L.K.: Observations and Treatment Chart

 [See photos of jaw wiring in place at end of page and below that a diagrammatic 
of  the typical pattern and method of jaw wiring
]

8/599     L. presented at the office with mother, grandmother and Aunt. Mother M. had contacted the office for the first time yesterday and revealed some critical point had been reached regarding her daughter's weight problem (close to 300 lbs; age 18). In a three way telephone conversation the day before we discussed the problem at length. M  found me through my website. She  read all the material that  had been prepared there. They had already discussed the pros and cons of trying the jaw wiring approach to weight loss and concluded that it was worth trying, indeed they had even discussed the problem with L's physician who had given approval to go ahead.  Talking to them revealed they were anxious, and appreciated a review of the  procedure and what might lie ahead. They had tried other methods without much success. They were dead set against surgery, and the latest medicines like Meridia and Xenical. One of the Television newspapers had done a segment on the weight loss medicines. One of them, she told me, had  side effects which included addictiveness.  I reminded them that the  underlying causes (hormonal, metabolic, psychiatric) of becoming overweight had to be addressed. I was convinced they were sincere and that L. was a good candidate for Jaw wiring. When they arrived at my office they completed the introductory forms and we spent another half-hour reviewing the  procedures, after which they both signed an "informed consent" (a written permission authorizing me to begin the treatment and containing pertinent information which was important for them to know in order that they might proceed  knowledgably). The brackets were bonded on L's teeth and her jaws wired together. The procedure took 30 minutes. I gave her a wire cutter and showed her how to use it if she desired/needed to remove the wires. I asked her to keep a log of her diet (which will  be shown later) and to begin a graph of  Weight v. Months. She was advised that 2-3 lbs a week was a reasonable goal. She was finally shown how to exercise her jaw when she cut herself loose at the end of 2-3 weeks.

8/6/99      Tel Con with  L. and  M.:  L. reported having a an earache, which was getting better. In response to M's question whether it was normal to get  an ear ache, I responded that it was the first time that an earache had been reported to me, but given the close relationship of the jaw and the ear, it was not surprising. She was advised to call me if the earache worsened. I explained that her tongue might begin to feel coated after a while, even with frequent use of Listerine. And that is because the tongue looks like a cornfield under a microscope. (This problem will need to be addressed...any solutions?)

8/8/99     Late evening tel. con. with M. requesting early AM appointment on 8/9 to rewire L. who had removed wires.

8/9/99     Today rewired jaws closed. L left office but returned 20 minutes later in great distress with earache pain on left side. Removed and rewired jaw closed again; wire had been tied too tightly on left side. Reason given for removal was hunger. Requested that L. write about the circumstances surrounding the removal of the wires to give herself and others insight into a problem of the jaw wiring approach to weight loss.

8/11/99     Tel. Con. with M...  M had taken L.K. to younger daughter's orthodontist when L.K. noticed  that  the front end of the  jaw wiring on her right side might be scratching the inside of her lip. The orthodontist, who had no  familiarity with the procedure, rather then simply "tuck inwardly" the offending wire (easily accomplished by the orthodontist), expediently removed the wires on both sides (easily accomplished by the patient), much to the total surprise of M. and L.K. .An appointment was made for 8/14 for rewiring.

[Note:  L.K. travels about 90 miles  one way  for each office visit. Extreme care is taken so that the two wire ends are tucked inward when wiring is placed. However, occasionally and end, albeit small, can become an annoyance.]

8/13/99     Email from patient indicating hesitancy/uncertainty regarding rewiring. Responded with acceptance of patient's uncertain state of mind and cancelled appointment of 8/14 for rewiring. Advised that the wiring brackets can be left in place without harm to the teeth as long as teeth are well brushed and that the brackets could be removed by a local orthodontist if that was more convenient.

