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Orthodontic Jaw Wiring Directory
The Final Cut of OJW for Dental Professionals the Documentary Film Vimeo site
Become a provider: OJW for Dental professionals
***All the FAQ's Related to OJW: Scroll Down***
May 3 2010: Orthodontic Jaw Wiring
[See Power Point Presentationpresented to American Association of Orthodontists in Washington, DC: E-Synopsis containing the documents referred to in the PowerPoint presentation: E-Synopsis
Orthodontic Jaw Wiring: The Dental Professional’s Role in Weight Control for Compulsive Overeating Leading to Obesity:
an article submitted to JADA (The Journal of the American Dental Association, February 5, 2009)
ADA Recognizes Obesity (Nov. 17, 2010)
OJW documentary film for dental professionals.htm
OJW DPOJW Course for Providers of OJW
The Informed Consent for OJW
The OJW Questionnaire Survey and the responses to it
Flow chart for the principles of providing the OJW service and the goals of the author
August 8, 2008: Part I and II YouTube videos on the Development and Application of OJW
OJW-DPOJW Power Point Presentation
The photo-documentary protocol for dental professionals to provide OJW (6/14/07)
An informative Letter to Would be OJW Patients Who are Ready to Proceed
OJW patent application drawings: Sheet 1 Sheet 2
The standards expected of providers of Orthodontic (Dental) Jaw Wiring
A Capsular View of OJW
La présentation Power Point : Orthodontic Jaw Wiring (OJW)
Ligature Orthodontique Intermaxillaire Rôle du praticien dans le contrôle des excès d’alimentation
Version française: Modèle de consentement éclairé du patient concernant la technique OJW
The First Forum on the Pros and Cons of OJW
A Letter to Orthodontists Regarding OJW Patient-care 9/22/03
The Second Forum on the Pros and Cons of OJW: responses to the letter of 9/22/03
The OJW Round Table Controversy Article in Orthodontic Products Magazine
The Diploma/Certificate granted to DPOJW members
Table Clinic Presentation on OJW at the 106th Orthodontic Meeting in Las Vegas May 7, 2006
How to Proceed When You Choose OJW
Response to a Binge Eater Seeking OJW
OJW Telephone Consultation Memo
Learn About the DDS System for Weight Loss
Interview with Sandra Whyte an OJW patient...1998
The information you find below is a compilation of responses to questions that have been posed since the service was posted on my website. As far as I know this site is the most extensive when it comes to information on this subject. I would be grateful if you did locate other sources to let me know about them.
As of the year 2000 more than 50% of Americans are heavier than their ideal weight. From 15 percent to 35 percent of adults are on diets, and Americans spend $30 billion to $50 billion a year trying to lose weight. An estimated 3 percent to 5 percent of the population of the United States, (at least eight million people, more than half of them women), are morbidly obese. Obesity greatly increases the risk of illnesses that are among the nation's leading causes of death, including diabetes, heart disease, respiratory problems and some forms of cancer. Obesity increases the risk of death by up to 100% and causes 300,000 premature mortalities a year. Experts on obesity have been forced to acknowledge that for the majority of obese patients, diet, exercise and weight-loss drugs simply do not work.}-- Denise Grady, NY Times, 10/12/2000 "Exchanging Obesity's Risks for Surgery's" On Jan 18,2002, CBS TV's documentary Journal "48 Hours" did an article entitled, "A LOT TO LOSE." (video tape $29.95 at 800 338 4847).
My own father struggled mightily with the problem of obsessional craving for between-meal snacks day and night. (Anyone know the "scientific name?)... He knew he wasn't hungry...he was nervous. His solutions even included a lock and chain on the refrigerator. He might have availed himself of a "lock and chain" on his teeth, so to speak, had it been available during his lifetime.
The following are questions that have arisen in the course of my years doing the procedure: Click on ANS. for the answer.
Ground Zero: Why do we eat when we are not hungry?...Answer
1000 Weight Maintenance Tips
IRS Allows Deduction of Certain Weight-Loss Expenses After an Obesity Diagnosis...Read the article
Q1. Can you direct me to useful information about obesity and weight management?...ANS
Q2. How Is OJW different than jaw wiring done by an Oral Surgeon?...ANS.
