A Forum for Orthodontic Jaw Wiring (OJW) for Weight Loss
P R Os  and C O Ns
http://www.drted.com/index.html/Jaw wiring pros and cons.htm

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PS. In the American Journal of Orthodontics January 2002 apropos of denigrated procedures, it was pointed out that the only justification for the orthodontic specialty is that it remedies some social and psychological problems that sometimes arise form having crooked teeth HOWEVER,  "orthodontists do not treat disease, periodontal disease or caries. and orthodontic treatment does not contribute to patients  physical health ...scientific evidence that  malocclusion is not associated with morbidity and mortality. Malocclusion may not be associated with tempormandibular (TMD), and orthodontic treatment cannot lessen or prevent the future development of TMD, Also, orthodontic treatment cannot routinely improve one's periodontal health (ie, "straight teeth are easier to clean"); in fact orthodontic treatment has been associated with increased plaque retention, gingivitis, periodontitis, decalcification, dental caries and root resorption. [TMD to boot] Even after orthodontic treatment we struggle to hold the aligned teeth in position. As orthodontists, we should assume that instablility is the norm, and the only strategy to ensure acceptable alignment posttreatment is probably to use fixed or removable retention for life". Orthodontics Justified as a Profession"--Rinchuse and Rinchuse.

**The relevance of this quote for me is that the "orthodontic" profession has rightfully grown in stature from disparagement to full public and professional acceptance because we have solved a dental problem of grave social and psychological significance for many people. OJW for weight loss is a treatment modality for a  serious "social, psychological and physiological" problem that can help some people to get a start on treating a problem with potentially grave consequences. Obesity is legion and epidemic and recognized as a precursor to a host of serious illnesses. I am exploring the orthodontic approach to help alleviate this epidemic in those cases where it may be applicable. I think orthodontists can deliver this service with compassion and intelligence. My experience to date is that it is safe, and reasonably effective when performed with proper protocols that are presented herein.  [See OJW Directory].

Dr. Thomas is right about some risk of degenerative changes resulting from immobilization of the joint and I do not discount his words of wisdom. The protocol I have established is unlike IMF and MMF in that that the wiring creates a "passive" fixation of the jaws using brackets and "simple" wiring which is released and rewired at periodic intervals. Such a protocol warrants controlled studies by orthodontists to assess any temporary or permanent damage, short term or long term that can ensue from immobilization of the joint. (See the differences between IMF-MMF and OJW).

2/2/02   JS, 26 male in treatment with Invisalign conversation via IMs  P R O

SixFootToo:  i'm reading your letter...  is there any side effect of not being able to use your jaw?
 Dr ted35:  yes immobilization might lead leads to stiffening of the joint. The tighter and longer the joint is immobilized the more stiff it gets.. 
SixFootToo:  is it permanent?
Dr ted35:  nope…in my treatment approach the patient must remove the wires for 3-5 days and exercise the joint and besides when I wire them there is a little play in the wires that holds the jaws together
 SixFootToo:  are these people able to talk?
 Dr ted35:  I wired a patient recently and she sounded remarkably clear. The clearer your speech is to begin with the better you sound when you’re wired.
 SixFootToo:  actually i'm  talking with my teeth closed right now…   and i can speak effectively
Dr ted35:  I made a sound file of the new patient just after she was wired…you can hear it at www.drted.com/index.html/Jaw wired Valerie2102
 SixFootToo:  thanks for your answer about the over bite....  i guess i should have no problem fixing my teeth with invisalign.   1485 to have your jaw wired? lol (laughing out loud) crazy,  the Track in my neighborhood is free i would rather just jog
Dr ted35:  good man
SixFootToo:  these women in your emails aren’t even that fat..  jaw wiring for a 165lb woman?? 
Dr ted35:  Others have life styles that do not permit that. Today's patient is 220. She wants 160. Is that unreasonable to you?
SixFootToo:  One thing about jaw wiring is its not a permanent solution. If they lack the will power so badly that they need jaw wiring what will happen when the wires come off?
Dr ted35  you give me the answer to this question...it really has a complex answer...you know what I mean?
SixFootToo:  most likely they will just balloon up again.. in my opinion
Dr ted35:  Many will! but some will change for the better. Some is better than none.
Dr ted35:  some is better than none Dr ted35:  huh
 SixFootToo:  true… they might do what's  necessary to keep their new body
Dr ted35:  so they are the ones that deserve a chance...and should be given a round of applause for trying something that might work for them
SixFootToo:  once they are thin they might get the inspiration and necessary motivation to diet and excercise...  i agree with you..
Dr ted35:  Others will resort to different ways and means...some will die prematurely because of their being overweight
Dr ted35:  Did you read what Dr. Moscowitz wrote and what Dr. Thomas wrote?
SixFootToo:  no wheres that?  in the links?
Dr ted35:  www.drted.com/index.html/Jaw wiring pros and cons.htm
Dr ted35:  i'm on the page right now
SixFootToo:  lots of CONS
Dr ted35:  I just sent you the answers to Dr. Moscowitz's cons 
 SixFootToo:  i read it...  yeah those guys are getting too deep into it… u cant compare jaw wiring to "lip sewing"  etc..
Dr ted35:  even he admits that the comparisons are absurd
Dr ted35: "far fetched"
SixFootToo:  i like how u have three doctors opinions along with mine, a guy with a business degree and an obsession with his overbite.. lol
Dr ted35:  Yes, you are right. You provide balance!
SixFootToo:  lol 
SixFootToo:  But I am chock full of common sense. Jaw wiring is better than stomach stapling any day, and cheaper.
Dr ted35:  lol indeed
Dr ted35:  I wish i was not the only one in the milkyway galaxy providing the service... there are multiple needy
people…if orthodontists knew more I am sure some might try a few test cases.  See scientific articles or  the Jaw wiring FAQ’s or the informed consent for jaw wiring. 
Dr. ted35:   Can I print our conversation?
SixFootToo:  yes go ahead

