Orthodontic Jaw Wiring The Dental Professions Role in

Orthodontic Jaw Wiring The Dental Profession’s Role in the Control of Compulsive Overeating This MS power point presentation is an abridged version of the original. The complete presentation (72 slides) is available gratis on the CD prepared for the GNYDM and the American Association of Orthodontists. 8 min. 30 sec. to view 1

The Dental Profession’s Role in the Control of Compulsive Overeating: Orthodontic Jaw Wiring (a kinder gentler way) (OJW) Presented at The Greater NY Dental Meeting November 29, 2004 and to the American Association of Orthodontists May 22, 2005 2

Presented by: Ted Rothstein DDS, Ph. D Member of the AAO 1973 - Present Founder DPOJW Dentist Providers of Orthodontic Jaw Wiring Specialist in Orthodontics for Adults and Children 35 Remsen, Brooklyn NY 11201 718 852 1551 Fax 718 852 1894 Web site: www. drted. com Email: drted 35@aol. com 3

Meet Dr. Ted • Dr. Ted and grandsons Caleb and Joshua • Review Dr. Rothstein’s CV 4

Meet OJW Orthodontic Jaw Wiring 5

JOIN THE DPOJW (Dentist Providers of Orthodontic Jaw Wiring) REGISTER FOR PART I/IV OF THE ONLINE COURSE TO BEGIN JANUARY 30 AT: http: //www. drted. com/OJW DPOJW Course. htm BE ONE OF THE FIRST 25 AND BECOME A FOUNDER/CHARTER MEMBER OF THE DPOJW. 6

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http: //www. op. nysed. gov/article 133. htm#def NY State: Article 133 § 6601. Definition of practice of dentistry. The practice of the profession of dentistry is defined as diagnosing, treating, operating, or prescribing for any disease, pain, injury, deformity, or physical condition of the oral and maxillofacial area related to restoring and maintaining dental health. The practice of dentistry includes the prescribing and fabrication of dental prostheses and appliances. The practice of dentistry may include performing physical evaluations in conjunction with the provision of dental treatment. 8

Interpretation of NY State Article 133, § 6601 as it relates to the practice of dentistry, and to the dentist who chooses to provide OJW to patients who meet the selection criteria. Following is a direct quote provided by Dr. Milton Lawney, the Executive Secretary of the NY State Board of Dentistry, given to Dr. Rothstein on Thursday, October 14, 2004 in answer to the question: 9

“Is Orthodontic Jaw Wiring a service within the scope of dentistry? ” 10

Dr. Milton Lawney, the Executive Secretary of the State Board of Dentistry responds: "If the condition is properly diagnosed and a lawful treatment plan is prescribed by a professional authorized to do so, the fitting and attaching of appliances could very well have dental health implications and a dentist may be involved in those services. ” “It is not within the scope of dentistry to diagnose and treat independently the condition of obesity. Dental appliances aimed at weight loss may be prescribed if the condition is diagnosed by the proper authority. ” -- Interpretation of Article 133 § 6601 – Dr. ML. 11

CONSIDER: OVERWEIGHT / OBESITY IS EPIDEMIC IN THE UNITED STATES. 12

CONSIDER: Normal life expectancy: males 73 and females 80 But the life expectancy for chronically overweight/obese is: males 68 and females 75 13

Overweight / Obesity is defined by the “Body Mass Index” (BMI) BMI 25. 00 -25. 99= Overweight BMI≥ 30. 00 = Obese CALCULATE YOUR BMI NOW: http: //nhlbisupport. com/bmicalc. htm 14

The Progress of Man: Born 2000 - Died 2065. “He ate himself into the grave”. OJW provided by dental professionals in cooperation with the patient's physician offers hope of increased life expectancy to some compulsive overeaters. 15

CONSIDER: DENTAL PROFESSIONALS ARE UNIQUELY EMPOWERED TO PROVIDE OJW TO PROPERLY SELECTED CANDIDATES. 16

CONSIDER: IT IS NOT SURPRISING THAT THE OVERWEIGHT ON THEIR WAY TO OBESITY WOULD CHOOSE OJW WERE IT MORE WIDELY AVAILABLE. 17

General Conclusions of the Literature Review 1/5. Jaw wiring is generally accepted by the medical community as a therapeutically effective method to lose weight. 2/5. The only study of jaw wiring on teeth, gums and jaw joints per se shows that this procedure has no permanent harmful effects. 18

3/5. Behavior modification that results in maintenance of weight lost is extremely important. 4/5. There are no studies specifically aimed at the harmful effects on the Temporo-mandibular joint of a long-term "immobilizationrest/exercise TMJ-immobilization" protocol as utilized by Dr. Rothstein. 19