Q3. Has jaw wiring for weight loss been medically researched?...ANS.
Q4. Why do you lose weight when your jaws are wired together?...ANS.
Q5. How are the jaws wired closed?...ANS.
Q6. Is orthodontic jaw wiring for weight loss safe?...ANS.
Q Who can provide the orthodontic jaw wiring service?..ANS.
Q How much experience do you have with the OJW approach to weight control?...ANS.
Q I am interested in losing weight by having my jaws wire closed. Can you provide me with information about this technique and its possible adverse affects?...ANS.
Q When can I get an appointment to have my jaws wired?...ANS.
Q So I have to remove the wiring every 4-6 weeks?...ANS.
Q. How do I maintain good oral hygiene when my jaws are wired together?...ANS.
Q When I release my jaws from the wiring what can I eat...ANS.?
Q What causes me to eat compulsively anyway?...ANS.
Q What other approaches to weight loss are available?...ANS.
Q Who is not a good candidate for this procedure?...ANS
Q Could I remove the wires if I wanted to or needed to in an emergency?...ANS.
Q Could I rewire myself if I wanted to or needed to in an emergency?...ANS.
Q What if I needed to remove the wires "immediately" and forgot my wire cutter?....ANS.
Q What can I do if I want to have the braces (brackets) removed and I can not return to Dr. Ted's office?...ANS.
Q How much weight can be lost?...ANS
Q Has any OJW patient ever voiced regret or complained?...ANS
Q How does it feel to have your jaws wired closed and what happens to your speech? ...ANS.
Q Can the jaw wiring cause harm to my teeth and gums?....ANS.
Q Would my breathing be affected, and in what way?...ANS.
Q Are there any harmful consequences to being on a liquid diet?...ANS.
Q Should I consult my physician before embarking on such an endeavor as OJW?....ANS.
Q If I have bridges or missing teeth would that prevent me from having my jaws wired?...ANS.
Q What is the fee for OJW?...ANS.
Q Any success stories?...ANS.
Q Why should I consider OJW for weight loss?...ANS
Q How do I begin if I want Dr.Ted provide the OJW service for me?...ANS.
Q I'm coming from out-of town. Can you give me directions form the three major airports in and around NYC?...ANS.
Q I live in distant state from Dr. Ted's office. Doesn't that present problems?...ANS.
Question1: Can you direct me to useful information about obesity and weight management?
Answer: http://members.aol.com/besharat/health72.htm "Obesity and Weight Management"
You will be surprised when you see the answers to that part of the article that answers the question: "WHY DO WE EAT WHEN WE ARE NOT HUNGRY?"
Under the category SURGERY the author states: "Jaw wiring is another commonly used, but not recommended, surgical treatment. Initial weight loss is similar to gastric procedures on average but data on weight maintenance is quite variable."
OJW (Orthodontic Jaw Wiring) can not by any medical definition of the word be viewed as a "surgical" procedure. Au contraire. That is precisely the reason why the moderately obese can choose OJW.
See also: http://www.weight-loss-i.com
Question 2: How Is OJW different than jaw wiring done by an Oral Surgeon?
