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A Protocol for Providing Orthodontic Jaw Wiring for Compulsive Overeating Leading to Obesity: A New Role for the Dental Professional Ted Rothstein, DDS, PhD (Facial anthropology), private practice orthodontist, NYU 1971; inventor of OJW in 1988.

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 your effort to help them; they will not begrudge you 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.

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

 Case exaple.. 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 Rothstein’s 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.

What you will learn by taking the course in Orthodontic Jaw Wiring: To administer and safely provide the service as shown in the above figures, by understanding: 

x  BMI (Body Mass Index) the index of ponderal mass.

x  The physician’s role/responsibility vis-a-vis you as part of the health-care team.

x  The responsibilities Orthodontic Jaw Wiring entails for the provider.

x  Legal and liability issues.

x  The major concerns of the provider.

x  Effective marketing of jaw wiring for weight loss/control.

x  Ten reasons to provide OJW beyond profit motivation.

x  Good candidates for OJW.

x  When OJW is contraindicated

x  The nature of compulsive overeating.

x  The three instruments you need to provide the service.

x  Obtaining the instruments and supplies for OJW.

x  The fee for the OJW service and the various ways it can be paid.

x  The sine qua non of OJW: the Informed Consent.

x  The four objectives of the telephone conversation memo.

x  The three documents you must obtain before providing the OJW service.

x  The OJW visit exam and records and wiring procedure.

x  Understanding the difference between the normal envelope of motion of the lower jaw and the OJW envelope of motion.

x  How to bond the brackets.

x  Those important details to effective wiring of the jaws apart.

x  Teaching patient or their significant other to rewire themselves when indicated.

x  The examination prior to rewiring.

x  The five simple tools the patient can use to remove the wiring.

x   Emergencies and how to handle them.

x  The one document to provide patients with to help them achieve their weight-loss goals.

x  Removing the brackets.

x  Pointing the patient in the direction of behavior modification to prevent mindless eating.
 

The gates of the Future are patrolled by a thousand guardians of the Past.--Anon.

Ted Rothstein DDS, PhD

Dr. Ted Rothstein is a private-practice cosmetic orthodontist for adults and children since 1973 in Brooklyn Heights. He is a clinician, author and inventor. His patent for orthodontic jaw wiring (OJW) is presently under examination. He has provided OJW to 85 patients since its inception in 1988. His complete resume is available on his web site drted35@aol.com. He is the conceptual founder of the DPOJW (Dentist Providers of Orthodontic Jaw Wiring), and author of the free course on this subject. Dr. Rothstein holds a PhD from the University of Pennsylvania in Facial Anthropology, 1971, and is a graduate of the NYU Orthodontic Department, 1973. He has been a member of the AAO and the NYU Alumni Orthodontic Society since 1973. He has presented OJW table clinics in New York, San Francisco, Las Vegas, Paris and lectured to the Queens County chapter of the AGD. His article on this subject was submitted to the AJO-DO, 2008.