Responses to OJW Protocol Report Updated: September 22, 2003

Subj:
Orthodontic Jaw wiring for weight loss (OJW): A primer and protocol for orthodontists updated.
Read the letter/report which generated the responses below

1. From Dr. Larry Jerrold respected legal counselor in the orthodontic profession, orthodontist and Head of the Department of Orthodontics University of Jacksonville:

I have gone over your informed consent documentation regarding your orthodontic jaw wiring protocol and am prepared to make the following comments.

 

My biggest problem is that the services that you render do not fall within the statutory definition of the practice of dentistry as elaborated in the New York State Dental Practice Act.  Having said this I do believe that there are methods to resolve this issue however I find them either lacking or uncompelling.  This is not to say that you are not rendering a valuable service, quite the opposite.  I believe that control of compulsive overeating is a major problem facing the population of the United States today.  Your attempt to address this condition is laudable.

 

I would be infinitely more comfortable if your therapy were adjunctive to treatment for this condition that is being rendered by a physician.  I would like to see a physician examine a patient BEFORE you render any treatment and actually recommend this procedure for you to perform.  As long as the primary care physician for the patient is an MD who personally recommends this procedure, asks you to perform it, and then is willing to supervise the patient’s response to the jaw wiring therapy in conjunction with the help of other ancillary health care practitioners, e.g. psychiatrists, dieticians, physical therapists, etc., I have no problem.  For you, or any other orthodontist who assumes the role of primary care practitioner is fraught with potential problems from a medico-legal perspective.

 

I know that your informed consent form provides that the patient must avail themselves of the services of these other health care practitioners; however, I believe that from a legal perspective, the cart has been placed before the horse. 

 

Please reconsider the “chain of command” issue as I see it and if it is reconfigured, I wish you all of the praises that can be lavished upon one who is seeking to better the overall health status of those compulsive overeaters who have the good sense to seek a remedy which might prevent them from reaching the point of being morbidly obese and then requiring bariatric surgery where the mortality rate is now 1%.

 

Dear Dr. Jerrold

 
    Thank you very much for taking the time to review the legal problems related to OJW for the "control of compulsve overeating" .  I view OJW as method a patient could choose to prevent them from ever reaching the condition of  morbid obesity (more than one -hundred pounds overweight). In fact, if one has  become "morbidly obese"  in the OJW protocol one is no longer a suitable candidate for OJW they are a suitable candidate for surgery.  
    I do agree with you wholeheartedly that the would-be OJW patient is best served by being referred from their primary-care provider. Indeed, the prudent orthodontist/dentist should unfailingly contact the patient's physician prior to providing the service to "complete due diligence". Indeed I regard my work with OJW much in the same way as dentists/orthodontists who routinely, "treat" snoring/apnea with the multitude of appliances touted to remedy this problem. I wonder if the AAO has been brave enough to take a stand on this issue.
    In speaking to Jim Bowlin, legal counsel for the AAO,  this morning he indicated that he spoke to you and that you are best suited to express the view from the AAO's point of view. He went on to say that the AAO per se was was neither for nor against OJW. He declined on behalf of the AAO to prepare any statement regarding pertinent legal issues. He postulated that the issues needed scientific validation. He indicates that the AAO would have no problem if the AJODO would take up the issue in the journal. Cordially, Ted
 

2. From  Jim Bowlin, legal counsel for the American Association of Orthodontists:

Dr. Rothstein,
Confirming our conversations in regard to this matter, this will confirm that I have no objection to the AJO/DO addressing the issue of orthodontic jaw wiring.  I think it would be best that any article relating to the issue originate with Dr. Jerrold (or anyone else similarly trained) given his legal and orthodontic background.  I would be happy to review the material, and offer any additional legal information that may be helpful.  Please let me know if you need anything further. 