Answer: Oral surgeons call the procedure that they do IMF (Inter-Maxillary Fixation) and MMF (Maxillo-Mandibular Fixation). You can read a succinct summary answer by going to "ask jeeves" at http://www.askjeeves.com/ and ask the question: What is jaw wiring? The basic differences are as follows: OJW is only done by an orthodontist never by an oral surgeon. It is non-invasive and done in the office never in a hospital. OJW takes 35 minutes without any anesthesia because it is painless and that is because "brackets" are bonded to the teeth (30 minutes) and there is no post procedure pain or possibility of post procedure infection.You can see how Oral surgeons wires the jaws together using "Ivy" loops in yesteryear. you can see why Oral surgeons lost any interest providing the OJW service. (See Ivy loops). The brackets of the upper jaw are laced with a thin wire to the brackets of the lower jaw in 1-2 minutes. OJW is done on carefully selected overweight patients. IMF takes more than an hour under general anesthesia usually in a hospital operating room because it is invasive. IMF is done on patients who have been subject to trauma, disease or who need to undergo surgery to correct deformed jaws. It is typically accomplished nowadays by attaching an "arch-bar" to each of the upper and lower jaws with wires that are threaded between the teeth (and usually the gums as well). The upper and lower arch bars are connected with elastics. In IMF the lower teeth are compressed against the upper by the elastics. In OJW the the lower teeth do not compress or even touch the upper teeth...the lower jaw is wired so as to suspend it from the upper jaw. The distance between the upper and lower teeth is about the distance between the bars of this equal sign =. Finally, in OJW the wiring is removed and reapplied every 4-6 weeks for 3-5 days of exercise to prevent or minimize any stiffening of the jaw joint that might occur over a long period of time, for example,4-8 months. In OJW the patient can remove the wire in less than 10 sec with a wire cutter. Removing the braces and leftover adhesive cannot easily be done by the patient. In IMF the arch-bars are removed once and for all in 6-10 weeks under local or general anesthesia. In IMF the patient has no knowledge of release and remove procedures of the arch-bars which is usually done under local or general anesthesia because it is painful and can be removed only by the oral surgeon.
Question 4: Why do you lose weight when your jaws are wired together?
Answer: 1. Heightens resolve: Wired jaws are tangible evidence, and a persistent reminder that you have decided and are determined to lose some if not all of your excess weight.
2. Prevents eating solids: Wired jaws prevent/make it difficult for you from eating all/most of the very worst foods: bread and cake, candy, cookie and pastries, pastas, pizza, Frenchfries, burgers and other meats, that often contain excessive fat.
3. Minimizes snacking: Wired jaws minimize your snacking because preparing a snack takes special time and effort to prepare (liquify/puree) the snack. So jaw wired patients are less inclined to have the snack.
4. Focuses you on nutrition: Wired jaws compel you to think more about nutritional value of food such as fat and salt content, vitamins and minerals, and calories.
5. Helps controls calories: Many people who are limited to a liquid diet may well choose the products offered by companies like Ensure and Slim-Fast. The caloric values and contents are exactly known; consequently, dieters can know and more easily control their daily caloric intake.
6. After 2-3 weeks your stomach shrinks and the need/desire for food becomes less intense.
7. You see yourself losing weight...it gives you pleasure...you see yourself as being in control...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 self-control are renewed.
Question 4: How are the jaws wired closed?
Answer: You can see photos of an actual jaw wired patient and just below that a diagram of the typical pattern and method I use to wire the jaws closed. The wiring is placed on the first and second premolars and the canines. You can see a simplified version of it if you [click here].
Question 5: Is OJW for weight loss safe?
Answer: In a word...yes. I would point out to the reader that oral surgeons are the originators of jaw wiring (IMF and MMF) and provide this service to thousands of patients world-wide annually in the course of their work when treating patients with with broken jaws or providing their surgical skills to patients who need correction of jaws that are diseased or malformed. In the oral surgeon's purview patients must often be wired using rather crude techniques for 4-6 weeks to allow healing of jaws that have been "surgerized". I have never heard of a single mortality caused or resulting directly from jaw wiring, and here I am specifically referring to mortality resulting from the aspiration of vomitus into the lungs. I conclude that given that the provider of the OJW for weight loss [use of brackets on teeth to wire the jaws and periodic release of the wiring for exercise] chooses patients who present no "contraindications," i.e., patients who do not have pre-existing conditions (see partial list below), that would make them poor candidates for the procedure to begin with, are acceptable candidates/risks for OJW. Moreover, adherence to the "protocol" for delivering the service is also essential. I have not experienced a single incident of harm to any patient who has been under my care. (Those of you who want more information can go to http://www.ncbi.nlm.nih.gov/PubMed/ and do a search on "jaw wiring for obesity." Here is the abstract of an article that appeared in Lancet, a respected medical journal:
Lancet 1977 Jun 11;1(8024):1221-2 Related Articles, Books, LinkOut
Jaw wiring in treatment of obesity.
