Back to Intro page Dr. Ted's Home Page Site Additions Orthodontic Jaw Wiring
Prologue to OJW DPOJW Course: Legal and Liability Issues
Why OJW has now become a viable and desirable treatment option:
Until now, Medicare has paid for weight-loss surgery, for example, only if it was intended to treat a condition like diabetes that arose from obesity.
Dr. McClellan of Medicare said he was expecting a deluge of requests that Medicare pay for treatments like surgery, diets, behavioral therapy and exercise therapy. The agency does not pay for drug treatments.
An estimated 18 percent of the Medicare population meets the official definition of obese - a body mass index above 30, as would occur, for example, in a woman who was 5-foot-5 and weighed more than 180 pounds or a 6-foot man weighing more than 221 pounds. With weight-loss surgery costing $30,000 to $40,000 if there are no complications, the cost to Medicare of obesity treatments could be astronomical. But that depends on whether the agency decides what obesity treatments are effective. And that, in turn, depends on what constitutes effectiveness.
"We do need to get input," on those questions. (Note from Dr. Ted: OJW is a safe and effective modality of treatment that will without doubt help some obese from ever reaching the BMI that that necessitates the need of bariatric surgery. If OJW becomes popular it could put a severe crimp on the bariatric surgeon's lucrative grasp on the obese.) Read the article in the NY Times
Members of the dental profession can make a difference by providing the service. Institutes of higher learning can make a difference by doing the necessary research that shows dentistry and Medicare Medicaid that OJW is a beneficial service. When that happens private insurers will follow in the path of M-M as they always do and OJW will eventually receive its own CPT/CDT number and dentists will no longer have to think twice about not only offering the service, but feeling comfortable that they are covered by their insurance policies when they do. As of now only the bold among us have the courage to offer the service since both the ADA and the AAO seem to lack vision of the horizon.
Following is a direct quote provided by Dr. Milton Lawney, the Executive Secretary of the State Board of Dentistry, given to Dr. Rothstein on Thursday, October 14, 2004 in answer to the question:
Is Orthodontic Jaw Wiring a service within the scope of dentistry?
"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
“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.
Moreover, Jaw Wiring for weight loss is not new: Oral surgeons have been doing it since it was first noticed that when they wired their patients closed to facilitate healing in trauma or pathology cases and placed the patients on a liquid diet the patients lost weight.
Safety and effectiveness of jaw wiring:
http://WWW.DRTED.COM/index.html.bak2/Jaw wiring for weight loss literature
General Conclusions of the Literature Review:
1. Jaw wiring is generally accepted by the medical community as a therapeutically effective method to lose weight.
2. The only study of jaw wiring on teeth, gums and jaw joints per se shows that this procedure has no permanent harmful effects.
3. Behavior modification that results in maintenance of weight lost is extremely important.
4. There are no studies specifically aimed at the harmful effects on the temporo-mandibular joint of a long-term "immobilization-release/exercise -immobilization" protocol as utilized by Dr. Rothstein.
5. Research on jaw wiring has been sadly neglected by dentists and orthodontists for lack of a protocol and an Informed Consent leading to serious concern about medico-dental and liability issues. The protocol and Informed consent for the OJW service has now been provided by me. It is time for the research arm of our profession to validate what is I have shown to be the case that OJW is SAFE AND EFFECTIVE.
Dentists and orthodontists are uniquely capable to provide a service that no other professional can deliver as safely, gently and competently.
In a recent survey I conducted, I spoke with 15 oral surgeons comprising a total of 275 years practicing experience to inquire what their experience was in wiring jaws as a modality of treatment for patients with broken jaws and other pathologies. Not one of them could recount any morbidity/mortality related to the experience other than typical problems that accompany wiring*. Death from aspiration of vomitus was unheard of among the group I sampled. Consequently, I believe that OJW is relatively safe when the strict protocol I have created for OJW is followed. Indeed, my experiences with more than fifty cases, (except for one) not a single untoward event occurred. In the single exception that did occur the patient failed to heed the instructions to unwire herself for a period of three months in spite of being warned that her jaw might become stiff. When she finally did unwire she was unable to open her jaws more than two fingers rather than the three fingers we consider typical. It took about 10 days for her to return to normal opening.
The issue of effectiveness of OJW is another major controversial issue, and one question is how to define success. Obese people want to look thinner. But academic obesity programs, said Dr. Gary Foster, the clinical director of the Weight and Eating Disorder program at the University of Pennsylvania, defines success as losing 5 to 10 percent of your weight. That, he says, is the amount of weight loss needed to improve blood pressure, blood glucose levels and cholesterol levels. People may still be fat, but healthier.
* OJW is totally unlike the IMF (InterMaxillary Fixation) that oral surgeons do because they wire the jaws in such a way as to effectuate occlusal contact of the upper and lower teeth unlike OJW where the lower jaw is wired to the upper in a "suspension" like fashion.
