Jaw Wiring for
Weight Loss Literature References
National Library of The abstracts included below were obtained
from a search done through the website of the Medicine at
http://www.ncbi.nlm.nih.gov.
To obtain these results Search PubMed for "jaw wiring AND weight loss".
General Conclusions of the Articles Presented Below
Jaw wiring is generally accepted by the medical community as a
therapeutically effective method to lose weight.
The only study of jaw wiring on teeth, gums and jaw joints per
se shows that this procedure has no permanent harmful effects.
Behavior modification that results in maintenance of weight lost
is extremely important.
There are no studies specifically aimed at the harmful effects
on the Temporo-mandibular joint of a long-term
"immobilization-rest-immobilization" protocol as utilized by Dr. Rothstein.
Orthodontists seem uniquely reticent and reluctant to provide a
service that no other professional can deliver as safely, efficiently and
competently.
Bruch, Hilde, M.D., EATING
DISORDERS Obesity, Anorexia
Nervosa and the Person Within
1973, Harper Colophon Books
| : Obes Surg 1993 Aug;3(3):261-264 |
 Books |
Preoperative Intermaxillary Fixation has no Influence on
Weight Loss Induced by Vertical Banded Gastroplasty.
Hedenbro J, Frederiksen S, Jansson O, Jisander S.
Department of Surgery, Lund University, Lund, S-221 85, Sweden.
Surgery is the only therapeutic modality that has shown lasting results in the
treatment of morbid obesity. Ability to lose weight by voluntary dieting has
been associated with unsatisfactory weight loss after gastroplasty. This report
examines the effect of preoperative inter-maxillary fixation (IMF) on weight
reduction induced by vertical banded gastroplasty (VBG). Twenty-four patients
entered the study and were randomly assigned to either 10 weeks of IMF or 10
weeks on the waiting-list. Patient groups were similar in respect to age, gender
and Body Mass Index (BMI). All patients were urged to lose weight
preoperatively. Patients in the IMF group lost 18 kg (-12 to -36; median, range)
and the waiting list group lost 3 kg (+ 3 to -30) during the 10 weeks prior to
surgery. Total weight loss from time of inclusion to 24 months postoperatively
was the same in both groups. Our results suggest that weight loss up to 2 years
after VBG is not Influenced by short-term preoperative IMF. Although
we found no
obvious advantage in having patients pre-treated by IMF, our findings indicate
that jaw wiring can be used for patients in whom moderate preoperative weight
loss is desired without endangering the effect of VBG on body weight
development.
PMID: 10757930 [PubMed - as supplied by publisher]
Treatment of obesity.
Bjorntorp P.
Department of Medicine I, Sahlgren's Hospital, University of Goteborg, Sweden.
Current treatment of obesity seems to be focused mainly on the success of losing
body weight, which can be achieved, in order of increasingly drastic manoeuvres:
by simple nutritional advice; professional follow-up of a negative energy
balance; drugs with effects on appetite regulation, energy absorption or
expenditure; total seclusion with control of every administered calorie;
surgical intervention; or even jaw-wiring. The only treatment of this sort that
has been convincingly shown to have long-lasting effects is surgical
intervention in the gastrointestinal tract, but this can only be accepted for
use in severe cases. Thus, the problem of treatment of moderate obesity is to
find an effective therapeutic modality which iss efficient in maintaining a
reduced weight. Obesity treatment also seems to have focused too much on the
mass of excess body fat, which is not necessarily an indicator of the medical
hazards of the condition. It is important to realize that the risk factor
clusters following obesity are often efficiently treated by successful reduction
of the obese condition. Instead of specific treatment of each of these
complications by, for example, multi-pharmacological therapy, a sufficiently
efficient obesity treatment would be a preferable substitute. This goal may, if
necessary, be achieved by treatment with a single drug with a useful therapeutic
profile, including efficiency in the long-term to prevent relapse. Chronic
treatment might then be considered acceptable in the same way as chronic
pharmacological treatment of hypertension and hyperlipidemia, for example. No
drug has as yet proven to have these characteristics.(ABSTRACT TRUNCATED AT 250
WORDS)
Management strategies for weight control. Eating, exercise
and behaviour.
Caterson ID.
Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, Australia.
Obesity is a major health and social problem worldwide for which no single
satisfactory treatment exists. Because of the prevalence of the disease,
numerous therapeutic strategies have been attempted--often unsuccessfully.
Weight loss programmes based on dietary restriction of caloric intake and
nutritional education, exercise, surgical (gastroplasty, gastric bypass) and
procedural (gastric balloon, waist cord, jaw wiring, liposuction) intervention
and pharmacotherapy (appetite suppressants, thermogenic agents, bulking agents)
used alone or in combination, have produced weight loss in the short to medium
term; however, weight is generally regained on discontinuation of treatment.