Rodgers S, Burnet R, Goss A, Phillips P, Goldney R, Kimber C, Thomas D, Harding P, Wise P
17 patients with severe (median percentage above ideal weight 100%) and resistant obesity underwent jaw wiring. There were no major complications and patients tolerated the procedure and subsequent minor inconveniences. All patients lost weight at a rate (median 25-3 kg in six months) comparable with that of intestinal bypass surgery and one achieved and maintained her ideal weight. Two-thirds of the patients, however, regained some weight after the wires were removed. Jaw wiring is a simple effective procedure which can be carried out in most hospitals, and has a place in an integrated approach to obesity. Read the 2 page scientific article in Lancet the prestigious medical journal. [CLICK HERE]
- SPECIAL NOTE FROM DR. TED:
REGAINING OF WEIGHT SHOULD NEVER BE THE SOLE CRITERIA OF THE EFFECTIVENESS OF A WEIGHT CONTROL METHOD. OJW IS A UNIQUE METHOD CHOSEN BY THOUGHTFUL AND INTELLIGENT PERSONS WHO HAVE CAREFULLY CONSIDERED ITS PROS AND CONS.
PMID: 68326, UI: 77191459
Question 6: Who can provide the OJW service?
Answer: I feel confident when I say that orthodontists are well suited to provide this service to carefully selected candidates. That is because they have knowledge of the teeth, gums and jaw joints that no other practitioner in a health service can offer. In addition, they have the skills to bond brackets on teeth to which wires can be attached. Finally, they are used to seeing patients every 4-8 weeks. I have seen jaw wiring done by an oral surgeon (for whom I have the highest regard) that resulted in such discomfort and gum tissue harm that the the patient simply could not maintain the work; which had to be removed and was accompanied by much discomfort. However, in support of oral surgeons, they have much more experience overall than orthodontists. Unfortunately, their experience is limited to wiring broken and surgerized jaws, unlike orthodontists who can choose patients who have few or no jaw/jaw joint problems. Sadly, orthodontists as a group believe/act as if this modality of treatment is not in their "purview"; i.e., to assist overweight patients in their unique way . Weight loss clinics and enlightened physicians, especially those associated with hospitals, would do well to consider this OJW for select patients well before referring their patients for invasive, life threatening "bariatric" surgery
Question: How experienced are you with the OJW approach to weight control?
Answer: I began OJW on patients who chose the method about six years ago. In total I have wired more than 40 patients, including a young woman who wanted to have the procedure done in the US, but could not find a provider for this service. She finally went to England to have it done. However, the method used to accomplish the wiring left her in great discomfort. When she found me I had to remove the work done and redo it properly. I am sure I could arrange for you to speak with her if you desired, or with Sandra Whyte, another patient whose jaws were wired. At present I have four patients whose jaws are wired closed. You may see their medical charts by going to the OJW Directory and choosing the case you want to review.
Question: I am interested in losing weight by having my jaws wire closed. Can you provide me with information about this technique and its possible adverse affects?
Answer: Prior to the jaws being wired together you will be required to complete an "acquaintance" form which provides information regarding your past and present dental and medical history. Then Dr. Rothstein will examine your mouth, teeth, gums and jaws to determine if the status of the oral environment is in good health. If the examination and/or history shows that there is or may be a dental or medical problem that requires attention he will advise you to see the appropriate health provider before he will wire your jaws together. Prior to OJW he will provide you with an "Informed Consent" memo to sign which signals your intent to go ahead with the procedure and that you have been properly informed of the facts related to the procedure.
The entire OJW procedure takes about 40 minutes to complete with the patient seated in the dental chair. No anesthesia is required because there is no pain or discomfort. The teeth are first cleaned on the tongue side. The procedure of bonding the brackets (hooks to attach the wires to) onto the teeth takes about 30 minutes and about 10 more minutes to weave the wire, which is about as thick as this letter "I", up and down around the brackets. There is no pain and no discomfort and therefore anesthesia is not required.