What is Compulsive Overeating? COMPULSIVE OVEREATING: REFERS TO A MULTI-FACTORIAL "EATING DISORDER" characterized by the unintentional, excessive and uncontrolled ingestion of food at mealtime and between meals which results in the patient experiencing depression, spiraling overweight and loss of self-esteem frequently accompanied by systemic problems such as high blood pressure, diabetes, cardiac disease and various pathologies of the knee and hips. Indeed the mortality rate for such people is considerably higher than those weight is closer to normal for their height and skeletal type. 21

Is jaw wiring for weight control something new? Not at all. Oral surgeons have been doing it since it was first noticed that when they wired their patients closed to facilitate healing in trauma or pathology cases and placed the patients on a liquid diet the patients lost weight. 22

So what is new about jaw wiring for controlling weight? 1. The jaws are wired together via orthodontic brackets bonded to the premolars and canines. 2. Until now the delivery of jaw wiring had no protocol and no informed consent. 3. Until now no one had addressed the problem of how to choose patients (who to exclude as a candidate). 4. Until now no one had addressed the issue of possible TMJ stiffening over time. 23

Following are some comments from people who had OJW 24

G. S. -- First, I want to say how very important it is that Dr. Ted provide this service. For some people it is the only way to lose weight and conquer uncontrollable eating habits. Detractors really need to gain a little more insight into the problem of compulsive eating before being judgmental. I feel that the considerable and growing problem of obesity and overweight in this country will not be solved until food addiction is recognized as a valid condition the same as alcoholism, smoking and gambling. Any amount of help is available for addicts with those problems and one wouldn't dream of telling an alcoholic to just stop drinking without any help, it is almost impossible so why then is it expected that people with eating problems are told to just stop overeating? After all, doesn't obesity cause myriad health problems also? 25

J. G. -- I needed to do something also as my health was going down hill. I do not enter into things lightly. I researched all of my options for quite some time. I did not want to gamble with my life and to me bariatric surgery is a BIG, BIG gamble. (The death rate is 3/1000). Those odds are very high and besides they cut you open like a tuna. And later: I am down 31 lbs. and can’t tell you enough how excited I am about this program. Now this procedure is not without its ups and downs, but it works! I am almost half way to my goal. 26

OJW in a Nutshell • Brackets are bonded. • Jaws are methodically wired to allow 1. 5 mm of mandibular movement in all excursions. 27

1 minute to place wiring • Voila! 28

Oops! • Note error in placing the wire according to the “figure 8” wiring pattern. 29

Why do you lose weight when your jaws are wired together? 7/7. You see yourself losing weight, maybe for the first time, and it gives you pleasure. You see yourself as being in control, maybe for the first time, and it gives you more pleasure and a sense of success. You recognize you can modify your behavior and you begin to take small steps to do so on a more permanent basis. Your aspirations to regain selfcontrol are renewed. 30

CONSIDER: DENTAL PROFESSIONALS ARE UNIQUELY EMPOWERED TO PROVIDE OJW TO PROPERLY SELECTED CANDIDATES. 31

RATIONALE FOR MEMBERS OF THE PROFESSION TO PROVIDE OJW: 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, or for that matter, any member of the dental profession, 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. 32

10 REASONS TO PROVIDE OJW TO THE OVERWEIGHT / OBESE 1. You are a dentist who believes the "risk / benefit" ratio of OJW would be inside your "comfort zone. “ 2. You strongly believe dentists are guardians of the mouth and the TM joint and are well positioned in helping the overweight. 3. You are not overweight or obese, nor are your staff members, and therefore offering OJW in your office would not bring undesirable and embarrassing attention to you or your staff members. 33

4. You believe that providing this service would enhance your image in the community in which you practice. 5. You are a dentist who is quite capable of bonding a bracket to a tooth. 6. You believe that OJW is effective and safe. 34

7. You believe dentists are professional health providers who should be helping the overweight. 8. You feel strongly that OJW is relatively safe to provide and puts you at no greater risk liability-wise than you are already. 9. You know your dental license is not in jeopardy. Why should it be? 35

AND FINALLY 10. You believe that the new DDS System clears the way for dentists to provide services to the overweight, and providing OJW still further implements your armamentarium. 36

RATIONAL FOR OJW: SOME COMPULSIVE OVER-EATERS BEGIN TO FEAR they have lost almost all control of their ability to eat sensibly. In their minds they have failed at all the methods of losing weight they have tried. They see in OJW an approach which is more aggressive than fad diets and less menacing than the weight control pharmaceuticals with their sometimes unpredictable side effects, Moreover, the thought of surgical intervention be it liposuction, lap-band or bariatric surgery has been deemed anathema by them. 37

CONSIDER: IF DENTISTS STEP FORWARD AND RECOGNIZE THEIR RESPONSIBILITY TO CARE FOR SELECTED PATIENTS WHO MEET THE CRITERIA OF BEING OVERWEIGHT / OBESE, THE LEADERS OF THE ADA AND AAO WILL BE OBLIGED TO CLEARLY DEFINE THE DENTAL PROFESSION’S ROLE IN PROVIDING SERVICES TO THE OVERWEIGHT. 38