E.B.: Observations and Treatment Chart

11/10/99     E.B: Female, age 32, Height 5' 10", Weight 270 lbs.  Goal: 190 pounds in 10 months (9/10/2001).  E. had found me the website by searching keyword "jaw wiring." She  read all the material that  had been prepared there and another copy of the same material was provided to her. The clinical exam of her mouth and teeth showed good oral hygiene with all teeth present and well-cared for. Her expectations fro weight loss were reasonable and she showed almost no anxiety about the procedure. She was well aware of the many other options for weight loss and realized the importance of a balanced diet and exercise. Furthermore, she realized the difficulties in keeping the weight off once her goal was reached. I was convinced she was sincere and that she was an excellent candidate for Jaw wiring. I advised her of some of the problems she might encounter: colds, yawning, sneezing, nausea/vomiting and other areas where the jaw wiring might impact on her life. I provided her with wire cutters. I reminded her that should she become panicky/anxious when her jaw was wired she had only to clip the wire and she was free. The brackets were bonded on E.'s teeth (the ones closest to the front of her mouth were clear/transparent), and her jaws wired together. The procedure took 30 minutes.  I asked her to keep a log of her diet (which will  be shown later) and to begin a graph of  Weight v. Months. She was advised that 2-3 lbs a week was a reasonable goal. She was also advised to exercise her jaws muscles by chewing and talking when she cut the wires off. Furthermore, she was advised never to cut the wires off unless she had made an appointment to get them back on in a few days. Listerine rinses 3 minutes, 4 times daily was recommended. After she was wired, her speech seemed slightly impeded. However, she was not anxious about it and it seemed to both of us that her speech was going to improve rapidly. She was advised to avoid grinding her teeth and the potential problems related to her jaw joint (TMJ Temporo-Mandibular Joint). 

12/28/99  Today the jaw wiring appliance was removed at E.B.'s request and the teeth cleaned and polished.  Examination showed that all teeth and jaw structures were in good health.  E. indicated  the following reasons for wanting the appliance removed:  1.  Her work required her to be in frequent oral communications and she felt that the appliance was an impediment to the clarity of her speech.  2. In spite of frequent use of antiseptic mouth rinses she felt less than perfectly clean inside her mouth.  3. Being out on a date with her mouth wired closed for her was embarrassing and awkward.  She indicated she had no misgivings about having given the jaw wiring method a try. In retrospect she clearly felt that the information I had provided her at the start  was complete and sufficient. She had lost no weight.

BEGIN TREATMENT CHART ENTRIES FOR T.T.

1/7/2000 T.T., Male, age 39, Height 5' 9", Weight 360 lbs. Goal: Initial commitment of 3 months (21 pounds) Residence: Connecticut. T. had found the website by searching keyword "jaw wiring." He read all the material that had been prepared there. The clinical exam of his mouth and teeth showed good oral hygiene and no gum /bone problems were present. Three molars were missing, the rest of his teeth were solidly rooted. He was well aware of the many other options for weight loss and realized the importance of a balanced diet and exercise. Furthermore, he realized the difficulties in keeping the weight off once his goal was reached. I advised him of some of the problems he might encounter: colds, yawning, sneezing, nausea/vomiting and other areas where the jaw wiring might impact on her life. I provided him with wire cutters and my home telephone. I reminded him that should he become panicky/anxious when his jaw was wired he had only to clip the wire and he was free. The brackets were bonded on T.'s teeth. The procedure took 30 minutes. I asked him keep a log of his diet (which will be shown later) and to begin a graph of Weight v. Months. He had started working on the preparation of a low calorie liquid/pureed diet. He was also advised to exercise his jaws muscles by chewing and talking and special exercises when he cut the wires off. Listerine rinses 3 minutes, 4 times daily was recommended. After he was wired, his speech was impeded, but he was not phased since that was what he had been told would be the case. He was also not anxious about it due to the nature of her work and circumstances. He was advised to avoid grinding his teeth and the potential problems related to his jaw joint (TMJ Temporo-Mandibular Joint).  He made an appointment to return in 3 weeks and I advised him to remove the wire 2-4 days prior to that. T. has supportive wife and best of all a mother who is dietician. He chose jaw wiring because he had injured his jaw some years back and had to have his jaw wired and he had lost a notable amount of weight.