Typical braces (called brackets) are bonded to 12 teeth: 3 teeth on the upper right and 3 teeth on the upper left and likewise for the lower. The patient places hsi or her lower jaw in "normal" bite position and a soft wire is "woven" up and down around the brackets on the left side. A separate piece of wire is similarly placed around the brackets on the right side. The jaws are wired in such a way so as to allow a slight bit of slack between the jaws. (See photo of brackets on patient.)
Once the wires are placed, oral hygiene is maintained by antiseptic rinses for behind the teeth and normal brushing for the front surfaces of the teeth.
Nourishment is accomplished with a liquid diet. It is rare to find a person who cannot take liquids in this manner. You can choose to drink through a glass or a straw.
I recommend the wire be removed to allow cleaning and exercise of the jaw muscles, i.e., as in talking, chewing, etc. once every 4-6 weeks. [See Jaw joint exercises] I advise patients to have me check them should they have any feeling of discomfort. I also advise them to have a simple wire cutter, which I provide (like the "Nippy" cutter one buys at Radio Shack for $4.50) with them at all times because sudden sickness (nausea) can lead to vomiting. If the vomitus (which is a liquid) cannot be expelled completely/rapidly enough through the mouth and nose there is a risk of it passing back into the windpipe (trachea) and then the bronchial tree leading into the lungs. There it can cause grave sickness, and even death can occur (pneumonia). That is why surgeons order "No food or drink" 12 hours before they do does your surgery. Anesthesia suppresses the gag reflex.)
This has never happened or ever known to have happened to anyone whose jaws have been wire closed. Ill be the first one to tell you about it. (See also interview with Sandra Whyte)
The longest time I have had a patient in OJW is about 6-7 months. They lose 1.5-2 lbs/week. Try talking with your teeth held together and you will have a sense of the experience. Listen to Valerie Freeland who was wired on Feb. 2, 2002. (Not every one sounds as good as she does.)
The fee for OJW is presently set at $2685 for the initial placement of the brackets and wires and $95-$135 to remove and replace the wire and clean the insides of the teeth (at least once every 4-6 weeks).
Question: When can I get an appointment to have my OJW?.
Answer: Patient-care hours for this procedure are Thursdays at 11:30 am or Fridays at 9:00 am. The appointment begins with a conference with Dr. Rothstein to review the most important facts related to jaw wiring and weight loss and patient and doctor responsibilities. The placement of the brackets and the wiring takes under 40 minutes. It would be advisable to remain at the office another 30-45 minutes after the procedure, which is painless, to "settle into" the feeling of having your jaws closed together. You should expect to be at the office for 2 hours and 30 minutes. Dr. Rothstein will provide you with his home phone if he has not already provided you with it.
Question: Why do I have to remove the wiring every 4-6 weeks?
Answer: You need to exercise your jaws to minimize potential stiffening that can occur with prolonged immobilization of the joint. The only knowledge of prolonged immobilization that I am aware of is the immobilization that oral surgeons do (IMF...Inter Maxillary Fixation and MMF...Maxillo-Mandibular Fixation) which is what they do to help jaws to heal when their patients present with disease or trauma that demands immobilization of the joint. Their technique for wiring the jaws is entirely different when compared to the "orthodontic" approach. The orthodontic approach begins with patients whose gums, teeth, jaws and jaw joints are in good health to begin with. It is common for oral surgeons to have patients wired continuously for as long as 2-4 months without release. I am told that some stiffening does occur during that time. Not a single study has been done by orthodontists to measure the possible transient or long-term harm to the jaw joints from short-or-long term immobilization (OJW) of the joint using the modified wiring approach that do for the patients I accept.
Question: How do I maintain good oral hygiene when my jaws are wire together?
Answer: You brush your teeth as you normally do on the outside surfaces. You use antiseptic rinses for the inside surfaces. You can also use "Glyoxide," an over-the-counter product made of glycerine and peroxide (especially good for gums). When you remove the wires for the periodic release you can have your dentist clean your teeth. You can use breath sprays to keep mouth odors, which might form more rapidly, from becoming offensive. Anybody have any other suggestions?
