Back to part II Dr. Ted's Home Page Site Additions Orthodontic Jaw Wiring
Part III/IV The OJW appointment
A. Greeting and Exam:
I reserve Thursday after my last orthodontic patient for OJW appointments. I schedule the patient to arrive at least one hour before the time I expect to do the wiring (12:30-1:00). You and you staff should be keenly aware of the need to welcome the OJW patient and put them at ease. Your patient's dossier should now include a signed: Informed Consent, Medical-Dental history form, an office acquaintance form and an OJW Telephone Memo. You should also have a note from the patient's primary healthcare provider indicating that that "there are no medical reasons why the patient can not begin a low-calorie liquid diet". To this will be added the OJW reminders to patient form. This document will spare you and the patient the bothersome task of reminding the OJW patient the essential elements of the work your are doing for them in their courageous attempts to regain control of their compulsive overeating and hopefully to help them modify their behavior forever. I think the best time to give then the form is after they have settled themselves and feel relaxed.
Exam: I examine my OJW patients as if they were Orthodontic patients. I pay particular attention to the TMJ making sure to note any clicking, crepitus and deviations from normal movement. I listen for joint sounds with a stethescope. I record my findings and report them to the patient.
Records: Occasionally I take a panoramic X-ray.
Note: Completing due diligence for some providers may entail calling not only the patient's physician, but the patient's dentist as well. THE PURPOSE OF COMPLETING DUE DILIGENCE IS TO ILLUMINATE ANY POSSIBILITY THAT THE PATIENT HAS A PROBLEM/CONDITION WHICH MIGHT BE EXACERBATED BY OJW.
B. Wiring the jaw in The OJW position of rest
normal range/envelope of motion of the lower jaw:
in Protrusive: 6-8mm]
envelope of motion in OJW: Rothstein's OJW position of rest:
Vertically: Most often 2.0mm, extendable to 4.0 on demand.
Laterally: 1.5-2.5mm, extendable to 2.5mm-4.5mm
in Protrusive: 2.5, extendable to 4.4mm] These three hyperlinks all go
link to one location:
TEMPOROMANDIBULAR JOINT DISEASE AND TREATMENT, an ADA publication click here
Bonding the brackets:
Hyperlink to bonding the brackets
Placing the Wiring:
Pictorial documentation of the jaw wiring sequence.
See revised method of wiring jaws to allow any degree of separation desired.
The position at which the jaws are wired together is called :
"Rothstein's OJW Position of Rest"
A simplified view is shown at: [click here].
C. Teaching the patient and/or the patient's significant other how to do the rewiring:
My experience has been that most patients have come great distances to have me do the OJW. Consequently, it is a foregone conclusion that until OJW becomes generally accepted in the dental community they will not find another provider to rewire them. (Detached brackets are not a problem since any orthodontist will rebond a bracket.) Consequently, when I am certain a patient will not be returning to my office to be rewired I teach them, or their significant other, how to wire themselves in "Rothstein’s OJW rest position"© To accomplish instruction in wiring/rewiring I begin by wiring them slowly enough so they can follow along. I have three other teaching tools:
The First: Is the simplified diagram of the wiring [click here]. I explain to them how the brackets can be thought of as a straight line of brackets #1 being UR5 and #6 being LR3. I explain how the 8"-9" wire is initially placed around the UR5 (#1) and the top strand of the wire then wraps around the #2, the #3 and finally the #6 bracket. Then I show them how the bottom half of the wire wraps round the #4, the #5 and finally the #6 to meet the top half. I teach them to grab the two ends twist them and grab them with the Mathieu needle holder about 1/4" from the LR3 and twist the wire 5-7 turns at which time the wire will have brought the teeth into the "Rothstein’s OJW rest position"©. The patient will always feed back verbally info regarding their comfort. In addition they are instructed to rewire themselves if the feel their teeth are touching, especially so if any of the teeth are becoming sensitive.
The Second: Is a device I created is called the "Rothstein's OJW trainer": You can see it at
My assistant teaches the significant other while I am placing the OJW or shows the patient before or after I place the brackets and wiring.
The Third: Is a simplified version of the "trainer" that can be made by the patient to practice at home. A template is provided for constructing the home version of the "Rothstein's OJW trainer" [See the simplified home version of the "ROJWT"]
1. The "Reminders to the patient" form: This form must be signed by the patient and copied. One copy is given to the patient and the other is kept in the patient's dossier.
See the document: OJW reminders to patient
D. Financial matters:
The initial payment $685 (non refundable paid in advance prior to the OJW visit) is the fee paid for reserving the appointment time for the OJW. If the fee is not paid at least 24-48 hours in advance of the time the OJW appointment is cancelled by telephone. If the patient breaks the appointment but has paid the initial fee I am willing to give them another OJW appointment without making another initial appointment reservation fee. At the OJW appointment the balance of the fee is paid in full.
E. Charting the patient's visit: Medical records.
Hyperlink to a typical first visit entry.
F. Advice offered by other OJW patients regarding exercising and losing weight on a liquid diet should be made available to successive OJW patients. You can see the remarkable letter an OJW patient who took the time to write a letter.
the letter of advice
G. A kit of important documents and instruments including a wire clipper and a fork.
See The front cover of my guide book for OJW patients:
Part IV/IV: Post OJW examinations and removal.