3. Reserved for Dr. Miki Kuftinec, NYU Post Grad Orthodontic Department arch-demonizer of OJW who said" 0n 3/27/02:     " I urge you to stop that totally unscientific nonsense. The procedure is not supported by the human nutritionists in this or in other countries. This fact was made clear to Ted. While he is at it and in order to increase the number and the kinds of patients he "can help as orthodontist" [or did he say that he has an obligation to help?] perhaps we should pronounce that the jaw wiring can stop various speech impediments, swallowing patterns, even saying the wrong things!!! If it could only stop someone from using his keyboard Stop this nonsense, please." (Response from Dr. Rothstein:  Your credentials qualify you above all to provide us with literature citations to support your contention as it pertains to OJW for weight loss. Please feel free to post your response to "OJW protocol updated (responses)"
Scientific literature in support of Jaw wiring in general: See Jaw wiring for weight loss literature references

See also Article in Lancet;  See also use of magnets as
substitute for jaw wiring



4. From Jay Freeman

December 11, 2003
Today Jay Freeman, attorney from Littleton, Colorado, was placed in OJW by his dentist Dr. Ivan Naiman. Jay originally intended travel to NYC to have me provide the service. However, after speaking to Dr. Naiman, his  dentist, on a number of occasions to my surprise he agreed to provide the service to Jay, and I happily agreed to be at his beck and call.

Dr. Ted -- Thank you for your concern, and your guidance of Ivan.  It speaks highly to your character and your commitment to the beneficial result of OJW that you would willingly help another dentist, thousands of miles away, to assist him in treating me -- even after I had initially decided I was going to  New York for your care.  Thank you so much -- you saved me a great deal of time and trouble for me and my family by your teaching Ivan what you have learned over the many years of your own practice and experience. 
 
I feel quite empowered by the wiring -- for the first time in my life I am not a slave to the food addiction -- or at least, am not capable of giving in -- which, in itself, is a victory.  I can really see possibility of success.  That is not to say that the experience of having my teeth wired shut is pleasant -- I never considered how dry my lips would be (can't use tongue to wet them) or how dry my mouth is -- for which a reason I can't think of.  Drinking is a new chore -- of course the usual "gulp" that I would take is no longer possible -- tiny sips, and only by way of a straw seems to be what I must do to avoid spilling. Of course, yawning is out -- and coughing not easy.  Speaking is impaired -- but not impossible; although it is impossible to "scream" at my kids (dog, wife, etc) and be understood -- so there are some real benefits to them from this <g>!
 
Why anyone would choose to have their belly cut open and have their stomach cut -- with all the risk of death from infection, blood loss, anesthesia instead of OJW is beyond me.  There is no free lunch -- and I suspect people who do bariatric surgery do so because they have given up on the possibility of self-control -- and I have not given up on that possibility. It is my hope and expectation that my OJW experience will allow me to get my weight to a level where exercise does not cause such pain that it impairs/prohibits my continuing to exercise.  I am recovering nicely from my last knee surgery (have had 4) -- but the orthopod told me I'd have to have knee replacements within 5 years at my current weight and damage.  I have compressed nerves at cervical levels; my lumbar levels are a total mess -- and have been having steroids injected for pain management so that I could play with my children.   I can't change the physical damage that has already occurred -- but I sure can my weight -- and intend to; ANY orthopod or neurosurgeon will tell you that extra weight will very quickly tear down the body and destroy bone and cartilage -- most will tell you that extra weight is the ONLY reason for joint replacement (other than traumatic injury).  If I need to (again) have OJW in the future (which I hope is NOT the case) then so be it -- but my success will have still occurred -- and will again.
 
If you have any suggestions for the dry mouth/lips -- I'd love to hear.  I will endeavor to keep a record and give it to you.  I start today at 240.  My intention is to use Medifast as my meals.
 
Again -- thanks for all you have done for me (and my family) and for my health.
 