2/4/02   LM, 18 female treated by Dr. Ted P R O
Now...to sum up my research. .I would have to say that I have searched far
and wide, but still there was not 1 website that actually did any study
about jaw wiring for weight loss...And when jaw wiring for weight loss was
mentioned, they would always conclude by saying it has always been
unsuccessful...BUT, they did not provide not 1 proof that it is 
unsuccessful, let alone harmful....your site has very valuable
information...and I must say after having our chats about jaw wiring for
weight loss, I must say that it's true.. orthodontists are better off doing
these procedures. .I mean I don't care if I were 900 pounds, **I refuse to have
an oral surgeon put wires through my gums...but Ted ..I swear when I say
this, and I'm not saying this as an employee, but as a former patient...I
couldn't find anyone better in the world to do this sort of
procedure...maybe when I get older and have children and gain weight, I
might give you a call :)
Love Always....................... Laighah
**An orthodontist can bond braces "brackets" on to the upper and lower teeth and then "lace" the jaws lightly together
 with soft wire without  ever passing wire between the teeth or through the  gums. The "lacing" takes 2 minutes
at most for each side. [Click HERE to see how the lacing looks.]

1/28/02   Dr. Paul Baker, Oral Surgeon, Brooklyn NY   C O N (cerned)
Dear Dr. Ted,
Although my experience with this treatment modality is sparse, I do have some concerns about this type of "behavior modification'.  As others have noted within the site TMJ degenerative changes are a possible risk if  the joint remains immoble for long periods of time.  Intermaxillary fixation is agreed not to be a benign treatment and can be detrimental in certain patient populations.  I am most concerned however with the participation of other health care professionals when treating this health problem.  I'm not sure that jaw wiring alone without some form of counseling or behavior modification is an appropiate treatment course.  What is the incidence of relapse with and without adjunctive thearapies?  Thanks for the opportunity to review this topic.
P. Baker,DDS

3/27/02   Dr. Miki Kuftinec, Orthodontist,  NYU Faculty   C O N

From:    Joseph Zernik <jz12345@earthlink.net>
Subject: Subject: Dr. Ted's writings; From: MKuftinec@aol.com
Sat, 16 Mar 2002 09:20:45 EST
From: MKuftinec@aol.com
Received: from MKuftinec@aol.com
Date: Sat, 16 Mar 2002 09:20:45 EST
Subject: Dr. Ted's writings
To: esco@listserv.uic.edu

To the Editor (Dr. Joseph Zernik of ESCO,  the online Study Club for Orthodontist from Dr. Miki Kuftinec):
     Did it occur to you to check first with those mentioned in the "open letter" sent and posted by Ted, to see if it all right to distribute what obviously started as a private communication between him and Dr. K [yes, that is I!]?
     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. yes, I do favor freedom of the speech, but you must exercise your editorial privileges at some point.
Miki Kuftinec, Professor & Director [IPO Orthodontics, NYU]; ScD[Nutritional Biochemistry from MIT]; Educationally Qualified in Public Health Human Nutrition

Dr. Rothstein's response to Dr. Kuftinec:

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   See also Article in "Dental Products" magazine October 2004
 

 Office Mgr to Dr. Rothstein C O N and PRO

     My opinion is reflected in Adlai Stevenson's quote:
"All progress has resulted from people who took unpopular positions." -- Adlai E. Stevenson
and Alan G. MacDiarmid ..Nobel Laureate in Chemistry, who said:  "What is at the edge of scientific or social acceptability today is often commonplace tomorrow."