Question: When I release my jaws from the wiring every 4-6 weeks what can I eat?
Answer: You can eat whatever you want and think of it as a "well-deserved gift" to yourself for being controlled. Or, you can make it a test of your new sense of self control. If you binge, that tells you something, but if you stay in control of your desire to head for the refrigerator, or if you choose a nourishment that is far more sensible than the ones you used to choose you can add a new feather to your cap.
Question: What causes me to eat compulsively anyway?
Answer: The reasons are manifold. You can find complex answers related to levels of hormones and various chemicals that exist naturally in your body and eating "thermostats" that make eating alarms go off in your brain. In an article in The American Journal of Physiology in the their February 2002 issue the authors found the cause of Night-Eating Syndrome to be related to the lessening of Melatonin and Leptin and the rising of Cortisol in the blood serum at night.
My brother Jerry who lives on "Hawaiiisland" shared this with me about compulsive eating and how he overcame it. It's called "Eating Air." I think it is worth passing along to you. Since it's instant, easy and free, it's worth trying.
COMPULSIVE EATING aka FOOD ADDICTION
Until I consciously observed my own eating compulsion (i.e anytime I think of food I go for it, being unable or unwilling to stop myself from visiting the refrigerator or pantry) I had no understanding or sympathy for "addiction." Then it dawned on me: I was addicted - to food! I had no self-control barrier between the thought of food and getting it and eating it. I'd go to the refrigerator to look see even after I'd visited it a half-hour before and found nothing to eat...At meals, buffets, and potlucks, I'd eat two or three portions, not just one. The only person who ate more then me was the only person who was fatter than me. I finally realized that the desire to eat was not motivated by hunger but by (a) social discomfort when in public (it's easier to eat than socialize) and (b) procrastinating. Putting things off is what put me into the kitchen at home. There I could distract myself from what I should be doing but am not doing, by spending time preparing food, sitting down to eat it, and reading a newspaper or magazine at the same time. These two deficiencies seem to be the basis of my eating compulsion. When I'm busy and productive, I eat much less than when I'm not. I never eat because I'm hungry. I eat because its time to eat (3 meals a day) and between meals because it serves a psychological need. Did you ever examine what needs your eating compulsion serve?
"Eating Air: Overcoming the Compulsion to Overeat."by Jerry Rothstein
Try “eating air” as your initial approach to weight loss. This novel method has worked for me and has proved helpful for me to derail the desire to eat and quell that headlong impulse to graze the refrigerator and pantry between meals and after dinner as well as after going to bed. If orthodontic OJW is necessary, choose Dr. Ted because he is the first/only doctor in the nation/world to develop a an orthodontic jaw-wiring-for-weight-loss protocol. If you are already in OJW treatment, try “eating air” during the 3-5 day “release-the wiring-and-exercise” periods. If it works, use it to maintain desired weight once the OJW is removed. What Dr.Ted wants is help people lose weight, reestablish hope in themselves so that they will be motivated to maintain their new weight. I am sure that others of you have developed methods from time-to time that worked well or in part. Why not share them on the page where my idea is shown. See"Eating Air:Overcoming the Compulsion to Overeat."
Question: What other approaches to weight loss are available? Could you please e-mail me more information on jaw wiring for weight loss? I would like to know who does this procedure in Washington, D.C. Can I can have it done? What are the side effects?
Answer: I do not know of any other orthodontist/dentist or physician that does this procedure except for an oral surgeon in Midwest City, Oklahoma. The following information is a compilation of responses to other similar inquiries.
Above all you should be aware of other methods and concerns related to the various treatment/help approach currently available for weight/eating disorders. They include:
The harmful effects to the heart valves of the "Fen-Phen" combination (Fenfluramine -- Phentermine (Redux), the current vogue medications for weight loss together and especially when taken with anti-depressants such as Prozac "Fen-Pro", (See article NY Times, Jan 5, 1999, Sect. F, p. 2).
