responses support the conclusion that OJW is safe and effective using the newly developed protocol  to provide this service. Conclusions: The survey indicated that OJW is safe and effective. Consequently, dentists may  elect to provide OJW. It is our obligation and responsibility as part of a health-care team to provide this new service to the overweight and already obese who would seek us out knowing we are ready to respond to them.

 

 

 

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

 

OJW ARTICLE SUBMITTED TO THE AJO-DO ON OCTOBER  29, 2007


 

 

Contents of Special Article

Copyright Statement    1

Table of Contents   2

Acknowledgment   3

Dedication   4

   Title page   5

   Conflict of Interest Statement   6

   Curriculum Vitae   7

   Abstract <200 words   8

   Introduction including  five essential questions and answers 9

REVIEW OF THE LITERATURE

General conclusions of the literature review

METHOD OF THE STUDY

RESULTS

FLAWS OF THE STUDY

   Main text including conclusion 10-18 (word count introduction and main text 2223)

       Fig. 1:  The original conception of Orthodontic Jaw Wiring

       Fig. 2:  Case illustration: M.M. 33 y/o female, BMI 36; chronic adult thumb sucking

       Fig 3:  Showing use of self-ligating brackets to extend the range of apartness of the jaws

       Fig. 4:  Model demonstrating use of SmartClip brackets with OJW and the range of    inter-maxillary apartness achievable.

   References   19-23

Contact information   24

Footnotes:

*method to calculate BMI

** Captions for photographs

***  Definition of  the OJW position of physiologic rest:

NOTE:   Hyperlinks are references to URLs at www.drted.com which provide detailed information too extensive to include herein and found nowhere else but in the web site.

 

Acknowledgments

 My staff, and those who encouraged and cheered and above all the OJW patients who were always enthusiastic and tireless in their efforts to be in control of their eating habits

Dedication

To my colleagues, my wife Frances, sons Lenard and Jonathan and BroJer

 

Title page

Orthodontic Jaw Wiring (OJW): The Dental Professional’s Role in Weight Control for Compulsive Overeating Leading to Obesity

By Ted Rothstein, D.D.S., Ph.D., private practice orthodontist

35 Remsen Street, Brooklyn, NY 11201

(718) 852-1551  drted35@aol.com   www.drted.com


 

 


 

Curriculum Vitae

AAO-NESO- Life-active member, and NYU Orthodontic Alumni Association. 1973-present; Ph.D., University of Pennsylvania in Physical Anthropology: growth and development of the cranio-facial components age 9-15; published in the AJO March 2000 and the AJODO November 2001. See complete resume at www.drted.com 

 

Abstract <200 words 

 Introduction: Obesity is legion and epidemic in our country, if not worldwide in developed countries, and recognized as a precursor to a host of serious illnesses. Indeed, Medicaid and Medicare have classified obesity per se as a disease.  Method: Orthodontic Jaw Wiring (OJW) using brackets on the canines and premolars and inter-occlusal wiring to control weight by limiting jaw opening in conjunction with a liquid diet is new more gentle approach to the problem of obesity that can help some people avert its potentially grave consequences. OJW is applicable to those carefully selected individuals whose Body Mass Index (BMI)* indicates they are overweight or obese as diagnosed by their physician. Twenty-four former OJW patients out of seventy-seven invitees responded to a lengthy in-depth survey. Results: Their responses support the conclusion that OJW is safe and effective using the newly developed protocol  to provide this service. Conclusions: The survey indicated that OJW is safe and effective. Consequently, dentists may  elect to provide OJW. It is our obligation and responsibility as part of a health-care team to provide this new service to the overweight and already obese who would seek us out knowing we are ready to respond to them.

 

Introduction

     Obesity is a major healthcare problem affecting 35% of the United States population, In more affluent countries, obesity is common not only in the middle-aged, but is also becoming increasingly prevalent among younger adults and children and recognized as a precursor to a host of serious illnesses.1, 2, 3, 4, 5,5.5 Indeed, Medicaid and Medicare have classified obesity as a disease in itself. These agencies are seeking new and less expensive approaches to the costly lap-band and gastric surgeries extant whose mortality rate reaches 3/1000.5

      Orthodontic Jaw Wiring for weight control, as defined below,  is an approach to a serious social, psychological and physiological problem that can help some people who are obese or on a path to obesity and its potentially grave consequences among which include airway impairment and sleep apnea, whose co-morbidities are myriad.3
     Dentists and orthodontists have taken cognizance of their role in the treatment of this problem,.7 and in coordination with the patient’s physician,  can provide the appropriate mechano-therapy. Moreover, the AAO sanctioned such intervention beginning in 2004 by offering liability coverage for the first time for treatment of sleep apnea. Formerly, the orthodontist’s and dental professional’s role in providing mechano-therapy was frowned upon, and totally neglected by the dental profession.. This author has been providing this service since 1998 and in this article provides would-be OJW providers the data and experience he has accumulated.

