OJW Two Cases

OJW REMINDERS FOR PATIENTS ON THE DAY OF THEIR APPOINTMENT

Thank you for having chosen me to provide you with OJW. It is my fondest hope you will reach the goals you chose by “dedicating passionately” to the OJW the number of months you elected when you completed the Informed Consent. You may expect to lose 1.5-2 pounds each week, and even more if you exercise.

Keep in mind that above all your goal is to modify your eating behavior forever. In the best of all possible worlds you achieve your weight goals and never regain the weight. In other cases you may achieve the weight loss you desire and then regain some or all of it back, and in the worst case gain even more than when you began your weight loss program.

For some losing weight control is an on again–off again lifetime process because the problem lies in some deeply rooted psychological process underlying the need to overeat. It is my fondest hope that OJW will lead you to the brink of discovery of the underlying causes of the desire to eat to excess.

With much care and concern, Dr. Ted Rothstein

Reminder 1. It is highly recommended to have your jaws wired properly, i.e., to have the lower jaw placed and wired in the "semi-mobile rest position called "Rothstein’s OJW rest position"©, which allows the jaw to move 1.5 millimeters in all directions.

R2. When wired properly your upper and lower teeth do not touch.

R3. It is highly recommended to remain wired the entire 4-6 weeks and then remain unwired for 4-6 days to allow your joint to recover from any stiffening it may have suffered. METHODS AND INSTRUMENTS TO REMOVE THE WIRES

R4. The jaws must be exercised for at least 5 days.

R5. If the jaw joint feels stiff (pain on opening with 3 fingers inserted 1” into mouth) wiring should be left off 5 more days or until the jaw joint no longer feels stiff.

R6 Have your teeth, gums and jaw joint examined for any possible problems that could be developing as result of the jaw wiring, ex. night grinding.

R7. Always carry your wire cutter and be aware of other instruments (a fork) that could be useful to remove the wiring if an emergency suddenly developed.

R8. The first 10 days may be very difficult so read A.T.’s story (OJW directory: item #2).

R9. Partake of a liquid diet that supplies good nourishment but not more than 1100-1200 calories if you are female, and 1300-1400 calories if you are a male. Every superfluous pound you are now storing on your body contains 3000 calories ...go figure. Your body will now begin to convert them to fuel. TRACK YOUR DAILY CALORIC INTAKE*. If you do not know the number of calories of the standard portions of foods you customarily eat /snack reject it. At first you will be anxious, then it will become a habit without angst.

R10. Use nutritional supplements like vitamins and minerals.

R11. Expect to lose 1.5-2.0 pounds each week and even more if you exercise.

R12. If a bracket breaks have an orthodontist replace it. However, you may temporarily wire two teeth to three teeth.

If you will be having a different healthcare provider rewire you:

Reminder 1. OJW (Orthodontic Jaw Wiring) providers will be hard to find.

R2. If you find another OJW provider who needs advice from me, have the provider call/email me at my office: 718 852 1551/drted35@aol.com

R3. “Certified” OJW providers are members of the DPOJW Assoc. (Dentist Providers of Orthodontic Jaw Wiring).

R4. It is highly recommended that you unwire yourself if you are having pain or discomfort since OJW properly done does not cause pain at any time.

R5. OJW limits the motions of the jaw joints as a result they may become stiff.

R6. After OJW your next stop may well be at the bariatric surgeon’s office.

R7. Remove the wires without delay in the event of sickness accompanied by nausea and vomiting.

R8. Alcohol suppresses your gag reflex making it easier to vomit. If stomach contents manage to get into your airway you are in danger of either choking or “drowning.” Warning: AVOID ALCOHOL.

R9. Look for excuses NOT to remove the wiring.

R10. If you remove the wiring seek reasons to REWIRE as soon as possible.

R11. Make sure the new provider makes contact with your primary health care provider.
R12. Some who have been diligent in following the regime of a liquid diet, may encounter difficulty weaning themselves off the liquid diet and back to solid food. The expertise of a registered dietitian may facilitate the change back to solid food.

R13. The brackets bonded to your teeth/gums will never harm them as long as you brush your teeth adequately.
Last Reminder. The OJW bracket-wiring system will be removed at any time you wish on written request at no charge.

R14. I have bonded three brackets on each side of the upper and lower teeth, i.e. 12 in total. If one becomes detached have it replaced by an orthodontist in the least possible delay. You may find you can still rewire yourself, nevertheless I urge you to have 12 brackets for the OJW system as I designed it. If a bracket breaks you will find spare ones in the KIT WE GAVE YOU. Email me the Firs, Last name and address of the three closest ORTHODONTISTS to where you live or work along. Provide me their telephone and email address and I will promptly contact them and arrange for the bracket to be rebonded. More than likely they will decline rewiring you. Some will rebond the bracket gratis others may charge.

Methods and Instruments to remove the wiring

The protocol for OJW requires that under ideal conditions the patients jaws remain wired apart in "Rothstein's OJW position of rest" for 5 weeks and then the wires are removed for at least 5 days, and 3-5 days additional if the jaw felt in the least bit stiff. During the 5 days the wires were off the patient is ordered to exercise the jaws: using manual exercises or just talking, singing and chewing gum. In that way the joint if impaired would fully recover.