Writing in the current issue of Lancet, an international medical journal published in Britain, the scientist, Dr. Richard Wurtman, director of the clinical research center at the Mass. Instit. Of Tech. (MIT) said:
Phentermine inhibits an enzyme, monamine oxidase, that normally breaks down serotonin. Other drugs also inhibit the same enzyme and they are considered unsafe when combined with other drugs that raise serotonin, like Prozac and related antidepressants like Paxil and Zoloft other drugs that inhibit the enzyme include medicines like pseudoephedrine, the decongestant in cold medicines like Sudafed, and ephedrine and norephedrine, which are found in over-the-counter diet pills A particular concern to obesity experts is that some doctors are prescribing phentermine and Prozac, in a combination known as phen-pro, to people who want to lose weight "I would never use it," said Dr. Foreyt, calling it a good example of a combination that has never been studied.
2. Other medications now being advertised on television such as Meridia:
(see http://www.4 meridia.com/ for information.) I had patient in 1997 who decided not to go ahead with OJW and chose to use Meridia instead. I have since lost contact with her. Xenical is another newly arrived medicine for losing weight, weighing in heavily in 1999. A plethora of information on Xenical can be obtained at: http://members.loop.com/~bkrentzman/meds/xenical/xenical.html
3. Weight Watchers (weekly meetings), Jenny Craig (direct purchase of food products).
4. Special programs for severely over-weight people at hospitals such as: St. Luke's Roosevelt in Manhattan (see next) and Maimonides in Brooklyn (718) 283 7129: Nina Dehan registered dietician with Dr. Eli Hamaoui.
5. Liquid diets, such as Ensure (choice of 6 types), Slim Fast, Metrecal (over-the-counter), and others such as Optifast by Sandos-Novartis (prescribed), and those developed and tested at Hospital Weight-Control Centers such as the one at St. Lukes-Roosevelt, NYC, (212) 523-8440, The Van Italie Center at 425 w. 59th St. (Dir. Xavier Pi-Sunyer; Chief dietician: Cathy Nonas).
6. Surgery whose objective is to reduce the size of the stomach and or the intestine. St. Lukes- Roosevelt Hospital offers such surgery under the auspices of Louis Flancbaum, MD, a nationally recognized authority on the surgical treatment of obesity and chief of the division of Bariatric Surgery. The National Institute of Health recommends that only those with a BMI of 40 or more (at least 233 pounds for a 5'4'" woman) are appropriate candidates. Others recommend a BMI of 33 (193 pounds for a 5'4" woman). At present the surgery is done on around 50,000 people annually. For those who are interested and would like further information about the gastric bypass operation being offered there see: Gastric Bypass Information. A lengthy article appeared in the NY Times on Thursday, October 12, 2000 entitled: "Exchanging Obesity's Risks for Surgery's." The surgery discussed is for "morbidly" overweight people (more than 100 pounds). It is considered to be highly successful. (Costs about $20,000-$35-000); "High benefits and high risks..." One doctor said that of 900 patients he had operated on, seven died, all of them at great extremes of morbid obesity. You can read that article at: http://www.nytimes.com/2000/10/12/science/12FAT.html.
"Morbid" obesity is defined as being more than 100 pounds overweight. When you reach this weight you are a candidate for "Bariatric" surgery such as the "gastric bypass" and related surgery such as the "roux en y". I posted some information to provide you some basic information about this kind of gastric surgery: [The gastric bypass.."stomach stapling"] [The "Roux en y"] [Hospitalization after "Bariatric" surgery] **[The risks of gastric surgery] [The long-term outlook].
Finally, the NY Times published an editorial on November 20, 2002 titled Drastic Surgery for Drastic Obesity. It was a commentary on the subject of stomach stapling following the national coverage of the subject when Al Roker, the popular television weatherman, underwent the operation. Click on this link to read the article.
6a. Surgery for the severely overweight (less radical: placement of a "Lap-Band")...where "Lap" stands for the word laparoscopic (laparotomy) See article in the NY Times June 5 2001. Click here to read the article.
6b. Gastric banding: [Info source 1], [Info source 2], [Info source 3]
[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 an "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.] The cost of this procedure is $16,000. Click here to read an article in the NY Times.
