Back to Part I Dr. Ted's Home Page Site Additions Orthodontic Jaw Wiring
Part II/IV Selection of patients
Overweight / Obesity is defined by the “Body Mass Index” (BMI). A person with a BMI of 25.00-25.99 is considered overweight. A person with a BMI≥30.00 is categorized as being obese. Candidates for bariatric surgery have a BMI of ≥40. Those whose BMI is between 35 and 40 would fall into a "halfway" category in which they might still choose OJW. The Informed Consent for OJW will give you an excellent profile of the patient's suitability to be an OJW patient. The answers to the questions in red will either make you feel at ease about selecting the person or rejecting their candidacy as an OJW patient. It should be analyzed in conjunction with the their medical-dental history form and their acquaintance form information. Any omission of information should alert you to the need to complete due diligence more so if the would-be OJW patient fails to provide the name of their dentist or physician and/or does not give you permission to contact them your suspicion might be aroused.
CALCULATE YOUR BMI NOW: http://nhlbisupport.com/bmi/bmicalc.htm
Let me tell you about the typical OJW patient: Seventy-five percent of OJW patients are female between the ages of 25 and 35. They eat compulsively and are unhappy about their inability to control their appetites. They are overweight to an alarming extent, generally 45-90 pounds beyond the healthy range for their height and body type, often meeting the clinical definition of obese; i.e., a body mass index (BMI) above 30 as would occur, for example, in a woman who is 5’5” and weighs more than 180 pounds, or a 6-foot man weighing more than 221 pounds. However, they are searching for a solution to relieve the anxiety and guilt each time they feel compelled to satisfy their need for oral fulfillment.
FACTORS RELATED TO HOW MANY CALORIES A PERSON NEEDS DAILY: [CLICK HERE] [OR HERE]
CALCULATOR TO COMPUTE THE NUMBER OF CALORIES MALES NEED: [Calorie Calculator Males]
CALCULATOR TO COMPUTE THE NUMBER OF CALORIES FEMALES NEED: [Calorie Calculator Females]
The major factors that are input into the computation are: Height, Weight, Age, Level of activity.
Question: Who is not a good
candidate for OJW?
Answer: Your mouth has many functions both obvious (talking) and not so obvious
(sneezing) and is therefore the source of many pleasurable activities. The loss
of any of them may provoke anxiety. Therefore, one should think carefully about
undertaking this method of weight control. A partial list of poor candidates for
OJW would include:
a. Persons who need
to floss their teeth due to gum problems or other compulsive reasons.
b. Persons who speak abundantly for business or other reasons whose speech might
be rendered less than perfectly clear because of being wired closed.
c. Persons whose sex life would be rendered intolerable if intimate oral
functions were impaired… even a little.
d. Persons with
multiple-missing, loose or decayed teeth
e. Those with psychological or emotional disorders who might feel powerless/
panicky with their mouths wired closed.
f. Those whose work functions might be impaired such as an actor, singer,
waiter, teacher etc.
g. Persons with systemic diseases such as diabetics whose diets could not
accommodate a liquid diet.
h. Persons who
cannot breathe through their nose and whose breathing might be compromised by
being held continuously in a closed bite teeth position.
i. Those who are highly allergic are more at risk.
j. Persons who have respiratory ailments such as snoring and/or sleep apnea as
well as those who must use a broncho-dilator spray such as asthmatics.
k. Persons who have a history of Temporo-Mandibular Joint dysfunction (TMJ).
l. Persons who are
taking oral pill/capsule form medications could encounter some difficulties
trying to pass a large capsule into the mouth behind the last teeth. It would be
virtually impossible if the wisdom teeth were fully in place.
m. Persons who compulsively clench/brux/gnash their teeth.
n. Persons who have, or are suspected of having, anorexia or bulimia to begin
with.
o. Persons with frank unresolved periodontal (gum-tooth socket) problems.
p. Persons who
drink alcoholic beverages excessively. In the event of alcoholic intoxication,
vomiting can occur.
(Alcohol suppresses the gag reflex, vomiting can lead to aspiration of vomitus).
q. Persons who 1. will not provide a telephone number 2. do not have an Email
address. 3. below the age of 21 unless accompanied by a parent. 4. are MORE than
110 pounds overweight or LESS than 25 pounds overweight (i.e. moderately obese
and obese, but not "morbidly" obese).
