The “appliance” shown above, and the protocol for using it as a weight control device, is called Orthodontic Jaw Wiring (OJW™). It was invented by the author — an orthodontist.
The two-minute video below demonstrates how the author wires the jaws after the brackets have been bonded on to the canines and premolars.
Weight Control for Compulsive Overeating Leading to Obesity—The Dental Professional’s Role
I’m a specialist in “orthodontics and dentofacial orthopedics”. As such, I treat patients of all ages who have cosmetic or functional problems resulting from crooked teeth and/or jaw bones that are mismatched in size or proportion. I have been in practice since 1973.
I never heard of jaw wiring for weight control until one day, in a year long forgotten, a young woman from California appeared in my office, wanting me to remove her braces. Moreover, she continued: “Would you be willing to wire my jaws together? I need to lose some weight—all the dentists in C-A do it.” The glib manner in which she spoke completely disarmed me of any objections I might have mustered. I removed her braces and cobbled together an inchoate device that would serve the purpose. After all—“everybody was doing it.” Only later, would I learn how remote from the truth that was. Nevertheless, that’s how I was introduced to Orthodontic Jaw Wiring for weight control.
Obesity is a disease whose long-term consequences are life threatening. Only physicians may diagnose it. However, its manifestation in a given individual can have multiple underlying causes that stem from factors related to mental states, like depression, anxiety and worry, and others related to genetic and hormonal disturbances. Conversely, obesity can potentiate and exacerbate its very causes. Consequently, treatment may sometimes require the resources of a “healthcare team.” Dental professionals have come to recognize that they have the right and responsibility to be a part of that team, more so because studies have shown that obesity has oral manifestations. This is the story of my contribution to caring for patients who are obese. *
Orthodontic Jaw Wiring for weight loss is my approach to a serious social, psychological and physiological problem. It can help some people who are already overweight and regressing with ever diminishing control toward obesity—with its multiple potentially grave consequences.
OJW was envisioned to help carefully selected candidates who are overweight and tend to eat “compulsively.” The selection of patients is based on the author’s assessment of the likelihood the patient will be successful using this method. Candidate selection is predicated on information provided to me in a medical-dental health questionnaire, an “Informed Consent” document and a lengthy telephone interview.
OJW can help alleviate this epidemic, in those cases where it may be applicable to carefully selected individuals whose Body Mass Index (BMI) indicates they are overweight or obese, as diagnosed by their primary care physician (PCP). BMI is an index of the extent to which a person is overweight based on their height and weight.
Orthodontic Jaw Wiring refers to the entire domain of the OJW provider’s duties to provide this dental service in a responsible manner. Such a provider is designated as a licensed dental professional practicing in a state that does not expressly proscribe the offering of OJW in its definition of the “Scope of Dentistry.”
In New York State, “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. (The proper authority refers to the patient’s PCP.)
The scope of the provider’s responsibilities include:
1. Select patients according to specified criteria; obtain their informed consent, insuring that they are aware of the risks and limitations of OJW and discuss the implications of the necessity of adhering to a low-calorie liquid diet.
2. Wire their jaws apart by a prescribed method.
3. Instruct them how to instantly remove the wiring, and rewire themselves if they are not able to return to your office, or cannot find a competent professional who will do it.
4. Re-examine and rewire them— typically once every five weeks— following an examination to determine that their teeth, gums and jaw joints have remained healthy.
5. Finally, remove the wiring and brackets when they indicate they have achieved their weight loss goal as stated at the commencement of their treatment in the Informed Consent.
It is the sole responsibility of the patient to lose weight by adherence to a low-calorie liquid diet. It is the dental professional’s responsibility to monitor the appliance to ascertain that it has not caused any harm to the patient’s teeth, gums or jaw joints.
What is novel about OJW as invented by Dr. Rothstein is as follows:
1. a jaw wiring approach was specifically applied to the goal of weight loss/control;
2. the jaws are wired through the medium of orthodontic brackets/attachments bonded to the premolars and canines in the upper and lower jaws in a manner that limits the extent to which a patient could separate their teeth, and still allow normal speech. I named the position “Rothstein’s OJW position of rest.” It is the normal (unconscious) “resting” position of the lower jaw—i.e., about 2–4 mm apart from the upper jaw. The delivery of jaw wiring is provided according to a strictly defined protocol that includes a robust informed consent provided by the patient to the service provider, and a note from the PCP indicating that the patient is in good health and may begin a long-term, low-calorie liquid diet.
4. a protocol was created that defines those who are poor candidates for OJW.
5. a protocol was created which takes cognizance of the possibility of jaw joint stiffening over the long term.
The first obligation of every health provider is expressed in the Latin phrase Primum non nocere — First do no harm.
Jaw wiring for weight loss has been researched and found to be a safe and effective procedure. My personal research in the dental and medical literature, and questionnaire-survey of my OJW patients, as well as an extensive search of legal archives does not reveal a single instance of harm coming to anyone from jaw wiring. Countless thousands of patients have had their jaws wired tightly together, without incident, by oral surgeons using “Inter-maxillary Fixation” (IMF) to treat jaw trauma and pathology. OJW is by far less aggressive and consequently even more safe.