 

     There are some fundamental questions the reader should pose: What is Orthodontic Jaw Wiring?  Is jaw wiring within the scope of the dental profession?    Is orthodontic jaw wiring safe?   What is new about Orthodontic jaw Wiring as proposed by the author? 23:    The answers to these questions are broadly provided below.

What is Orthodontic Jaw Wiring?  

Orthodontic Jaw Wiring23 refers to the entire domain of the OJW provider's responsibility to:

1. select patients according to specified criteria, and obtain their informed consent15 so that they are aware of the risks and limitations of OJW;

2. wire their jaws apart by a prescribed method;25

3. transmit that know-how to patients (especially if they are not able to return to your office and cannot find a competent professional who will do it for them);

4. re-examine and rewire them, typically once every five weeks, after examination demonstrates that their dentition, gingiva and TMJ have remained healthy over a period of time lasting 3-9 months during which time they will reduce weight by two pounds per week;

5. remove the wiring and brackets when patients indicates they have achieved their goal.

 

     OJW presumes the service is provided under the auspices of a health-care team which would well include input from the patient's primary-care physician, dentist, OJW provider, dietician and, when applicable,  psychologist and/or psychotherapist as well as a bariatric surgeon when indicated. 14

See captions for figures below**

Fig 1a. Left photograph; Fig 1b. Right photograph

Fig 2.

Fig 3.

Fig 4a and 4b. 

 

Is jaw wiring within the scope of the dental profession?

Dr. Milton Lawney, the Executive Secretary of the New York State Board of Dentistry responds:

     “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.21

     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 achieve a healthier weight by providing OJW.

IS ORTHODONTIC jaw wiring safe?

Jaw wiring for weight loss has been researched and found to be a safe procedure historically 13 and as demonstrated by the present study. Moreover, my personal research in dental and medical literature as well as an extensive search of legal archives by an attorney fail to identify a single instance of harm coming from the jaw wiring itself.  If harm has come to a patient it has not been reported in the literature. Finally, I have personally spoken with more than a score of oral surgeons who could not report a single instance of injury to a patient who had jaw wiring for trauma or pathology.22  This is important to note because oral surgeons totally immobilize the jaws maximizing risk to the TMJ while in OJW the goal is to provide fixation with the maximum allowable mobility possible which concomitantly prevents ingestion of solid food.

What is new about OJW as proposed by the author? 23:

1. Interocclusal jaw wiring has been specifically applied to the goal of weight loss/control.
2. The jaws are wired through the medium of orthodontic attachments bonded to the premolars and canines and the teeth and jaws are wired apart in a position named “the OJW position of  physiologic rest.”***

3. The delivery of jaw wiring is provided according to a defined protocol to be followed by the practitioner16

4. An  Informed Consent was created specifically for orthodontic jaw wiring. See URL to Informed consent. 15

5. A protocol was created listing the contraindications of Orthodontic Jaw Wiring.

6.. A protocol was created which takes cognizance of the possibility of TMJ stiffening over time and the possibility of extrusion of teeth.

7. A study (N=23) was carried to assess  how patients fared following the protocol. See URL to OJW Questionnaire Survey  13.5

 

Is weight loss resulting from jaw wiring new?

     Not at all. Oral surgeons have long wired their patients’ teeth together with surgical arch bars to facilitate healing in trauma or pathology cases, with the consequence that their patients were required to exist on a liquid diet, resulting in the patient inadvertently losing weight.31 By conservative estimate more than fifty thousand patients have their jaw wired each year in the United States. Weight loss is a common unintended collateral side-effect. That is how the public at large came to be aware of “jaw wiring” for weight loss.

 

Is orthodontic jaw wiring safe?

Jaw wiring for weight loss has been researched and found to be a safe procedure. Moreover, my personal research in dental and medical literature as well as an extensive search of legal archives by an attorney fail to identify a single instance of harm coming from the jaw wiring itself.  If harm has come to a patient it has not been reported in the literature. Finally, I have personally spoken with more than a score of oral surgeons who could not report a single instance of injury to a patient who had jaw wiring for trauma or pathology.22  This is important to note because oral surgeons totally immobilize the jaws maximizing risk to the TMJ while in OJW the goal is to provide fixation with the maximum allowable mobility possible which concomitantly prevents ingestion of solid food.

 

      OJW is highly controversial.11 It has provoked some professional colleagues to declare that it is an inappropriate treatment modality for dental professionals to provide,12 when in fact it is minimally-invasive and has been shown to be safe and effective 13.5 unlike gastric surgery with its substantial cost, high mortality rate13 and post-operative surgical complications.2,5 Indeed,  efforts to promote the appropriateness of such a service provided by orthodontist has sparked vigorous debate and opposing views11,12  which has provided the author with the stimulus  to clarify and improve the Informed Consent, the protocol and the standards for providing the service,15,16,17 as well as conducting research regarding the safety, effectiveness and problems associated with this new service.