Jay Freeman
----- Original Message -----
From:
To: jay.freeman@mindspring.com;ivan@isndds.com;Chrisdrted@aol.com
Sent: 12/11/2003 12:55:35 PM
Subject: congratualtions on leaving the starting line...Best wishes to Jay

 
Dear Ivan and Jay:
 
See Orthodontic Jaw wiring: A.T.’s diary of her experiences during the first two months.
 
  1. I hope both of you will one day contribute your thoughts to:Responses to the letter of 9/22/03. and
  2. 48. You can see the "TYPICAL FIRST VISIT" medical chart entry for an OJW patient.[GO].
Best wishes to you both. I remain at your disposal should you have any need of me. Cordially, Dr. Ted Rothstein...Best wishes for all the holidays.

JANUARY 9, 2004
STATUS REPORT FROM JAY FREEMAN...FIRST PATIENT TO BE WIRED BY HIS OWN DENTIST IN COLORADO

Greetings from Colorado, and Happy New Year!
 
A quick note.  I am 22-25 lbs lighter - Hurray!  I am not wired today -- it's my birthday and I have an appointment to have my teeth cleaned and rewired monday and am going skiing this weekend.  This is the 2nd time the wires have been off since I started; the first time happened when a wire broke and so I took the other side off - and got re-wired the next day.  Actually, since my dentist is so fabulous and helpful (and close) I think this is a good protocol -- when the wires came off today my jaw, while stiff, was still able to open (one finger) and now (5 hours later) to two fingers.  I do not see any downside to this protocol (as long as I do not gorge on food) and see a real upside (less risk or actual TMJ problem, able to brush teeth and/or have teeth prophylaxis, allows for special events).
 
I have been exercising diligently, every day -- cardio 3-4/x week, weights 2-3/week.  Contrary to experience of others, I do not find myself totally exhausted - in fact, I seem to have more energy.  That may be due to weight loss -- or mild ketosis, since I am using Medifast -- which is high protein, low carbs.  I drink tons of water/tea.  I do find it hard to breathe hard during high exertion; I also found it a little discomfiting to ski -- although I did so.  A real treat for me has been a "smoothie" - blended ice, some fruit and protein powder -- if real indulgent, will use a banana and teaspoon of peanut butter. 
 
The positive feed back I've received from the weight loss is beyond belief.  The response to my decision to wire has been largely supportive (or at least to my face).  The most negative comment is "will you be able to keep the weight off" -- to which I now respond, "if I was an alcoholic, you'd support my decision to not drink, even if I might fall off the wagon in the future- right"?  Of course, alcohol is not necessary to live -- and food is -- but they both can be powerful addictions -- and no one would say to the alcoholic "just cut back on your intake..."
 
Talking is harder than  I thought -- but manageable.  I do experience some pain on my teeth from the constant pressure the wires exert when speaking.  Needless to say, being wired over the holidays was a great idea from the point of no overeating. 
 
This is a very powerful process for me -- I can actually envision myself as a "thin" person!  Thank you, thank you Dr Ted for your pioneering work in this area.
 
I will keep you posted as time goes by.
 
Jay Freeman

5. Dear Ted,
We are doing OJW in our office, Hollywood Bracestm, for the last 10 years, with-out big advertising or public debate; I did not see a one patient who had any TMJ or periodontal problems after OJW, most of the time we offer OJW with referral from MD and with dietitian’s supervision. We recommend our entire OJW patient pool to visit your web site for step by step instruction and pro and con, before they start treatment