Choosing the correct weight control method should be done with serious consideration. OJW is not a panacea. It best serves those who overeat compulsively and fear they have lost control of their ability to eat sensibly. They seek to reestablish a modicum of control of the destiny of their health and their appearance. They see OJW as a safe and effective approach that is more aggressive than fad diets and less menacing than weight control using pharmaceuticals with their sometimes unknown and unpredictable side effects. Moreover, the thought of surgical interventions such as liposuction, lap-band and “bariatric” surgery—are anathema to them. Indeed, unlike Orthodontic Jaw Wiring, they are invasive procedures with a mortality rate as high as 2/1000.
After fifteen years of providing this service to more than 200 patients, the worst that can be said is that some of them regain the weight they lost when the appliance is removed. Those who do reach their weight goals are at liberty to leave the brackets on as a psychological “safety net,” if they feel uncertain of having regained sufficient of control over their compulsive eating.
If successful weight loss is defined as a permanent reduction in weight that results in a person attaining a BMI in accord with their height and weight as specified by the National Institute of Health, then it is safe to say all weight loss methods are flawed.
I have persisted in providing OJW for three reasons: First, because patients continually seek this service and come from everywhere in the United States to obtain it absent other providers. Secondly, even though there are patients who are unable to complete the OJW regime successfully, none are remorseful about having tried it. Finally, many patients have expressed abundant satisfaction. I would have discontinued providing the service long ago had I become cognizant of any detrimental consequences or lasting dissatisfaction.
Paradoxically, in spite of providing a plethora of free instructive teaching material to my colleagues, I remain the sole provider of the service, judging by the absence of professionals offering it online. I attribute this to the fact that Orthodontic Jaw Wiring is not expressly named and explicitly sanctioned in the Scope of Dentistry in any state. Moreover, the principle organizations that provide dental professionals with liability insurance—the ADA and AAO—have not expressly stated that this procedure is covered.
Recognition and integration of the OJW service among health providers can be achieved only if health insurers accept it as a method of treatment and introduce appropriate coding into their fee schedules. Government programs that provide healthcare insurance like Medicaid and Medicare (“M and M”) are actively seeking newer safe and effective weight control methods to offset the enormous budgetary expenses resulting from obesity. Those methods are being invented by physicians and dentists like myself. Other providers of such insurance tend to follow the lead of M and M. Insurance coverage for the OJW service and similar services would galvanize dentists to be more attentive to their overweight patients.
I firmly believe that the OJW service and related weight control services are still in their infancy and will continue to be developed and refined. In time it will be offered as one of many weight control devices offered by dental professionals as part of a healthcare team in their local communities.
In conclusion, obesity is legion and recognized as a disease per se as well as a precursor to a host of serious illnesses and other comorbidities. If more members of the dental profession step forward and recognize their right and responsibility to care for selected patients who meet the criteria of being overweight or obese, based on a diagnosis of the patient’s physician, the leaders of our profession in the AAO and ADA will be obliged to clearly define the dental professional’s role in providing this service. Leading health insurance providers beginning with Medicaid and Medicare are cognizant of the cost savings that will accrue to them by intercepting obesity from the start. The trite chestnut “an ounce of prevention is worth a pound of cure” could not be more appropriate. I have demonstrated how this can be done with an appliance of my own invention—Orthodontic Jaw Wiring (OJW™). Others are encouraged to follow suit.
June 18, 2013 — NY Times
The New York Times prints an article announcing that the American Medical Association had officially designated obesity as a disease, not just a risk factor for other disorders, and further notes that this new classification will foster the development of new therapies, and lead to better coverage by insurers.
Prior to this news release, the cover page story of the November 2012 issue of the Journal of the American Dental Association augured a sea change for dental professionals. In effect, the ADA acknowledged that dental professionals were, by and large, overlooking their duties to provide services to those patients who were overweight and rapidly heading toward a condition of obesity. Never before had weight control assisted by dentists been so clearly noted in an American dental journal. The article also presented a survey showing that one of the primary reasons for their reluctance was based on a hesitation to broach the subject with their patients lest they offend their sensibilities.
Dental professionals are the primary caretakers of the mouth. They possess an abundance of social skills and mechano-therapies to provide services to the overweight with discretion and sensitivity. They can do this by providing dietary advice directly and by offering literature on good nutrition in their office waiting rooms. Indeed, many dentists do provide this service — especially those who are holistically oriented.
Providing oral appliances — be they removable or fixed — is a service that can be provided in conjunction with the patient’s primary healthcare provider (PCP). The patient’s physician, under the OJW protocol, is responsible for diagnosing the patient’s weight condition since the scope of dentistry does not permit dental professionals to diagnose weight problems.
Once the patient has provided the dentist with a note from their physician approving a long-term, low-calorie liquid diet, the orthodontist is at liberty to fabricate a customized weight control appliance. In a study conducted by the author 78% of the sample agreed that dental professionals should be considered as part of a healthcare team that provides services to the overweight. Moreover, depending on the patient, the healthcare team would also include a general dentist, dietician, psychologist and/or psychotherapist and bariatric surgeon.
Ted Rothstein DDS PhD
Atlantic Medical Arts Facility
161 Atlantic Ave.
Brooklyn, NY 11201