 

      The orthodontic approach to jaw wiring was conceived of as a minimally invasive method help alleviate the problem in those cases where it may be applicable to carefully selected individuals15 whose Body Mass Index (BMI) indicates they are overweight or obese as diagnosed by their physician.

The "orthodontic approach" is so called because it makes use of orthodontic attachments bonded to the teeth and the protocol requires the patient to return every five weeks to be rewired, similar to the time period orthodontists typically have their patients return to the office for adjustments. Moreover, in some cases, it can be provided pari passu with orthodontic treatment26 and, finally, because it is possible to segue directly from active orthodontic treatment into retention in conjunction with orthodontic jaw wiring.27

 

     It is obvious that dental professionals have already becoming increasingly cognizant of their role as shown by the advent four yeas ago of a removable appliance called the DDS System and, most recently, a fixed device invented by Jan Renders in conjunction with an orthodontist, Rene Linders, ready for clinical trials in Philadelphia.3,6,7,8,9,10. Moreover,  Jackson University  is undertaking a research project to determine if the orthodontic office is an appropriate venue to address childhood obesity.

     Given that we are the primary caretakers of the mouth and endowed with the skills and a choice of  mechano-therapies to provide services to the overweight, we ought to be actively engaged disseminating information in our offices and providing services to those who seek it.  The public at large should be made aware that we are now ready and prepared to be a part of  the health-care team already serving the overweight heading towards obesity as well as those who have already attained obesity with its attendant co-morbidities. The health-care team includes: weight control hospital clinics, general practice physicians/internists, bariatric surgeons, nurses, registered dieticians and psychotherapeutic counselors.

 

REVIEW OF THE LITERATURE

This subject has never ever been broached before no less by any peer-reviewed articles written by dental professionals.  Moscowitz wrote in an editorial 11.5 that dental professionals  had no place to assist those who were "morbidly" obese (BMI* ≥ 40 e.g., 5'8”, 260 pounds). It should be noted that OJW as proposed by the author was never intended for such a category of obesity. OJW was intended for those who were approaching obesity and were already obese  (BMI,   28.0 - 38.0, e.g., 5'8” 190 pounds).  The morbidly obese  are beyond the help of the dental profession. They have become candidates for bariatric surgery where the mortality rate can reach 3/1000. It is our role to help those who are not as yet morbidly obese who seek our services after having failed at all other weight -control methods and who see OJW as the last  conservative approach before gastric bypass surgery. Moscowitz on the other hand points the while OJW patients might benefit from OJW to "jump start" a diet, regaining the weight is renders it a useless approach. Moreover, "jaw wiring  in already medically compromised obese patients may result in irreversible harm and possibly death. Aspiration of vomitus has always been a real adverse occurrence of any jaw-wiring efforts".  However, there are no reports supporting his claim any where in the dental literature (in particular, the literature published by oral surgeons) of such an occurrence. Moreover, OJW has its own built-in safeguards such as: pre-treatment screening with a comprehensive Informed Consent, and a  list of contraindications that would allow a provider of this service to help him decide to whom he would provide the service. Jerrold  stated, 11.5  "Certainly, obesity is the number one health risk in our society today. and it is increasingly prevalent among the orthodontic patient demographic. For this reason alone, if there is anything that we can do to help address the health issue, we should take part in the treatment process, but only in conjunction with concurrent medical oversight" Attorney Freeman concludes that "with proper informed consent...good screening of OJW candidates, good dentistry  etc, the risk of loss is likely not higher than any other dental procedure. Finally, Rothstein concluded that controlled research project and use of the null hypothesis that OJW has no place has no place in the gamut of treatment modalities to help the obese be initiate.   Toward that end the author has undertaken and extensive survey of patients to whom he provided orthodontic jaw wiring, The null hypothesis of the "study" was orthodontic jaw wiring neither effective or safe.

General conclusions of the literature review: 24

1. Jaw wiring in conjunction with a liquid diet is generally accepted by the medical community as a therapeutically effective method to lose weight.

1.5 Liquid diets are considered to be safe.

2. The only study of jaw wiring on teeth, gums and jaw joints per se shows that this procedure has no permanent harmful effects. 13

2.5 Liquid di

3. Behavior modification that results in maintenance of weight lost is extremely important.32,33

4. There are no studies that have examined the health of the TMJ using a long-term protocol requiring immobilization-rest/exercise and immobilization over a period of time as long as six to nine months as the OJW protocol advocates, viz. five weeks wired followed by five days unwired with jaw exercises, and rewiring again for another five weeks, etc. Research on jaw wiring has been sadly neglected by dentists and orthodontists for lack of a protocol and an Informed Consent, leading to serious concerns about medico-dental and liability issues. I suggest it is time this is remedied.14

5. Dentists and orthodontists are uniquely capable of providing a service that no other professional can deliver as safely, efficiently and competently.28

 

METHOD OF THE STUDY

A invitation to take a seventy-seven question survey was sent to seventy-five former OJW patients who were by and large patients who came for OJW  from out-of-state as a result of searching the web for "jaw wiring. They were accepted as "good candidates" (no compromising health problems) after a review of the Informed Consent, the dental-medical history and the typical orthodontic forms I requested they complete.