In only one case out of 100+ did any stiffness occur in any of my OJW patients. Read A.T.'s Story She left the wires on for 12 weeks straight at the end of which time she was unable to place three fingers vertically in her mouth. (This is the norm that dentists use to test the extent of mouth opening (see photo below). At the end of the twelve weeks she was unable to open her mouth more than two fingers. She recovered full mobility in a short time.

The three finger test: patient places his/her three fingers in his/her mouth as shown above.

In all cases the OJW patient is instructed to remove the wiring at least 5 days before returning to the OJW provider's office. (S)he will check the patient's gums, teeth, and jaw mobility. If the jaws are have retained their normal mobility in all directions (open and closed, right and left) the provider will clean the teeth (inside and out) and rewire the jaws apart in "Rothstein's OJW position of rest"

All patients are provided with two instruments at the OJW appointment:
1. An instrument to twist (and untwist the wires). and
2. A wire cutter.

The third "instrument" they are informed of is a simple fork whose tines are not pointy sharp.

The pictures below demonstrate the use of these tools to untie/remove the ligature wires.


This instrument is used to untwist the ends that were created when the jaws were wired apart. One of the loose end is held and unwrapped off the bracket.	The wire cutter is the recommended instrument to remove the jaw wiring. The patient simply nips open the wire and lifts off the wire.

If a situation were to arise that demanded instant removal of the wiring and the patient left their wire cutter behind, a fork inserted between the wire and the tooth would forcibly cause the bracket to detach immediately allowing the wire to be lifted off the other brackets.	A close up showing the utility of a fork to forcibly cause the bracket to detach.

This a nail and cuticle scissor. I had no problem cutting the wire	I like this one the best of all. It supplants the wire nipper by far and away. This is the LA CROSS cuticle trimmer #75920.Costs $3.99. I tested this and it nipped the wire open with ease. It looks good and has multiple purposes.


Dr. Ted meets and greets the family upon their arrival from Seattle. more than likely this visit will be the their first and last visit to the office. So we have much work to get done...shall we dance?	The basic rules for success and staying out of harms ways are reviewed: The daily caloric maximum in the liquid diet to lose about 2 pounds /wk; when and how to quickly (5-10 seconds) release and rewire the jaws for exercises and how to prevent any jaw joint stiffness; the correct apartness of the correctly of the wired jaws; what to do if brackets detach.	The role of the OJW's significant other; assurances that no harm has ever come to anybody that has had their jaws wired; a brief review of the about to done OJW procedure ( tell--show--do)

Here I am showing her my OJW training device. I use this device to teach how the jaw wiring is done. (See below.)	The patient's OJW starting weight is recorded.	Patient should be encouraged that a successful outcome is likely if the adhere to the regiment of the OJW protocol.

Here I am wearing the OJW simulator appliance to allow the person learning the wiring to do it in in-situ.	Here I am looking at the panoramic I took then and there. In the course of your examination of the dentition, occlusion, periodontium and TMJ you will decide if their are any contraindications to your doing the OJW. You may have already spoken to his/her general dentist if they came from a long distance to your office. In this patient's case I learned for the first time that she had had four first premolars removed so I used the first molars the the second premolars and the canines to do the OJW.	Here I am introducing Alex to the method of wiring I usually use: It's like a waltz I say: one, two and three...four, four, five and six. for Alex this was a cake walk. This device is shown in some of the following photos.

Here Alex is putting the requisite 6th, 7th, or 8th twist in the pigtail using a back-locking hemostat. The demo device is fashioned to simulate the position of the brackets and right side of the teeth in the OJW wired position.	Here Alex is finishing twisting the stainless steel jaw wiring material using the demo device I prepared for them. See use of demo device	Here I am wearing the device I invented to facilitate teaching the person who will do the jaw wiring under conditions that approximate the real mouth. See use of this unique OJW training device.

With the lip retractor in place all the teeth that are going to be bonded are etched: This is an ATYPICAL case because the molars are being used. More typical cases make use of the premolars and the canines. Clear braces used on the canines are a cosmetic enhancement that could easily be done. The author prefers metal, but on patient insistence, could provide clear brackets.	The teeth are etched for one minute.	A light-cure-method primer is painted on the teeth. In retrospect, I should have done only the upper arch first. The dentist should avoid painting deeply into the interproximals because you will seal the teeth together when you cure with the curing light. You should test with floss after curing to make sure you have not sealed the teeth together.

The brackets were coated with adhesive and positioned on the teeth: I positioned the top brackets about 1.5 mm more distally leaning slightly distally to allow easier placement of the ligature wire.	Here I am am simply taking an overall look to see if the brackets are properly positioned.	At the the previous picture having assessed that the brackets were positioned correctly I then light cured them for three seconds and again checked their position. Having assured myself that all is well I now light-cure each bracket for 20 more seconds.

