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Clinical Notes: Randi Lewis, Occupation: radiology, North Lauderdale, FL, Age 34, 5'4'' 200 lbs:  Goal 145 pounds, Very active, willing to commit 6 months passionately to OJW.  Email address: fortlauderdal954@hotmail.com  (ok to contact)...Expected weight loss 50 pounds

October, 2007:
    Examination of teeth, gums, all soft tissues, extent of movement of jaws, and TMJ (Temporo-Mandibular Joint) reveals that Randi is in good health. Her medical dental history indicated that she had no medical or dental problems related to treatment using OJW. Randi provided a note from her physician indicating she had no gastro-intestinal issues that would interfere with her going on a liquid diet. A routine panoramic X-ray was taken, which further showed that her teeth and TM joint were normal in appearance  i.e. no abnormalities of the hard tissues of the jaws was evident. Her occlusion was tested with articulating paper in order to test for/locate any possible traumatic occlusion. There were some noted. Moreover, the presented with an deep vertical overbite (7.0 mm see photos below) and her upper teeth leaned in more than was considered normal. Stethescopic examination of the joints revealed she had bilateral early opening clicks. She was aware of the clicks, but was otherwise asymptomatic. Indeed she had consulted with some dentists none of whom advised her that the TMJ problem might well be related to her bite problem. (The Temporo-Mandibular Joint (TMJ)) is a "ball and socket" joint. The "ball" is the top part of your lower jaw and is called the "condyle". You can feel them by putting your fingers just in front of your ears when opening and closing your mouth. Randi was told that in OJW the jaws are wired apart with the teeth of the upper and lower jaw resting apart about 2mm enough to provide her reasonably good speech and some freedom of the lower jaw to allow TMJ functioning. thus allowing about 2.0 mm of lower jaw movement in ever direction. Consequently, no pressure is placed on the TM joint. She signed the informed consent for jaw wiring . She came alone. and was provide a review of the entire procedure and  was advised of the dangers she might encounter and how to avoid them. the informed consent and the FAQ's were reviewed and she signed the OJW Telephone memo indicating that she was aware of all aspects of the OJW treatment method for the control of compulsive overeating. "Begg" brackets were bonded on upper teeth 4,5,6 and 11, 12, 13 and lower teeth 29,28,27 and 22,21, and 20. (the canines and first and second premolars Both the teeth and the brackets were micro etched and the teeth were then also acid etched. All of the teeth to which brackets were bonded had normal enamel. The brackets were "double bonded", in that a second layer of adhesive was place on the flanges of the bracket. All excessive and unsightly adhesives was removed and the space between the teeth was checked for unimpeded passage of dental floss. Randi was shown the wiring method and practiced on the intraoral wiring training device under Dr. Ted's supervision with precautionary advisements. Finally, she was asked to put her teeth gently "together" and the wiring was done with "dead soft" .012 inch diameter dead soft stainless steel round wire.  Randi observed the wiring technique and then cut out the wire as a practice procedure which she did with ease in about 5 seconds. She was then wired closed on the right and left sides. She agreed to follow the recommended protocol: After 5 weeks snip off the wires, exercise for 5 days and return to the office for evaluation, cleaning and rewiring.  She said her jaws were very comfortable and that the jaw wires permitted her a slight bit of jaw movement. She was given instructions and practice regarding how and when to remove the wire. She was given instructions on how to exercise her jaws  during the 5 days she would be released from the wires and advised re the possibility of the joint becoming more limited in motion over time (two fingers of opening rather than 3 fingers).  She was counseled to adhere to a 1250 calorie  low/no salt liquid diet http://www.drted.com/Liquid diet Brody article.html  She was advised to always carry her wire-cutter with her. Lacking a wire cutter a simple fork could accomplish the emergency removal of the wire. She was provided with instruments to assist in the removal and replacement of the wires. Finally she was provide with the OJW reminders to patient a document created to help her succeed in her goals and stay out of harms way.

Ps. She indicated that she would not to return for follow up visits and was advised to weigh herself each day.  She was instructed to keep a graph of her weight loss 18"wide (each day) by 9" high (weight) and make an entry every day/week.

Her case was somewhat of a challenge because the cusps of her upper canines and premolars covered up her lower teeth more than usual requiring that the lower brackets be placed closer to her gums than usual and therefore special attention to good brushing was needed. In addition

When bonding her brackets I inadvertently  place the bracket on the lower right canine which led me to the serendipitous discover that required that I had to complete the wiring by passing it THROUGH the bracket rather than around it. When I completed the wiring on that side I realized the upside down bracket had an advantage in that it secured the wiring in away that  prevented it from slipping off. She agreed that it was ok to leave it that way. Her speech was very acceptable to her.

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