 Twenty- three people chose to participate. None were excluded from the study. The concerns of this study included: 1.  INVITATION TO TAKE THE SURVEY   2.  DEMOGRAPHIC QUESTIONS (1-3)  3. BACKGROUND OF PATIENTS (4-21)    4.  SAFETY OF OJW (21-30)  5.  EFFECTIVENESS AND BENEFITS (31-40)    6.  PROBLEMS OF OJW (41-55) 7. CONCLUSIONS (56-73)    8.  MISCELLANEOUS (74-77)   The details of each question and the responses were posted to my website at: http://www.drted.com/Responses to ojw questionnaire survey.htm .

RESULTS

The twenty-three  respondents in this survey came from all over the United States, because there were no other providers for OJW.

The preponderance of patients were females between 24 and 44 years of age 75% of whom reported  were still in OJW and whose average starting weight was 230 pounds approximating a BMI of 36. They or their significant other were instructed how to accomplish the rewiring following the protocol for orthodontic jaw wiring: five weeks wired, five days unwired, then rewired for five more weeks, etc. (low calorie liquid diet approved by their physician/dietician). They reported their present weight as a group to be 193 pounds representing a BMI of 32.7. The reported suffering most often pain and discomfort in  knees and or hips, followed by depression, snoring, sleep apnea and finally, lower back pain. Risk and/or fear of surgery were important in choosing OJW. 85% of them reported it was impossible to find another OJW provider. 70% had been in OJW for less than seven months. 78% indicated that the OJW service was highly valuable and 83% of the sample said it helped them to get better  control of their eating habits. The problems they reported: The inside of my mouth felt unclean. 56% My jaw got stiff. 44% : speech was impaired too much 31%; It was too costly, 31% However their social and sex lives were not impacted to any great extent. 21% reported stiff and or painful jaws, Indeed 21% answered that they "gave up on OJW because the jaw joint become stiff or painful. 84% of respondents  felt they "did NOT make a big mistake by choosing OJW and that it was NOT a waste of time and money.  Surprisingly 84% reported that having to rewire themselves was not a problem. 94.4 % of the respondents indicated that rewiring themselves reported that "I might have continued if an easier method to rewire myself was available" indicating that for most having to rewire themselves was not an issue.  The author is not advocating that OJW patients be encourage to rewire themselves.  Indeed, it is always preferable to have the patient return to be examined and rewired by the OJW provider. Question 58 was considered most important:  Given that vomiting could lead to the inspiration of vomit back into your airway leading to effects ranging from choking to death, please state your position(s) from the list below (17 respondents  reported)  The Informed Consent I filled out told me all I needed to know, (58.8%).   It's possible but highly unlikely, (41.2%).  The risk of death from surgery bothers me more, (23.5%).  You can die from some diet pills as well, (23.5%). I carefully researched that possibility and found no instance of its occurrence, (29.4%).  I was warned of that so I carried my wire clippers with me at all times,(47.1%.   All of the above,  (47.1%). Question 62 was also of interest: Do you believe that OJW gave you a "jump start" with your weight loss efforts? To which 16 of 19 patients responded affirmatively.  The responses to question 63  Why did you choose the OJW method to begin with revealed that   My being overweight was causing me to be depressed (83%).  I felt this approach might help me bring my compulsive overeating under control, (72%). I realized that my excessive weight could have serious health related consequences, (67%)  I was finally able to locate a dental professional who would provide the service, (61%).    I just didn't like the way I looked and previous methods were ineffective for me, (56%).Overall 90% reported that they believe OJW is a useful procedure for carefully selected patients and that "it is the right and responsibility for dental professionals to provide this service to compulsive overeaters" , 84%, and 84% reported that OJW be more available/widespread. In response to question 69, If you did regain the weight you lost did you hold the OJW provider responsible? 90% reported "No".  Finally, in response to: If you did have an experience related to OJW with special attention to nausea, vomiting or choking please comment here: All respondents except four offered no response to this question. The four who did said "not applicable".

 

FLAWS OF THE STUDY

1. small sample and bias of the respondents. Perhaps those who did not respond did not because their responses would have been unfavorable.  

 

  DISCUSSION AND CONCLUSIONS

   Herein, it is hoped that dental professionals will consider OJW as a service that can improve the lives of some of their patients; indeed, even as far as saving a life that might have been lost as a result of surgery itself. If there is a safer and more effective way we can help combat the obesity epidemic, surely we should not withhold our expertise in achieving such a meritorious goal.

