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Clinical Notes: Jane O, Occupation: Bank Loan officer,  Columbus, OH, Pa, Age 25  Ht. 5'6" Wt. 172  Goal 140 pounds, Moderately active, willing to commit 5 months passionately to OJW.  Expected weight loss 45 pounds   Email address:  juhzane@hotmail.com  (ok to contact).

December 21, 2007:
Examination of teeth, gums, all soft tissues, extent of movement of jaws, and TMJ (Temporo-Mandibular Joint) reveals that Jane is in good health. Her medical dental history indicated that she had no medical or dental problems related to treatment using OJW. Jane 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 except that a deep cavity was revealed by X-ray and Jane was advised to have it filled. No other the hard tissues of the jaws was evident.

What makes Jane's case  unique is that she decided to have both orthodontic treatment and OJW. Since she had come from afar we agreed that putting on upper and lower braces and OJW at the same visit would expedite orthodontic treatment would be an agreeable treatment plan for both of us. This visit of 2.5 hours was somewhat arduous and tiring. It is documented below in photographs. Her case demonstrates how upper and lower braces and arch wires as well as OJW wiring were placed all at the first visit.

Jane 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 every direction. Consequently, no pressure is placed on the TM joint. She signed the informed consent for jaw wiring . She came alone. She  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. Jane 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" .014 inch diameter dead soft stainless steel round wire.  Jane 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 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.

December 27, 2007

As planned, Jane who had vacationed in NY for a week, returned to the office for examination. Her OJW wiring was off and brackets LR2, LR5 and LL6 were detached.  Undoing the parts to allow rebonding the brackets and rewiring her took about an hour. She indicated she would be returning to NY January 12 and would come with her friend Victoria who was also going to begin OJW.

January 14, 2008

Jane presented with detached bracket lr6, lr3 and lr. Total bkts detached is now 6. Jane advised to pay careful attention to a soft diet.  Rebonded brackets and placed new PC 8-9 n 7-10 and 24-25  n 26-23. Note some progress in space closure. Advised  Jane re surcharges for detached brkts above 5.  Today redo OJW using .012 dead-soft. Reminded Jane to report detached bkts without delay and to report when ojw wires are removed by her for whatever the reason.