Behaviour modification programmes appear to offer the highest success rate in
the long term. Weight loss is not rapid, although losses of 10 to 15 kg have
been achieved after 6 months, and this may be increased when behaviour
modification therapy is combined with more aggressive treatments such as severe
caloric restriction or jaw wiring. Behaviour modification is particularly
beneficial in special patient groups such as the obese elderly, children or
adolescents, and disabled patients. Thus, although it appears that each of the
treatments developed for the management of obese patients has its place, the
cornerstone of therapy for most patients remains a programme of dietary
restriction, combined with exercise and behaviour modification.
Effect of the Garren-Edwards gastric bubble on gastric
emptying.
Velchik MG, Kramer FM, Stunkard AJ, Alavi A.
Department of Radiology, Hospital of the University of Pennsylvania,
Philadelphia 19104.
The Garren-Edwards Gastric Bubble (GEGB) was introduced in 1984 as an
alternative to surgery (jaw wiring, gastrointestinal bypass, vertical banded gastroplasty) for the treatment of morbid obesity in patients who had failed
behavior modification therapy or dietary management for weight reduction. Its
mechanism of action is unclear and previous reports have not demonstrated any
significant consistent alteration in gastric emptying (GE) as measured by
radionuclide techniques. Other proposed mechanisms include: placebo, hormonal,
mechanical "satiety", behavioral modification, and neuronal. In order to
determine the effect of the GEGB on GE, ten obese (mean % overweight = 89%)
patients, 27-50 yr old (mean = 36 yr), had solid GE scans before and 5 wk after
endoscopic placement of the bubble. GE scans were performed in six patients
after removal (12 = wk residence time). The meal consisted of 300 microCi
[99mTc]sulfur colloid in the form of a 300 kcal egg sandwich (egg white 248 g,
white bread 40 g, butter 6 g; composition = CHO 40:PR 40: FAT 20) with 180 ml
deionized water. Images were obtained in the anterior and posterior projections
at 15-min intervals for 1 hr (four patients) or 2 hr (six patients) and the %GE
(decay corrected geometric mean) was calculated. Unlike other studies involving
the GEGB, adjunctive therapy in the form of dieting and behavior modification
were not employed in this study. The effect of the GEGB alone in the treatment
of obesity has not been previously evaluated. There was a significant (p less
than 0.025) delay in gastric emptying at 1 hr (pre-bubble mean % gastric
retention = 46%; bubble mean = 57%; n = 10). After removal, GE returned toward
baseline (mean % gastric retention = 51%; n = 6) (p less than 0.05) (Student's
t-test). The average weight loss was 5.5 lb (n = 10; p less than 0.025). One
mechanism of action of the GEGB may be delayed gastric emptying resulting in
early satiety and decreased food intake with resultant weight loss
Inpatient-outpatient randomized comparison of Cambridge diet
versus milk diet in 17 obese women over 24 weeks.
Garrow JS, Webster JD, Pearson M, Pacy PJ, Harpin G.
Rank Department of Human Nutrition, St Bartholomew's Hospital Medical College,
London, UK.
Twenty-two obese women were recruited for a prospective cross-over trial of the
effects of either the Cambridge Diet (CD) or 1200 ml milk with iron and vitamin
supplements (milk) during a three-week inpatient study, then 20 weeks as
outpatients, then a final week as inpatients. Five dropped out, leaving eight
who took initially milk and then CD and nine who took CD and then milk. Within
each diet group five women had their jaws wired together during the outpatient
phase. The four groups (CD/milk, with/without jaw wiring) were initially well
matched for age, height, weight and resting metabolic rate (RMR). There was no
significant difference (by unpaired t test) between the groups during the
initial inpatient phase in rate of weight loss, or N loss/kg weight loss, but
patients on CD during days 13-22 had a greater daily N loss than those on milk
(2.08 vs 0.28 g N/day, P = 0.02). When the change in weight loss, N loss and
N/kg weight loss on changing diet within a patient group was compared by paired
t test the patients changing from milk to CD showed no significant change, but
patients changing from CD to milk showed a reduced rate of weight loss
(0.36-0.23 kg/day; P = 0.012), a reduced N loss (2.02-0.28 g N/day; P = 0.0013)
and reduced loss of N/kg (6.26 to 1.02 g N/kg; P = 0.025). During the outpatient
phase weight loss was not significantly related to the diet, but patients with
jaws wired lost more weight than those without jaw wiring (0.151 vs 0.077
kg/day; P = 0.04).(ABSTRACT TRUNCATED AT 250 WORDS)
When to advise surgery for severe obesity.
Garrow JS.
Rank Department of Human Nutrition, St Bartholomew's Hospital Medical College,
London, UK.