     I have always felt that Dr. Ted's goal was not to make believers out of  nay-sayers, but rather to open the door separating orthodontists from OJW.  Hopefully these criticisms both good and bad will lead to more research and inquiry into OJW so the orthodontic community will have a venue to turn to when patients are seeking professionals they can trust to provide the OJW service.
     I would like to add that I am in disagreement with OJW as a method of losing weight permanently. Diet is "a way of life".  My belief is that OJW is not teaching behavior modification, which is essential if the weight is to be kept off.  At the same time  I feel the same way about  liposuction which has brought harm (including death) to many patients, but the procedure is as common as extraction of teeth! OJW is simply a choice in the same way that  "The Atkins Diet" or "The Zone" or "Meridia and  Xenical, or Bariatric surgery and more currently "Gastric Banding" are choices.
     OJW has given us the opportunity to help wonderful people from all around the country jumpstart their battle against being overweight.  Although I am not in agreement with it's effectiveness as a method of weight loss I don't feel that the choice should be taken away from them.
     The road less traveled is the more difficult choice; I  for one am glad Dr. Ted has taken it.

Jerry Rothstein,  Older brother...wise person, Kialua Kona, Hawaii.  PRO

In a message dated 3/30/2002 4:07:25 AM Eastern Standard Time, jerry@turquoise.net writes:
Dear Teddy:

  I question your inclusion of the office manager's comments in your Pro & Cons. If all the doctors (most doctors) disparage it, and your own office manager thinks poorly of OJW for weight loss (which in one place you even highlight), then many people who might otherwise be interested might not go for it. It's not doing any good for you and if anything its doing harm. Who needs it. Her truth is commendable but it has no place in your testimonials if you're looking for business.

Dear Brother Jerry:
 You are right to question the reason for the inclusion of her commentary. In fact promoting business is not my goal. I am an orthodontist and make my living by straightening teeth. Indeed, even raising the fee does/has not seemed to discourage people from seeking OJW, for it now seems that I am at least getting 2-3 inquiries every week. If a person does contact me I am left without any doubt that these would-be patients are ABSOLUTELY AND RESOLUTELY CERTAIN THAT OJW IS THE CORRECT PATH FOR THEM. The PRO part of Chritine's commentary echoes exactly my goal: making OJW a CHOICE that orthodontists can offer without intimidation from the likes of Dr. Miki Kutinec, whose paternalistic approach to teaching /guiding would-be OJW providers, leaves us cowering and hollow without any understanding of why he is so adamant. I will take up the slack as best I can. In my heart I am certain there are way more orthodontists like me than like him. I wish more of my "PRO" brother doctors would speak out, however I understand how difficult it is for them take a public stand. I've been there.
With Love, Brother Ted


April 5, Philip Cook, Marketing  Manager St. Anthony's Hospital, England  CON

Dear Dr. Rothstein,
Thank you for your email. The experience of our doctors is that obese patients do lose weight with jaw wiring but put it on again pretty smartly once the wiring is removed. Our laparoscopic gastric banding program is an adjustable surgical solution closely linked to psychiatric counseling to help patients to control the need to eat as well as helping them lose weight. A gradual approach aims to help patient lose 80% of excess weight over a 24 month period. This seems to have better long term results than dramatic short term weight loss.
Our web page for Gastric banding is at www.stanthonys.org.uk/obesity.html.
Philip Cook...Marketing Manager...St. Anthony's Hospital...Cheam...Surrey...UK
[Note from Dr. Rothstein: A "small surgical incision" just below the front ribs through the abdominal wall allows the placement of an inflatable cuff around/encircling the upper part of the stomach just below where the stomach joins to the esophagus. The cuff is joined to a thin hollow tube that passes to the outside of the body and connects to a "miniature air pump" that permits the passage of air to the inflatable cuff and which patient or doctor can use to inflate the cuff  and thereby control the tightness of the cuff wrapped around the stomach. The more inflated the cuff, the more full the stomach feels for a given amount of food eaten.] Click here to read an article about the "lap-band" in the NY Times.    Three other useful information sites include: [Info source 1], [Info source 2], [Info source 3]
a
 