BELOW YOU WILL FIND A LIST OF CONSULTANTS WHO CAN PROVIDE INFORMATION CONCERNING THE MEDICO-LEGAL AND LIABILITY ISSUES: 39

NYSDA (New York State Dental Association) Sandy Di. Noto 518 465 0044 sdinoto@nysdental. org MMLIC (Medical Malpractice Liability Insurance Company) GNYDM Booth 2308 or David White, 800 683 7769, dwhite@mlmc. com ADA (Insurance Dept. ) http: //www. ada. org/prof/prac/insure/index. asp AAO (Insurance Dept. ) http: //www. aaomembers. org/aaortho member/insurance/index. cfm James Bowlin, 800 424 2841 x 223, jbowlin@aaortho. org Dr. Mlton Lawney: Executive Secretary of NY State Board of Dentistry 518 474 3817 x 550 optombd@mail. nysed. gov 40

The Informed Consent for OJW The complete Informed Consent can be viewed at www. drted. com (Choose “Orthodontic Jaw Wiring”) 41

Important Message: Read Carefully You will note that your sole responsibility is to provide the OJW jaw wiring mechanics, and to subsequently evaluate every 5 weeks the health of teeth, gingiva and TMJ as well as to clean the teeth. In no way does the provider guarantee that the OJW recipient will lose weight. It notes the need for the patient to be on a lowcalorie liquid diet. 42

Question: Who is not a good candidate for OJW? Answer: Your mouth has many functions both obvious (talking) and not so obvious (sneezing) and is therefore the source of many pleasurable activities. The loss of any of them may provoke anxiety. Therefore one should think carefully about undertaking this method of weight control. A partial list of poor candidates for OJW would include: Continued: 43

a. Persons who need to floss their teeth due to gum problems or other compulsive reasons. b. Persons who speak abundantly for business or other reasons whose speech might be rendered less than perfectly clear because of being wired closed. c. Persons whose sex life would be rendered intolerable if intimate oral functions were impaired… even a little. Continued: 44

d. Persons with multiple-missing, loose or decayed teeth e. Those with psychological or emotional disorders who might feel powerless/ panicky with their mouths wired closed. f. Those work functions might be impaired such as an actor, singer, waiter, teacher etc. g. Persons with systemic diseases such as diabetics whose diets could not accommodate a liquid diet. Continued: 45

h. Persons who cannot breathe through their nose and whose breathing might be compromised by being held continuously in a closed bite teeth position. i. Those who are highly allergic are more at risk. j. Persons who have respiratory ailments such as snoring and/or sleep apnea as well as those who must use a broncho-dilator spray such as asthmatics. k. Persons who have a history of Temporo. Mandibular Joint dysfunction (TMJ). Continued: 46

l. Persons who are taking oral pill/capsule form medications could encounter some difficulties trying to pass a large capsule into the mouth behind the last teeth. It would be virtually impossible if the wisdom teeth were fully in place. m. Persons who compulsively clench/brux/gnash their teeth. n. Persons who have, or are suspected of having, anorexia or bulimia to begin with. o. Persons with frank unresolved periodontal (gum-tooth socket) problems. Continued: 47

p. Persons who drink alcoholic beverages excessively. In the event of alcoholic intoxication, vomiting can occur. (Alcohol suppresses the gag reflex, vomiting can lead to aspiration of vomitus). q. Persons who 1. will not provide a telephone number 2. do not have an Email address. 3. below the age of 21 unless accompanied by a parent. 4. are MORE than 110 pounds overweight or LESS than 25 pounds overweight (i. e. moderately obese and obese, but not "morbidly" obese). 48

CONCLUSIONS Members of the dental profession are uniquely positioned to work as part of a team with other health care providers to help the overweight/obese to achieve a healthier weight by providing orthodontic jaw wiring using the protocol and Informed Consent presented herein. The health-care team includes: Weight control hospital clinics, GP physicians, bariatric surgeons, nurses, registered dieticians and psychotherapeutic counselors. 49

POST SCRIPT I take pleasure in noting that my table clinic on the subject of Orthodontic Jaw Wiring was selected for presentation at the annual international meeting of the American Association of Orthodontists (May 21 -24, 2005) being held in San Francisco. There I will demonstrate how orthodontists are able to make the transition from active treatment in braces to passive treatment (retention of the corrected teeth) using OJW for those of their patients who elect to control weight by the OJW approach, and who meet the criteria for selection. My grateful appreciation to those who took the time to view this presentation. You are cordially invited to share your comments, suggestions and criticisms. Cordially, Dr. Ted Rothstein, drted 35@aol. com, Fax 718 852 1894. 50

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