REGAINING OF WEIGHT SHOULD NEVER BE THE SOLE CRITERIA OF THE EFFECTIVENESS OF A WEIGHT CONTROL METHOD. OJW IS A UNIQUE METHOD CHOSEN BY THOUGHTFUL AND INTELLIGENT PERSONS WHO HAVE CAREFULLY CONSIDERED ITS PROS AND CONS. Read the 2 page scientific article in Lancet the prestigious medical journal. [CLICK HERE]
RATIONALE FOR MEMBERS OF THE PROFESSION TO PROVIDE OJW:
OJW for weight loss is a treatment modality for a serious "social, psychological and physiological" problem that can help some people to get a start on treating a problem with potentially grave consequences. Obesity is legion and epidemic, and recognized as a precursor to a host of serious illnesses. I am exploring the “orthodontic” approach to help alleviate this epidemic in those cases where it may be applicable. I think orthodontists, or for that matter, any member of the dental profession, can deliver this service with compassion and intelligence. My experience to date is that it is safe, and reasonably effective when performed with proper protocols that are presented herein.
RATIONALE OF DETRACTORS OF OJW/ANY DENTAL PARTICIPATION IN THE FIELD OF WEIGHT LOSS
See article to be submitted for publication in the NYS Dental Journal, 2005 in which Dr. Rothstein responds to the present editor of the journal, Dr. Elliot Moskowitz, whose article entitled The Limits of Dentistry sets forth the authors reasons for not providing services to the obese. [Link]
10 REASONS TO PROVIDE OJW TO
THE OVERWEIGHT / OBESE
1. You are a dentist who believes the "risk / benefit" ratio of OJW would be inside your "comfort zone.“
2. You strongly believe dentists are guardians of the mouth and the TM joint and are well positioned in helping the overweight.
3. You are not overweight or obese, nor are your staff members, and therefore offering OJW in your office would not bring undesirable and embarrassing attention to you or your staff members.
4. You believe that providing this service would enhance your image in the community in which you practice.
5. You are a dentist who is quite capable of bonding a bracket to a tooth.
6. You believe that OJW is effective and safe.
7. You believe dentists are professional health providers who should be helping the overweight.
8. You feel strongly that OJW is relatively safe to provide and puts you at no greater risk liability-wise than you are already.
9. You know your dental license is not in jeopardy. Why should it be?
10. You believe that the new DDS System clears the way for dentists to provide services to the overweight, and providing OJW still further implements your armamentarium.
WHAT ARE THE LEGAL AND
They have yet to be fully addressed and carefully defined. some leaders in risk management have spoken out and their voice may be comforting. You will need to speak to your own liability carrier for specifics. This field is new so you will find that insurance companies tend to give information not based on any statistics because the jaw wiring (for weight loss) is not as yet on their monitor. Dr. Larry Jerrold, orthodontist, Interim Dean and Program Director of the Department of Orthodontics at Jacksonville University, and the foremost legal analyst in the field of risk management and legal liability holds that dentists/orthodontists who provide OJW may initiate such a service after the patient's primary care provider has diagnosed the need for weight loss, and has given notice that the patient may choose a supervised liquid diet as the means of attaining their weight loss goals via OJW.
Consider: If dentists (orthodontists included) step forward and recognize their responsibility to care for selected overweight/obese patients (BMI 28 -38) who meet provider's criteria for being OJW patients, the leaders in the ADA and AAO will be obliged to clearly define the dental profession's role in providing services to the overweight seeking to bring this problem under control. Furthermore, liability carriers in time will respond by redefining the situations in which they extend coverage, e.g. orthodontists who prescribe devices for patients with obstructive sleep apnea were placed under the liability umbrella of the AAO insurance as long as they follow the guidelines in the same way that Dr. Jerrold has offered a guideline for providing OJW.
Until then, advocates of OJW will need to address those leaders whose whose opinions are based on scientific fiction, hearsay and who are simply out of touch with what is happening in our country. See article to be submitted for publication in the NYS Dental Journal, 2005 in which Dr. Rothstein responds to the present editor of the journal, Dr. Elliot Moskowitz, whose article entitled The Limits of Dentistry sets forth the authors reasons for not providing services to the obese. [Read the article]
BELOW YOU WILL FIND A LIST OF
CONSULTANTS WHO CAN PROVIDE INFORMATION CONCERNING THE MEDICO-LEGAL AND
NYSDA (New York State Dental Association)
Sandy DiNoto 518 465 0044 email@example.com
MMLIC (Medical Malpractice Liability Insurance
Company) David White, 800 683 7769,
ADA (Insurance Dept.)
AAO (Insurance Dept.)
James Bowlin, 800 424 2841 x223,
Dr. Mlton Lawney: Executive Secretary of NY State Board of Dentistry 518 474 3817 x550
Your sole responsibility is to provide the OJW jaw wiring mechanics, and to subsequently evaluate every 5 weeks the teeth, gingiva and TMJ as well as to clean the teeth. In no way does the provider guarantee that the OJW recipient will lose weight. It notes the need for the patient to be on a low-calorie liquid diet. Suggested:1350 calories for woman and 1450 calories for men
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 to achieve a healthier weight by providing orthodontic jaw wiring using the protocol and Informed Consent presented herein.
The health care team includes: Weight control hospital clinics, GP physicians, bariatric surgeons, nurses, registered dieticians and psychotherapeutic counselors.
Continue on to Part I/IV: Preparation