 

    Since we will be working with physicians to help the overweight and obese (and even upon rare occasion, the morbidly obese when they are referred to us by the bariatric surgeon for pre-surgical preparation), we must inform these members of the health-care team that members of the dental profession  are able and willing to provide this ancillary service just as we did for those suffering from snoring sleep apnea. Otherwise, how will they know we are part of the health-care team providing services to the overweight and obese?18

     Experience  providing OJW since 1998 to 85 patients has supported that it is safe and effective using the protocols presented gratis. Members are invited to peruse in-depth protocol for OJW at drted.com (OJW-DPOJW free course) .14

     Dentists, as part of a health-care team, are uniquely empowered to help those who are obese or are reluctantly heading towards it as diagnosed by a physician.28 My advice to dental practitioners is to offer OJW, but choose patients with due diligence and follow the OJW protocol. Strive to educate the detractors and inform the non-dental medical community that we dental professionals are disposed to provide our expertise to carefully chosen overweight and obese patients with tendencies to compulsive overeating.

     I have provided OJW for many patients without incident and with great success depending on how success is defined. If it is measured by whether the patient achieved permanent behavior modification regarding eating and exercise habits, I cannot say assuredly that OJW was a success. However, if it is measured by gratitude expressed and weight loss reported, the service was indeed successful.18
    . OJW providers are responsible for the maintenance of the health of the TMJ, dentition and gingiva.

     I have proposed the formation of a research arm under the 501c3 not-for profit corporate status that would seek funds to carry out research in the domain of the subject of orthodontic jaw wiring beginning with 14  OJW and behavior modification as well as post-OJW effects on the TMJ.

     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 a diagnosis of the patient’s physician, the leaders of the AAO and ADA will be obliged to clearly define the dental professional’s role providing this service just as they did when problems of snoring and sleep apnea first came to the attention of dental professionals, and the AAO responded in 2004 by clarifying the conditions under which clinicians who provided the service would be covered by the AAOIC.  OJW patients will applaud and praise your effort to help them; they will not begrudge you if they regain the weight post-treatment, 30  a problem encountered with every weight- loss method without exception.

     Today more than ever it is urgent that we as orthodontists examine our role in providing this service to those who meet the criteria. "We must do what we conceive to be the right thing and not bother our heads or burden our souls with whether we will be successful. Because if we don't do the right thing, we will be doing the wrong thing and we will just be a part of the disease and not a part of the cure." -- E. F. Schumacher 

 


 

 

REFERENCES

Citations in the reference list should follow this basic style:
  • Periodical
    1. Lauterbach M, Martins IP, Castro-Caldas A, et al. Neurological outcomes in children with and without amalgam-related mercury exposure: seven years of longitudinal observations in a randomized trial. JADA 2008;139(2):138-145.

     
  • Book
    2. Cohen S, Burns RC. Pathways of the pulp. 8th ed. St. Louis: Mosby; 2002:196.

     
  • Book chapter
    3. Byrne BE, Tibbetts LS. Conscious sedation and agents for the control of anxiety. In: Ciancio SG, ed. ADA Guide to Dental Therapeutics. 3rd ed. Chicago: American Dental Association; 2003:17-53.

     
  • Government publication
    4. Medicine for the public: Women’s health research. Bethesda, Md.: U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health; 2001. DHHS publication 02-4971.

     
  • World Wide Web site
    5. Hoffman ED, Klees BS, Curtis CA. Brief summaries of Medicare & Medicaid: Title XVIII and Title XIX of the Social Security Act as of November 1, 2007. Baltimore, Md.: U.S. Department of Health and Human Services, Center for Medicare & Medicaid Services, Office of the Actuary; 2007. “http://www.cms.hhs.gov/
    MedicareProgramRatesStats/downloads/MedicareMedicaidSummaries2007.pdf”. Accessed Aug. 28, 2008.

     
  • Publication in press
    6. McCoy J. Alteration in periodontal status as an indicator of general health. JADA (in press). NOTE: Authors should double-check the status of any in-press work cited in their reference lists before submitting the final manuscript to JADA.

     
  • Presentation
    7. Eichenstadt L, Brenner T. Caries levels among low-income children: report of a three-year study. Paper presented at: 146th Annual Session of the American Dental Association; Oct. 7, 2005; Philadelphia.

 

1. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report First guidelines developed by the Federal Government to address overweight and obesity-conditions that affect an estimated 97 million Americans and are the second leading cause of preventable death in the United States  http://www.nhlbi.nih.gov/guidelines/obesity/ob_gdlns.htm, NHLBI produced publications  228 pp. 1998.

 

2. Freudenheim  L, Other perils of overweight. New York Times, 2005: May 27. C1.

 

3. Davidson TM, The role of the dental professional in the diagnosis and treatment of Sleep-disordered breathing. Dentistry Today, 2005; September, p.118.