DUE DILIGENCE IN THE SELECTION OF PATIENTS: "THE CHAT"
Dental professionals who have chosen to provide OJW for weight control must do due diligence when selecting the patients to whom they provide this service. Failure to choose patients with care can spell the difference between successful weight loss (patient achieves their weight-loss goal) and early termination of the OJW.
Here is how I go about doing "due diligence"
DUE DILIGENCE IN SELECTING OJW PATIENTS
THREE DOCUMENTS AND A CHAT ON THE TELEPHONE
DUE DILIGENCE BEGINS WITH THREE DOCUMENTS
Dental professionals who have chosen to provide OJW for weight control must do due diligence when selecting the patients to whom they provide this service. Failure to choose patients with care can spell the difference between successful weight loss (patient achieves their weight-loss goal) and early termination of the OJW.
Only after I have received all the three documents listed below do I call the would-be OJW patients to "chat" with them. I believe it is a good policy to let them know they are suitable candidates for OJW during or soon after your chat.(See below some of the items you should cover in this chat.)
The chat for me is vitally important because most of my patients come from out-of-state and the OJW appointment is the first and only time I will see them. I do not want to have any surprises when the patient appears in 3-D.
The objectives are to choose patients who indicate they are strongly motivated, who are healthy but overweight and even anxious or depressed about their loss of control over eating. These patients are therefore highly likely to endure any "trials and tribulations" they might encounter during the time period they elect to "dedicate themselves passionately" to this mode of weight loss.
You should remember these patients have tried many methods of weight loss. They have rejected medications that promise weight loss and are have a natural fear of surgical invasion. Who wouldn't?
You can expect a higher degree of success and patient happiness if you have chosen your patients carefully. Not all patients succeed with OJW. Some of those who do lose weight will regain it. However, I assure you they will never hold you responsible for that.
Here is some good advice. Candidate selection should be based on a diligent reading of three documents: The Informed Consent: (Are all questions completed to your satisfaction and is it signed in all four places requested. Do you have permission to call the patients dentist and the physician).
The second document is their Dental-Medical questionnaire. It is preferable to do OJW on patients who do not already have medical problems. However, if they do have medical problems you would surely want to know what they are. You should pay special attention to patients who present with gastro-intestinal issues since OJW requires the patient to be on a long-term, low calorie liquid diet. For this reason it mandatory that I ask the patient to provide me with a note from their physician stating that "the patient is permitted to begin a long-term, low calorie liquid diet". In effect the physician has done the diagnoses of obesity for you. Indeed, dental professionals may not diagnose obesity,
The third document I use is what I call my Orthodontic Acquaintance form. This is the form all my Orthodontic patients must complete. (Basic demographic info, referral source, occupation, payment method).
THE CHAT
The chat follows after you have received and reviewed all three documents requested.
It is strongly advised that you do not provide the OJW service until you have received a note from the patent's physician to begin a long-term, low-calorie liquid diet).
The chat helps you to establish a rapport with the patient and helps you to decide if they are temperamentally suited to this procedure. You should begin this chat having clearly in your mind the patient’s state of origin, age, height, weight and BMI, and how many months they have indicated they will dedicate passionately to OJW. The most desirable candidate would say "Until I reach my goal weight".
Here are the items of interest I check off as I chat with the patient:
Whether they have the canines and the premolars and whether they are natural or prosthetic.
Whether they are wearing any removable prosthetic devices.
Whether they can move their jaws easily to the right and left and can open their mouth vertically at least three fingers comfortably.
Whether they had braces and if teeth were removed and which teeth.
Whether they have any problems with their bite.
You will remind them about the 5 weeks wired and 5 days with wire removed protocol they are expected to follow and their adherence to a liquid diet under 1000 calories even when the wires are removed.
You will remind them of the need to carry a small wire cutter with them at all times.
You will remind them the best wiring is three brackets to three brackets but never less than two brackets to two brackets.
You will remind them that if brackets detach it is best to have them re-bonded as soon as possible and that few, if any, dental professional will rewire them.
Your due diligence is completed.
At the OJW appointment you, or a staff member, will review the points that are most important using the “OJW prior to placement reminders” notice I have prepared.
Cordially, Dr.Ted Rothstein
12/04/10
Ted
Rothstein, DDS,
PhD
Specialist in Cosmetic Orthodontics
and Dentofacial Orthopedics
Adults and Children
Specialist in Orthodontic Jaw Wiring
American Association of Orthodontists
Life-active Member
35 Remsen St., Bklyn, NY 11201
718 852 1551 Fx 718 852 1894
www.drted.com drted35@aol.com