A typical severely obese patient will have about It is difficult to maintain this degree of dietary
restriction over such a long period, and procedures such as jaw wiring or
stomach stapling may help in some cases. Mainten50 kg excess weight to lose,
which is equivalent to a store of 350,000 kcal. The optimum rate of weight loss
in such a patient is about 1 kg/week, which involves an energy deficit of 1000
kcal/day for about a year. ance of weight loss is difficult
to achieve and may be helped by fitting a nylon waist cord after weight loss. On
theoretical grounds, patients who do not lose weight despite keeping to a
properly-designed reducing diet would not benefit from surgery, but in practice
this problem does not arise. It is dangerous to resort to surgery for the
treatment of severely obese patients who cannot diet by reason of psychiatric
disorder.
A cross-sectional cost/benefit audit in a hospital obesity
clinic.
Pacy PJ, Webster JD, Pearson M, Garrow JS.
A cross-sectional survey was made of the 25 men and 127 women attending a
hospital obesity clinic over a period of 6 weeks. Among the men the mean (+/-
s.d.) age was 37 (+/- 14) years, weight 115.2 (+/- 25.4) kg, height 1.70 (+/-
0.09) m, and Quetelet's index 39.6 (+/- 6.4) kg/m2. Among the women the
corresponding values were 41 (+/- 15) years, 102.2 (+/- 22.3) kg, 1.60 (+/-
0.07) m, and 40.3 (+/- 9.2) kg/m2. The most common reasons for wishing to lose
weight among both men and women was to improve appearance, shortness of breath
and pain in weight-bearing joints. About one-third of the patients tested had
raised fasting plasma triglyceride levels. Only one had tests indicating
hypothyroidism, and two were hyperthyroid. None of these characteristics
predicted how long the patient would continue to attend the clinic. Weight loss
was calculated according to the duration of attendance at the clinic, and the
method of treatment. Two men and 15 women were treated by jaw-wiring,
and the
remainder by dietary advice alone. No anorectic or thermogenic drugs were used.
Among men treated by diet alone the mean weight loss after 1-3 months, 4-6
months, 7-12 months and greater than or equal to 13 months attendance was 5.0
+/- 6.2 kg, 12.4 +/- 11.0 kg, 12.4 +/- 10.2 kg and 13.0 +/- 5.2 kg respectively.
Two men treated by jaw-wiring had lost 23.9 and 57.9 kg.(ABSTRACT TRUNCATED AT
250 WORDS)
Jaw wiring in the treatment of morbid obesity.
Ramsey-Stewart G, Martin L.
Fourteen patients originally presented with hyperphagia and intractable morbid
obesity have had maxillomandibular fixation (MMF) applied in an effort to
control their obesity. In 10 patients who were massively obese or considered
poor risk candidates for surgical control of their obesity,
MMF was applied with
the aim of reducing the obesity to a level where a surgical gastric restrictive
bariatric procedure could be safely carried out. Eight of these patients had
been rejected for surgical control of obesity elsewhere and two were edentulous.
Five of these patients after successful weight loss over periods from 16 to 40
weeks (mean percentage overweight lost 84.8, range 39-150) safely underwent a
gastric restrictive procedure. All five patients have had continuous weight loss
after bariatric surgery. Two patients requested removal of MMF 1 and 2 weeks
after application. The remaining three patients, who were candidates for
surgery, after successful weight loss over periods from 12 to 28 weeks (mean
percentage of overweight lost 45, range 38-50) decided not to proceed with
surgical control. All have subsequently regained the lost weight.
Four
originally morbidly obese patients, who had had a previously successful gastric
restrictive procedure followed by weight loss, requested MMF in an effort to
lose further weight. Over periods from 8 to 16 weeks three of the four had
further weight loss (mean percentage of overweight lost 18.3, range 5-30). After
removal of MMF all four patients regained some weight. In only one was there a
significant maintenance of weight lost during MMF.(ABSTRACT TRUNCATED AT 250
WORDS)
The surgical treatment of obesity.
Wastell C.
Surgery for obesity has developed continuously since it was introduced in 1956.
The early idea of small intestinal bypass has been refined to the point that the
majority of surgeons agree that about 45 cm of small bowel should be left in
continuity, 30 cm of jejunum and 15 cm of ileum. Providing care is taken to
given dietary supplements plus a high protein, low fat, low oxalate and high
calcium diet, together with a ready response to severe liver damage by treatment
of bacterial infection in the bypassed loop, this operation or one of its
variants appears to be reasonably safe. But it is nevertheless followed by
significant and undesirable side effects. Wiring the jaw is effective in
producing weight loss and has the advantage of simplicity and cheapness.