 

4. Freking K, Obesity rates climbing. Amhealth.  2005; p. 24, August 24.

 

5. Kolata G,  Grady D, Weight-loss field awaits change in Medicare policy. New York  Times, 2004; July 18 http://drted.com/OJW insurance coverage.htm

5.5 Young-soo,  S,  Regional Director of the World Health  Organization  MANILA, 2 February 2009  http://www.wpro.who.int/health_topics/obesity/

6. Loyd L,  Fighting against obesity one bite at a time. The Philadelphia Inquirer, 2007; Sept. 17, Business Section D5. .

 

7. Malmache L, Help your patients eat less! Dental Economics, August 2004 in “columns.” (re the DDS System).

 

8. Saib Bilal. Dental Weight Center of North Carolina: Introducing the newer, kinder
and more humane alternative to weight loss surgeries. Jaw wiring for weight loss.
    http://www.dentalweightloss.com/entry.html. 2006.

 

9. Renders J, et al. United States patent #6,138,679, A method suitable for influencing the ingestion of food by humans via the mouth cavity. October 31,  2000.

 

10. Florman MJ, Oral appliance and method for use in weight loss and control. Application for a utility patent submitted to the USPTO 2003: April 24. Application subsequently abandoned.

 

11. Piehler C, Orthodontic Jaw Wiring: A Roundtable on a controversial weight-loss procedure. Orthodontic Products Magazine, February, 2005, p. 36-38. (Participants: Elliot Moscowitz, Larry Jerrold and attorney Jay Freeman                                     See also: http://www.drted.com/OJW Roundtable article OPM PDF.pdf

11.5.  Moskowitz E,. The Limits of  Dentistry editorial,"  70 #9, p.3  NYS Dental Journal, December 2004.

published in the  issue of the

12. Rothstein T, http://www.drted.com/index.html.bak2/Jaw wiring pros and cons.htm. 2002, January 5.

12 5 Rothstein T, The Safety and Effectiveness of, and the Problems Associated with, OJW--a weight-control method,  published online January, 2009 http://www.drted.com/ojw_questionnaire_survey.htm

13. Rogers S, et al. Jaw wiring in treatment of obesity. The Lancet, p. 1221, 1977; June 11. p. 1221.

 

14. Rothstein T,  Dentist Providers of Orthodontic Jaw Wiring: a would be 5013c organization for research and furtherance of knowledge regarding jaw wiring for weight control/loss.  http://www.drted.com/OJW DPOJW Course.htm

 

15. Rothstein T,. The Informed Consent for OJW (English version). http://www.drted.com/index.html.bak2/Jaw wiring Informed Cconsent.htm;  last modification January 2009.

 

16. Rothstein T,  http://www.drted.com/OJW protocol report responses.html  2003; September 22.

 

17. Rothstein T,  The principles, guidelines and standards for providing the OJW service for patients who are medically cleared to begin a liquid diet and have chosen OJW as an aid to treat the medical problem of overweight and obesity resulting from compulsive overeating  http://www.drted.com/Jaw wiring principles for providers.html 2006; July 8.

 

18. Rothstein T, What is success when it comes to weight loss? http://www.drted.com/OJW Julie to Robin.html

 

19. Rothstein T, A letter sent to 20 bariatric surgeons indicating the consideration of OJW as a viable antecedent to the surgical alternative of gastric surgery.  http://www.drted.com/DPOJW note Bariatric Surgeons.html  2004: mid August.

 

20. Rothstein T, Documentation of the use of self-ligating attachments to increase the intermaxillary distance the jaws can be wired apart. http://www.drted.com/OJW using self ligating brackets.htm  2007; September 22.

 

21. Lawney M. Direct quote in response to the question: Is jaw wiring within the scope of the work of the dental professional.   http://www.drted.com/OJW The question.html

2004: October 14. 

 

22. Shephard  BC, Townsend G.C., Goss, A.N. The oral effects of prolonged intermaxillary fixation by interdental eyelet wiring.  Int. J Oral Surg,1982 Oct;11(5):292-8.

 

23. Rothstein T, United States utility patent application #11/534, 225, Orthodontic Jaw wiring, a fixed intra-oral device and method to limit jaw opening, thereby preventing ingestion of solid food. 2007: September, 22.

 

24. Rothstein T, All the literature on the subject related to jaw wiring. http://www.drted.com/index.html.bak2/Jaw wiring for weight loss literature references.htm  last revised 2007; June 24.

 

25. Rothstein T, The protocol for providing OJW. http://www.drted.com/ojw_protocol.htm.last revised 2007; June 7.

 

26. Rothstein T, The first attempt at combing OJW and orthodontic treatment simultaneously.  http://www.drted.com/Iris Pierre OJW n Ortho.htm   June 2007.

 

27. Rothstein T, Orthodontic Jaw Wiring.  http://www.drted.com/index.html.bak2/jaw_wiring.htm,  Feb 18, 1999.

 

28. Rothstein, T, A letter to orthodontic colleagues summarizing the rational for embracing the concept that is the right and responsibility of dental professionals to embrace efforts to help the overweight on their way toward obesity.  http://www.drted.com/OJW protocol report.htm   September  22, 2003.