Dr. Yury Geylikman

www.hollywoodbraces.com

323 656-9111; 323 650-9499 fax

OJW patient: Dawn Bolen:
 0ctober 9, 2003
   (Dawn's response to the letter)  Hello Dr. Ted.  This is Dawn Bolen, I came to your office for OJW on July 17, 2003.  Well this has truly been an experience.  I began the OJW weighing in at 195 pounds as of today I am 165.  Not to bad!! I lost good the first couple of weeks and then slower over the next few, but since I plan on having the wires removed at the end of October  in just 2-1/2 more weeks, I have really buckled down with a drastic fast for the past 10 days and have seen more  noticeable weight loss.  Yesterday I had my first headache and it lingered on all day.  I have really been fortunate.  My stomach growls a lot, but that's ok it ate good for a long time!!  A few co-workers still think I am crazy but they are amazed at my appearance!  I had to adjust my story of why my mouth was wired a few times depending on who I talked to.  I rewired myself only once  and this was after 6 weeks.  My jaw was too sore to open to 3 fingers and I felt that I really couldn't be trusted, the temptation was strong so I put them on 2 days later while my jaws were still basically closed.  I know that I can't take them off and put them back on now, mentally that part of the commitment is over.  I am 15 pounds from my goal of 150 so I am very happy.  I just received some appetite suppressants from my Dr. to help me adjust and maintain over the next 6 months once these are removed.  I refuse to gain any weight back.  This has been a blessing.  I would say on a scale of 1 to 10 with 10 being the greatest, that the difficulty level in having my jaws wired was a 4. It was an adjustment not being able to lick my lips or when I put on lipstick, not being able to smooth my lips together.  The day I left your office I had a 5 hour drive back to Maryland.  It was crazy to say the least, I had to keep talking myself out of cutting them off right then and there, convincing myself that I have thrown away more than $1800 before.  But around the 4th hour I was getting my head together.  I can't believe how many times I had to stop and get coffee, because I had convinced myself that I could not be awake with my mouth like this.  Anyway, once I made it home and stared at myself in disbelief the fear began to settle and before I knew it I had made it through my first week and was heading to my family reunion in Philadelphia.

         I made it through 2 family reunions and 2 weddings this summer.  The key is having your "mind right".  Although I believe I hit a weight plateau in September, so I had to drop the Ensure (I think it may have had too much nutrients for me, because I maintained for a little while) I have never, not once gotten, sick or even felt like I couldn't go on.  The bottom results have always been my motivating goal.  My sisters and mother have been encouraging and supporting me all the way (My mother thinks I should keep them on until December --- to lose even more -- just in case I gain, she has memories of me skinny and I don't know how long ago that was) but that is not going to happen.  My children, both boys ages 12 and 13 have had a problem with it the whole time because it cut into their eating out and "free for alls".  Now my boyfriend has had his own issues with it (but I don't care), he had issues with the weight gain also.  Anyway I got my first compliment from him this morning.... "You may have lost a pound or two..."   Ah, the key is truly having your "mind right".  Pants that I had at one time squeezed into and popped the top button, now hang loosely!  But I haven't reached my goal yet - I have to keep reminding myself or I just might get satisfied.  I began in July wearing a size 16 and I am now back in a size 12, my goal is size 10.

        In the beginning I tried to exercise, but I found myself starving and exhausted.  Before OJW, I was used to a 3 day 45 minute cardio work out, but once I was wired that was not working for me.  I needed a 2 hour nap after my workout.  So I basically stopped working out.  I just recently began doing a 20 minute walk.  Most of the time I know I could do more, but I just don't want to.  I am positive that if I had worked out more I would be further along - physically I didn't have the energy.   I didn't just have liquids either.  I fell in love with mashed potatoes!!  In the beginning once a week I would treat myself to a medium McDonald's Strawberry Milk shake (460 calories).  But I had to stop that also, I haven't had one in 4 weeks.   Well wish me luck with the rest! 

October 10, 2003   

Finally, as for your letter to your colleagues -- you know I agree with your analysis, and your letter is an articulate and persuasive effort.  Whether or not immediately successful is not the hallmark of success -- medicine, in all branches, is quite slow to adopt "new" or discard "old" ways of thought.  You will be cheered to know, however, that my dentist was very understanding of my intent, agreed to help me in whatever way needed (re-glue, prophylaxis, etc.) and on his own, commented on the sanity of my choice versus bariatric surgery.
Jay Freeman Law Offices
7887 E. Belleview, Suite 1100
Englewood, CO  80111