April 17, R. A.  An adult as close to being an orthodontist as a lay person can get.  PRO

I finally devoted the time to peruse most of the information you suggested I read.  I have derived at the conclusion from reading the plethora of information you have noted on OJW is "desperate people take desperate measures".  OJW should be offered and used as a last resort for an obese person who has exhausted all other measures in attempting to gain back their control and self respect.  The orthodontist should act as a conduit while performing OJW only under the auspices of a psychiatrist's care.  The "approved" patient, who would already had a preselected diet and exercise routine prior to arriving at the orthodontist's office, would arrive to the "facilitator"  for initial and routine visits and would be terminated if the psychiatrist feels the patient is living up to his or her diet and exercise regimen.   Hopefully after OJW is finished the patient's behavior would have been modified positively and he or she will start living a happier and healthier life.  I believe orthodontists should do what they do best......CORRECT MALOCCLUSIONS, STRAIGHTEN TEETH, AND PROVIDE PATIENTS WITH A HEALTHIER SELF IMAGE!!!!

Dr. Ted Responds:

 Treatment of a compulsive eating disorder can be as resistant to cure as the treatment of its polar counterpart anorexia. Many areas of expertise may ultimately be needed to help the patient including the  support from the patient's person's spouse or significant other, registered dieticians, as well as the patient's physician and the patient's psychologist/psychiatrist. The provider of OJW should realize as the "facilitator" what other resources may be helpful and guide the patient to those professionals who involve themselves in providing aid to the obese patient. Dr. Rothstein makes the proper referrals to physicians and other professional in the area of obesity.  In NYC we have access to a multitude of such specialists. Those people who come from long distance are encouraged to work with their psychologists/psychiatrists when undertaking OJW. The provider of OJW does not necessarily have to have a prescription from an psychiatrist to do the procedure no less than the orthodontist has to have a prescription from the dentist to treat a person with a malocclusion.  OJW providers should take the time to know who they are going to provide the service for. Orthodontists are in a position as no other specialist is to  help "PROVIDE PATIENTS WITH A HEALTHIER SELF IMAGE". Let those orthodontists who are less timid show themselves to people who could benefit from their skills. I suppose I feel confident to provide such help because of my special training and education and thus feel comfortable and competent to provide OJW.

April 19,  Dr. Elizabeth Mulder-Zoch.psychoanalyst/psychologist specialist in weight management CON
I did what I could to learn about this procedure.  To sum up, it is a last-resort procedure. And to follow all the proven weight loss procedures, such as Weight Loss programs, drugs, groups, spas, and health clubs, one would probably have failed at all these before deciding to do something so drastic.   And following it, one would be faced with the problem of ongoing control so as not to undo whatever was gained.   Thus, YOU WILL BE WORKING WITH THE MOST SICK PATIENTS!!!!    I do not think working with this population would be rewarding.  Unless you are desperate for additional income, why would you work with such a group of desperate people, who are probably angry to begin with and would sue you at the drop of a hat if anything went wrong?   I'm not sure the additional insurance you would have to take out to cover this would be worth it.  And I am not sure of how many people who are oral compulsive to begin with could stand to have their jaws wired.  I doubt many of them could stand losing their eating and talking mechanism for very long.  Sorry to not be more enthusiastic. 

Dr. Ted Responds: 

OJW is not a last resort. In the full spectrum of treatment modalities it is far less drastic than liposuction, lap-band placement and all the varieties of agressive/INVASIVE bariatric surgery.  Not one of the techniques (conservative or invasive) has a fail-safe mechanism to prevent regaining weight. All of the patients who request OJW have tried many of the commonplace techniques and have failed. The informed consent I provide spells out the limits of what I can provide and each person who chooses to go ahead has chosen OJW as the next most important step for them to get some measure of control over their lives. Moreover, the criteria for patient selection is very stringent.  Maybe THE MOST SICK PATIENTS  are those who are beyond trying to control their eating problem. When I provide OJW I am providing a service that helps them bridge to the next step which could well be the start of change for for the better or the recognition that jaw wiring did not work and other methods must be tried which may very well require psychiatric/psychoanalytic expertise. (Many patients are simply afraid to admit they need that kind of expertise and try everything else instead.)  As for being sued, one must always practice risk management with due diligence and the proper regard and awareness of the service they are providing.  I do  believe that the risk of providing OJW is actually much less than the risks attending the providing of orthodontic treatment. Patients undergoing jaw wiring (by oral surgeons for trauma, disease  and cosmetic surgery) number in the thousands annually and their approach is INVASIVE AND PAINFUL. Not so when done by the orthodontists with their orthodontic brackets. Finally, as  I noted previously, first and foremost I am an orthodontist and I earn a very good living as such.  I don't need the money per se. There is pleasure and satisfaction knowing that I might be helping someone with a real problem, and being paid is a bonus.    I am glad to know that you would accept a patient I referred to you either before, during or after OJW.