 

29. Rothstein T, Transitioning from active treatment to Class III retention with OJW: A table clinic presented to the AAO in Las Vegas, NE 2007; May 6.                                       http://www.drted.com/OJW AAO Table Clinic 2006.html

 

30. Garrow JS, Gardiner, GT. Maintenance of weight loss in obese patients after jaw wiring. Br Med J (Clin Res Ed) 1981 Mar. 14; 282(6267):858-60.

 

31. Brody  JE, Study finds a liquid diet works (but not for the 50% who quit it.  New York Times Science Section, 1992: May15. http://www.drted.com/Liquid diet Brody article.html

 

32. Wansink B Mindless eating. Bantam, 2007.

 

33. Wansink B. Mindless Eating Secrets and Stories web site: www.MindLessEeating.org


 
 

 

Ted Rothstein, DDS, PhD

Cosmetic Orthodontist for Adults and Children

American Association of Orthodontists

Founder DPOJW www.drted.com/DPOJW.html

35 Remsen St.,  Brooklyn, NY 11201

(718) 852-1551    Fx (718) 852-1894
drted35@aol.com     www.drted.com

 

Word Count: 2250 (introductions main text and conclusion)

Figures: Four figures each consisting of 2 photos.

    Fig. 1a, 1b:  The original conception of OJW

    Fig. 2a, 2b:  OJW with cosmetic and functional enhancements on a female patient started August 8, 2007 having a BMI of 36 attended by chronic adult thumb sucking

    Fig 3a, 3b: showing use of self-ligating brackets to extend the range of apartness of the jaws

    Fig. 4a, 4b: Model demonstrating use of SmartClip brackets with OJW and the range of inter-maxillary apartness achievable

 

Fig, 1a. Left: Brackets are typically bonded on the canines and premolars on both sides
Fig. 1b. Right:
Jaws are methodically wired apart (not obvious in this photo) to
allow 2.0mm-4.0mm or more of mandibular movement in all excursions.

Fig. 2a and 2b.. August 8, 2007, the case of MM: BMI 36; attended by an adult thumb sucking habit of 33 years.
Note: Both right and left sides are wire to create an equally balanced feeling.
When a patient is wired correctly the upper and lower teeth do not touch. This position is named the
OJW position of physiologic rest***
. Here I have used .012” dead-soft stainless steel wire to suspend
 the lower jaw from the upper jaw allowing the lower jaw to move 1.5-2.0 mm in all directions
(extendable to 4.0 mm for patient comfort on demand). Note also the use of clear attachments on the
upper canines for cosmetic enhancement.

Fig 3a. Left and 3b. Right side of teeth demonstrating on a 3M-Unitek model of SmartClip® braces how self-ligating braces are used as the attachments in the OJW system of weight control. Use of these brackets extends how far apart the jaws can be wired, thus providing the patient more comfort on demand. See Fig 4b.

 

Fig 4a Left and 4b. right, A 3M-Unitek SmartClip model demonstrating use of SmartClip brackets with OJW and the range of inter-maxillary apartness achievable pari passu with orthodontic treatment.

* * To calculate your body mass index BMI, follow these four steps:
Measure your height in inches (without shoes) and your weight in pounds (without clothing). Multiply your weight by 703.    2 Divide that number by your height.    Divide again by your height.
These categories were established after several studies examined the BMIs of millions of people and correlated them with rates of illness and death. The studies showed that the BMI range associated with the lowest rate of illness and death is approximately 19–25 in men and 18–25 in women, so people with BMIs in this healthiest range are considered to be of normal weight. Higher BMIs are associated with progressively higher rates of illness and death. People with BMIs of 25–30 are considered overweight, and those with BMIs of 30 or higher are considered obese. Obesity has recently been further subdivided into mild (BMI of 30–35), moderate (35–40) and severe (BMI of 40 and above). Severe obesity is roughly equivalent to being 80 pounds overweight if you are a woman or 100 pounds if you are a man.  Or go to
http://www.nhlbisupport.com/bmi    

**
Fig 1a. Left photograph:
Brackets are typically bonded on the canines and premolars on both sides.

Fig 1b. Right photograph: Jaws are methodically wired apart (not obvious in this photo) to allow 1.5-2.0 mm or more of mandibular movement in all excursions.

Fig 2. August 8, 2007, the case of M.M 33 y/o female with: BMI 36; attended by an adult chronic thumb-sucking habit. Note: Both right and left sides are wired to create an equally balanced feeling. When a patient is wired correctly the upper and lower teeth do not touch. This position is named  the "OJW position of physiologic rest”. Here I have used .012” dead-soft stainless steel wire to suspend the lower jaw from the upper jaw allowing the lower jaw to move 1.5-2.0 mm in all directions (extendable to 4.0+ mm for patient comfort on demand). Note also the use of clear attachments on the upper canines for cosmetic enhancement.