Do you remember the waltz? Here I am completing the "...and three" of the first part of the wiring : one, two and three.	Here we have completed the waltz: Orthodontists call this procedure of wiring "to figure eight: wire the teeth".	Here the dentist is gather the wire at about the place he is going to seize it with the hemostat.

The wire is twisted between 5 and 8 times until the dentist achieves a tightness of the wire that permits the patient to move the jaw at least 1.5-2.0 mm in all directions, but so slack as to slip out of the bracket.	Note the extra wire has been snipped away and the pig-tail tucked in to make the patient comfortable.	Here, using a wire cutter to make a single snip to to remove the wire. Other methods the patient may use to remove the wire.
	JUNE 7, 2007
Parting is such sweet sorrow. Bests wishes to Nazanin, her mom and her significant other.	SPECIAL NOTE: The patient will leave your office with a kit that includes: a few spare brackets; A wire cutting instrument; a hemostat to twist the wire and a list a patient guide/reminders to achieve success and stay out of reach of harm's. See the guide.


This patient initially came to the office for OJW for weight loss. When I told her I was confident I could treat her inter-dental spacing at the same time she was more than willing to proceed. Here you see I have placed the brackets on the upper and lower dentition in proper position for orthodontic treatment, and placed the first arch wire (.016 NiTi). You will note the brass pins I have placed to fasten the arch wire to the canines and premolars in order to facilitate placement of the OJW wiring (See below).	Left side

Anterior view showing the use of Cosmetic braces on the upper and lower dentition.	Here I have placed a lower .016 NiTi and wired the right and left using the typical OJW wiring configuration. The patient is wired so that the lower jaw can move 1.5mm-2.0mm in all directions

Here you can see the typical "figure 8' OJW wiring configuration on the right side	Left side view.
SPECIAL NOTE This case is unique not only because the orthodontic treatment and OJW treatment modalities are combined, but because the author is using .009 stainless steel wire for the first time. Typically I would have used a .014 dead-soft stainless steel wire. If this wire keeps its integrity for a reasonable number of weeks it will be used in the future. I did order .010 dead-soft wire for future use in the belief that it will be effective to ligate the arches and and have even more durability than the .009 stainless steel ligature wire used here.	SPECIAL NOTE cont. On July 18, Iris returned to the office. The .009 stainless steel wire had stayed intact. However, some brackets had detached and the wire just fell off. I rebonded the brackets (5) and rewired Iris with .012. dead soft wire. (See below.) at the same time I changed her upper and lower arches to .018niti/.016 niti. I added power chain to cont upper and anterior space closure.

	Visit of July 18: note the use of .012, deadsoft wire to to wire the jaws apart (about 2mm). The orthodontic treatment is progressing nicely as well.
See Iris's next visit to the office 8/10/07	Back to Site Additions Back to Index of Site URLS for OJW

11/1/2007 Front view showing OJW in place with power chain on the lower teeth only in order to pull back the lower front teeth. When they are back I will begin retracting the upper front teeth. The OJW in no way impairs the movement of the teeth.	11/1/2007 It's easier to see the "power chain" pulling back the lower front teeth in this photo. The power chain is attached from the 4th lower tooth to the hook I bent into the wire just in front of the lower eye tooth. it's difficult for the untrained eye to see it.

12/8/2007 Iris has 35 lost pounds. This photo demonstrates that at the start of wiring (upper right second premolar), it is prudent to leave some excess of wire (note the excess of wire between the upper right 2nd premolar and the lower right premolar). You can use the excess to adjust the final tension of the wrap of the wires. DO NO FORGET IF THE CASE WERE ONLY JAW WIRING YOU COULD FEED THE WIRES THROUGH THE VERTICAL SLOTS.	The instrument I use to begin twisting the wire to create the "pigtail" is called a back locking hemostat or (Mathieu needle holder. I provide every patient with one of them. Here I am showing that I take hold of the wire at about 10 mm from bracket of the lower right canine. It take between 6 and 9 twists to begin getting sufficient tautness to prevent the wire from slipping over the brass hook that I am using. I am using the brass hook only because it is an orthodontic case and the archwire precludes me from using the slot of the bracket.

Sometimes I first make a pigtail at the outer half of the wire as shown here. Then I continue twisting the wire until I can see that the twists have reached the bracket. Then I begin carefully twisting 1/2 to 1.5 turns more to achieve a tautness of the wire that allows the lower jaw to move about 2mm in all directions and sufficiently tight to prevent the wire from slipping over the brass pin.	Leave 1/8"h -1/4" of pigtail and tuck it away. There should be visible about 2'' of interocclusal space.

Note that the OJW wire pigtail is tucked away in front and most of the original excess slack in the rear has been used up in the act of adjusting the wire to allow the desired movement of the mandible. One must do the figure 8 wiring to allow the maximum amount of interocclusal opening within the limitations of the attachment hooks or slots of the bracket being used. balance the tautness of the wire so as to avoid but not so excessive as to overflow the hooks the wire was wrapped around.

May 15, 2008	May 15, 2008