Unfortunately when the suffer is released weight is gained in all cases. Gastric
operations designed to reduce the size of the proximal stomach to a paltry 50 ml
are of two types--gastric bypass in which the small and otherwise closed pouch
is drained into the small bowel and gastroplasty in which a 9 mm stoma drains
the pouch into the distal stomach. There is much to commend gastroplasty and
reports so far do not indicate such a large number of late complications as with
jejuno-ileal bypass. This surely is where the future of surgery in this
condition lies.
Locus of control in obesity: predictors of success in a
jaw-wiring programme.
Ross MW, Kalucy RS, Morton JE.
One hundred and thirty-three obese women were administered a modified version of
the Reid-Ware Locus of Control questionnaire prior to jaw wiring. The factorial
structure of the questionnaire was examined, and found to be primarily a
unidimensional measure of internal and external locus of control, with two
subscales. Total score had greatest predictive validity in terms of the four
criteria of success of weight loss while wired, percentage weight loss of wiring
weight, weight gain over six months, and compliance with the treatment regime.
Twenty items of the scale predicted success on one or more of these criteria of
success, and are presented as an abbreviated locus of control scale with a
higher degree of validity than the original scale.
The oral effects of prolonged intermaxillary fixation by
interdental eyelet wiring.
Shephard BC, Townsend GC, Goss AN.
The oral effects of prolonged intermaxillary fixation were investigated in 106
severely obese patients who had been jaw wired as an aid to weight loss.
The
principal complications during fixation were episodes of periodontal pain and
tooth mobility (40%). After removal of fixation, the principal sequelae were
residual periodontal problems (9%) and mandibular limitation (9%). These
findings were confirmed in a subgroup of 11 patients who had detailed
measurements made of their periodontal index, oral hygiene index and range of
jaw movements. These findings were discussed in relation to other methods of
management of obesity. [Oral surgeons apply the
wires by passing the wire between the teeth with great skill and care to try to
avoid having the wire damage the gums. Elastics are use to hold the jaws
together. Orthodontists are uniquely able to bond brackets to the teeth of the
upper and lower jaw and then thread a wire between the upper and lower jaws and
control the force being used to hold the jaws together...a far more simple and
less invasive/almost harmless procedure when compared to the approach of the
Oral Surgeon...Note added by By Dr. Rothstein]
Maintenance of weight loss in obese patients after jaw
wiring.
Garrow JS, Gardiner GT.
In treatment of obesity restriction of food intake is necessary to achieve good
results. Various operations have been devised to prevent patients overeating,
but in this study jaw wiring was used to limit food intake. This procedure
produces weight loss in obese patients but when the wires are removed the weight
is usually regained. This report studied a group of patients whose weight loss
was maintained after the wires were removed. A nylon cord fastened round the
waist of the patient after weight reduction was found to act as a psychological
barrier to weight gain. Seven patients were followed for 4-14 months after
removal of jaw wires and regained a mean of only 5.6 kg of the 31.8 kg lost
while their jaws were wired. This procedure compares favourably with other
treatments for severe obesity.
Treatment of massive obesity by prolonged jaw immobilization
for edentulous patients.
Goss AN.
Twenty massively obese patients who were edentulous in one or both jaws were
treated by prolonged jaw immobilization. Dentures were secured under general
anaesthesia to the edentulous jaws by various direct wiring methods and the jaws
immobilized by interdental wires, where teeth were present, and intermaxillary
wires. The wired-in dentures were generally well tolerated with minimal mucosal
reaction but with a high incidence of infection around the attachment wires.
Patients edentulous in one jaw alone, (11 maxilla, two mandible), managed well
and 11 achieved a satisfactory weight loss. The seven patients edentulous in
both jaws had considerable difficulty with pain and infection, three having the
fixation appliances removed in the immediate post-operative period and only one
achieved a satisfactory weight loss. Thus prolonged jaw immobilization is an
effective means of treating massively obese patients if they are edentulous in
one jaw alone but less so if they are completely edentulous.
Gastric reduction for morbid obesity: technique and
indications.
Kark AE, Burke M.
The results of gastric reduction for obesity in 12 patients are described.
Emphasis is laid on preoperative weight loss, using jaw wiring in 9 patients.
The successful outcome of the operation was found to depend on the formation of
a small gastric pouch and a narrow gastro-jejunal anastomosis. A constant-sized
pouch was achieved by forming the pouch around a 100-ml silicone balloon devised
for the purpose. Postoperative results were good in 7 patients, partial success
was achieved in 3 patients and there were 2 failures. It is concluded that the
procedure will produce successful results provided that a small proximal pouch
with a narrow outlet is fashioned in motivated and psychologically well-balanced
patients.
YO-YO dieting: Q and A
NY Times article April 25, 2006 by C. Claiborne Ray
Question:
"We have been told that
yo-yo dieting is unhealthy. But is gradual weight loss followed by gradual
weight gain really more unhealthy than just staying obese?"
[Read the answer.]
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