Fig 3. Left side and right side of teeth demonstrating on a 3M-Unitek model of SmartClip® braces how self-ligating braces are used as the attachments in the OJW system of weight control. Use of these brackets extends how far apart the jaws can be wired, thus providing the patient more comfort on demand See Fig 4b.20

Fig 4a and 4b. 3M-Unitek SmartClip model demonstrating use of SmartClip brackets with OJW and the range of inter-maxillary apartness achievable pari passu with orthodontic treatment.

 

***"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. Interocclusal wiring allows the mandible to move  2.0mm- 4.0mm laterally, vertically and antero-posteriorly  thereby minimally impeding speech and minimizing the possibility of temporo-mandibular joint (TMJ) stiffening. This position is often congruent with an observable interocclusal space of 2.mm to 4.0mm 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).
 
 
 

 

Ted Rothstein, DDS, PhD  
Specialist in Cosmetic Orthodontics for Adults and Children
Specialist in Orthodontic Jaw Wiring
BCAT 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 Dr. Turpin,

I am disturbed by your blatant bias against the subject matter I wish to resubmit for review by my peers. The three previous jurors all agreed the article was written well and addressed an issue that has bearing on the orthodontic patient demographic if not 34% of the entire United States population. 

Indeed all of their previous criticisms have been addressed including the need for substantiation with appropriate research which has now been placed in to the manuscript.

 My  subject matter is unique and pertinent to the dental profession and the orthodontic profession in particular. It is directly related to the work we orthodontists can do and do well.

The facts show that you have accepted articles for publication on treatment of problems related to sleep apnea and the use of injectable Botox which are "medical problems".  I would like you to reconsider the position you stated in your letter below and allow me to submit my article for peer review. Let the jury decide.

My work has a rightful place in the AJODO and nowhere else to begin with.

Yours truly, Dr. Ted Rothstein

In a message dated 1/27/2009 8:26:38 P.M. Eastern Standard Time, ckburke@aol.com writes:

Journal title: American Journal of Orthodontics & Dentofacial Orthopedics
Corresponding author: Dr. Ted Rothstein
Article title: Orthodontic Jaw Wiring (OJW): The Dental Professional's Role in Weight Control for Compulsive Overeating Leading to Obesity
Manuscript number: AJODO-D-07-00600

Dear Dr. Ted Rothstein,

Thank you for writing to the AJODO regarding the resubmission of your article.

It's been over a year since you first submitted the article, and I'm afraid that in that time, some things have changed. First, our backlog of articles has continued to grow. I am cutting back on the number of articles I accept; we need  to be publishing articles in under a year, not nearly two years, as we are now. Second, attorneys have pointed out to me that this is a medical problem, not an orthodontic one. Although the treatment you propose does involve the teeth, perhaps a medical journal would deliver a more interested audience.

Given these two factors, I would like to encourage you to submit your article to a different journal -- a medical journal, perhaps one that focuses on weight loss.

Regarding the citations you  mentioned, you might want to check with the journal you do submit to. Journals with an impact factor might not allow citations of website material. Although we do allow them in the AJODO, I don't encourage them because the material is not peer reviewed.

With kind regards,

David L. Turpin
Editor-in-Chief
American Journal of Orthodontics & Dentofacial Orthopedics
 

Attention: Dr. David L. Turpin, DDS, MSD,
Editor-in Chief American Journal of Orthodontics and Dentofacial Orthopedics
University of Washington

Department of Orthodontics,, D-569
HSC Box 357446
Seattle, WA 98195-7446

(206) 221-5413; fax (206) 221-5467    email dlturpin@aol.com
ckburke@aol.com
References:

www.elsevier.com
AJO-DO editorial manager website ees.elsevier.com/ajodo
www.icmje.org

Ms. Ref. No.:  AJODO-D-07-00600
Title: Orthodontic Jaw Wiring (OJW): The Dental Professional's Role in Weight Control for Compulsive Overeating Leading to Obesity
American Journal of Orthodontics & Dentofacial Orthopedics

 

In preparing this  manuscript  it was necessary to cite work which  appears only as hyperlinks to my own web site drted.com prompting me  to inquire of thepublisher the publishing rules  regarding hyperlinks to or on websites, to which the publisher of the AJO-DO replied:.."I don't encourage them because the material is not peer reviewed."  See the letter  and my response charging blatant bias against the subject matter for denying me permission to resubmit my manuscript now including the results of the study on the subject.

 

Transitioning from active treatment to Class III retention with OJW: A table clinic presented to the AAO NE 2007; May 6  . 2009-02-10. URL:http://www.drted.com/OJW AAO Table Clinic 2006.html. Accessed: 2009-02-10. (Archived by WebCite® at http://www.webcitation.org/5eUAhfhwK)

 http://www.drted.com/Liquid diet Brody article.html