January 21, 2003 Jake Graham:  OJW patient recently started.  PRO (obviously, but eloquent)
                                                     Read what Jake had to say.

February 11, Kelly Kirby:  A nice letter (unsolicited). PRO

I found your site after searching the web for Jaw wiring for weight lose. I live in DE wanted someone closer. I actually found an ortho who did it for me. I had to have a Dr.'s prescription and need to see the MD every week and the ortho. every two. The whole procedures including visits is only 900.00, but it has been submitted to my insurance so hopefully they will cover it I showed him exactly what I wanted done and he did it today. I had to have my jaw wired by an oral surgeon 4 years ago after a break. I lost 30 lbs in the 5 weeks that they were on. I managed to keep 20lbs off for almost 3 years. That is why I decided to do it again except this time through an ortho. I never would have been able to do it without your web site. I am 5'5 and weigh 190, I am hoping to get to 130. Thanks for your website.

kelly Kirby
kelkirby@mailexcite.com
 

October 1, 2007  Dr. Ken an orthodontist: CON

I sent Ken the manuscript for an article I am submitting to the AJO-DO: entitled
Orthodontic Jaw Wiring (OJW): The Dental Professional’s Role in Weight Control for Compulsive Overeating Leading to Obesity.
 respnded.

  

In a message dated 10/01/07 23:27:03 Eastern Daylight Time, Smilemagic@Smilemaster.com writes:

dear ted-- what can I say! you've taken it upon yourself to use the wiring procedure in order to help people. you say there is no downside. You site oral surgeons who agree that no negativity has occurred. If no one chokes inadvertently, if no one drinks to excess and aspirates his vomit and dies, etc, etc, all can be well. If someone does die or has a hospitalization  because they're locked in, their insurance company will have a field day with the practitioner--- not just malpractice, as your policy may not be effective( the insurance carrier does not want to represent you or pay ANY claims) but then you may be personally responsible. If so , what will you have remaining? You'll be a frigging pauper- the newspapers will demonize you, and you may not have any real Ortho patients who wish to come to your office. HOWEVER- you've done this 85 times AND HAVE BEEN SAFE SO FAR.   I'd rather give patients a medication that makes them slightly nauseous for a few months. They'll lose weight, for sure.  In my view, some ways to earn a fee just aren't worth it!
If the patient does not lose their Desire to eat, the weight will return and probably increase. The question is are you applying your mechanical expertise   or   are you really being a doctor?   Those are my thoughts. I too , as we all ,could have done this 34 years ago. I'm not comfortable with the Idea.   Good Luck     Ken
 

Dr. Rothstein responded a few days later:

Dear Ken,

Like I said it's controversial: http://www.drted.com/OJW Piehler article.html Thank you for your spin.  I am working on the problem of having an underwriter accept it under their umbrella of coverages.  Where would dentistry/medicine be were it not for our inventive confreres (like yourself) who were willing to put their necks on the line for some new device/operation/etc. they invented?  Your doomsday scenario is real enough that's why we do our best to have protocols in place that reduce the risk.  Simply getting up to do battle with the day is risky by itself. I have no doubt that some provider will do harm because of his own failure to do due diligence in the process of delivering the service.  There are many among us who will not do orthognathic surgery cases for the same rationale. Cordially and with great respect for your shoot-from-the-hip analysis.  Ted
Ps.  If you will recall, sleep apnea mechano-therapy was anathema to the AAO until the AAOIC decided to cover it as long as the physician made the diagnosis. Cordially,Ted  
Can I print your response  in the  pros and cons section?  The Second Forum on the Pros and Cons of OJW: responses to the letter of 9/22/03; I will keep your identity as ("Ken orthodontist NY" CON), and correct the typos etc. 
 PPs. I made some revisions to the article  including adding a recent case I started for a lady with a BMI of  36 whose secondary chief complaint was chronic thumb sucking. See http://www.drted.com/OJW to control adult thumb sucking.htm  Some interesting letters regarding this subject on that page. Looking forward to seeing you at the GNYDM