1/20/00  T. reported that wires broke during sleep the night before  and he removed both sides. He reported trying to be careful about continuing  the low calorie liquid diet he was nourishing himself with. An earlier appointment than was originally scheduled to rewire his jaws was arranged

2/4/00  Weight in: 344 pounds; weight loss 16 pounds; Attitude: pleased and optimistic. Exam and narrative from T. revealed no indications of problem. Today Rebond detached bracket #5; Prophylaxis lingual surfaces of teeth;. rewired jaw close R n L with 018. dead soft wire. Next appointment scheduled. (Within a week T. again broke his wires during sleep; wires sent with rewiring instructions and precautions, Wires resent 3/1/00.)

3/24/00  Wires arrived at T's house a week ago.  Confirmed that his wife successfully rewired his jaw closed.   T is too busy to return to office from Connecticut to be rewired. His wife reports he had regained some of the weight he had lost. Advised T. to return to office to replace a bracket that broke off. (Assymetrical forces are not good.)

BEGIN TREATMENT CHART ENTRIES FOR A.T.

1/14/2000 A.T., Female, age 45, Height 5' 4", Weight 145 lbs. Goal: 125: Residence: Denver, Co A. had found me the website by searching keyword "jaw wiring." She could not locate another provider closer to Denver. She read all the material that had been prepared there. The clinical exam of her mouth and teeth showed good oral hygiene with all teeth present and well-cared for. She was well aware of the many other options for weight loss and realized the importance of a balanced diet and exercise. Furthermore, she realized the difficulties in keeping the weight off once her goal was reached. I advised her of some of the problems she might encounter: colds, yawning, sneezing, nausea/vomiting and other areas where the jaw wiring might impact on her life. I provided her with wire cutters and my home telephone. I reminded her that should she become panicky/anxious when her jaw was wired she had only to clip the wire and she was free. The brackets were bonded on A.'s teeth (she chose all metals even though she was offered clear/transparent for her upper front eye teeth), and her jaws wired together. The procedure took 30 minutes. I asked her to keep a log of her diet (which will be shown later) and to begin a graph of Weight v. Months. She had already prepared her liquid/pureed diet indicating she was avid in her weigh goal. She was also advised to exercise her jaws muscles by chewing and talking and special exercises when she cut the wires off. Listerine rinses 3 minutes, 4 times daily was recommended. After she was wired, her speech was impeded, but she was not phased since that was what she had been told would be the case. She was also not anxious about it due to the nature of her work and circumstances. She was advised to avoid grinding her teeth and the potential problems related to her jaw joint (TMJ Temporo-Mandibular Joint).  She made an appointment to return in 3 weeks and I advised her to remove the wire 2-4 days prior to that. I advised I would do my best to find an orthodontist in her area who would rewire her periodically.

1/21/00  A. reported cracked lips not helped by lip balm.  Advised her that lips touching each other may harbor more bacteria. Consider use of :  medicated vaseline, Vitamin B supplement, direct application of Vitamim. E to lips, frequent cleansing of lips with soap and water. In addition, dehydration may be a factor so drink more water. Otherwise A.  reports a sanguine outlook and reports feeling a mental and physical well being.

3/1/00  Telephone conversation with A. She reports weight at 124 with no problems. Has scheduled to have jaw wiring appliance removed March 15.

3/15/00   Jaw wiring removed by Colorado Orthodontist. Weight achieved 121 pounds. A.'s mouth opening is limited to two fingers by joint stiffness resulting from failure to have wires removed every 3-4 weeks as instructed. Attempts to open mouth any further cause pain.  (normal opening is three fingers).  A. is not concerned having been amply warned as to the results of prolonged wiring without exercise.

3/18/00   A. reports that jaw mobility is returning to normal. (See the diary of her experiences.)

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