7.Psychoanalysis/Psychotherapy with a specialist who works with people with eating disorders, for example, Elizabeth Mulder-Zoch, 130 E. 63rd St. NY, NY 10021, (212) 319 1119
8. The new "Tummy Pacemaker".
9. Learn About the DDS System for Weight Loss : This device is custom made by certified dentists who begin by making a mold of your upper teeth and palate. The dental lab fabricates the device which reminds one a lot of the retainer that many orthodontists give you at the end of treatment to hold your teeth in place. It costs $350-$500.
10. Self-control methods: (see Jerry...Eating air).
Question: Who is not a good candidate for this procedure?
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:
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.
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 whose 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.
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 use a broncho-dilator spray such as asthmatics.
k. Persons who have a history of Temporo-Mandibular Joint dysfunction (TMJ). Learn more about the TMJ: [Information source number 1], [Information source number 2].
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 bulemia to begin with.
o. Persons with frank unresolved periodontal (gum-tooth socket) problems.
p. Persons who drink alcoholic beverages. (Alcohol suppresses the gag reflex). In the event of alcoholic intoxication vomiting can occur. [See note from respected oral-surgeon/orthodontist educator.]
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 NOT more than 125 pounds overweight or less than 25 pounds overweight (i.e moderately obese and obese, but not "morbidly" obese).
Question: Could I remove the wires if I wanted to or needed to in an emergency?
Answer: Yes. In fact I will provide you with wire cutters which you must have with you at all times. I recommend removing the wires for 3-6 days to exercise the jaws by eating , speaking and gum chewing. [See Jaw joint exercises] Indeed I will show you how to remove the wires. It takes less than 20 seconds. You would then return to the office to have your teeth cleaned and to have your jaws rewired closed again. [See the 5 kinds of instruments that can be used to remove the wiring]
Question: Could I rewire myself if I wanted to or needed to in an emergency?
Answer: For most people the answer is no. However, some patients are remarkably adept and are able to do it. Nowadays, I have no misgivings about showing an accompanying adult on the day the patient is rewired how to do it. I liken the wiring to an action identical to adding the laces to your tennis shoes and then twisting the ends together. A special instrument is used to twist the wire together just as you would use a "twist tie" when sealing a trash bag.
Question: What if I needed to remove the wires "immediately" and forgot my wire cutter.
Answer: The brackets and wire which wraps around them could be removed with many household objects including a fork, pliers, and under duress, even with your fingers. [See the 5 kinds of instruments that can be used to remove the wiring]
Question: What can I do if I want to have the braces (brackets) removed and I can not return to Dr. Ted's office?
Answer: I will help you to locate an orthodontist who will remove them who is located near you. I am certain that you could never remove brackets (and the leftover tags of adhesive) yourself. I do not make any charge for the last visit when I remove the brackets and adhesive. An orthodontist might easily make a fee of anywhere between $65 and and $135.
Question: How much weight can be lost?
Answer: 1st week lose 5 lbs; then 1.5lbs/week... varies slightly from individual to individual. Wiring is removed when you reach your goal.
Question: Has anyone ever complained or regretted having their jaws wire close?
Answer: No. If they did I would include their statements in my treatment charts. On the contrary they seem to take pleasure and pride that they were able to lose some weight. Those who persisted with the treatment had more successful stories than those who did not :-). Alicia F. has been the most thorough in documenting her experience. Her website is at: http://www.geocities.com/aliciaf1973/
Question: How does it feel to have your jaws wired closed and what happens to your speech?
Answer: Try speaking with your teeth together for 5 minutes that is the way it feels. Even now as you read this paragraph continue to keep your teeth together. Some patients may experience muscular tension or clenching, especially when they are anxious and/or under tension. Nobody has reported those things to me yet. Other feelings may be encountered when you yawn, sneeze, and when you are trying to release tension as you do when you are very angry with someone. The doctor who wires the jaw closed must accomplish the wiring so that the lower teeth are just barely NOT contacting the upper teeth with zero tension in the closing muscles. It easy to achieve this: First squeeze/clench your teeth together tight enough to make your jaw muscles contract...then begin relaxing the jaw muscles until you feel your teeth are lightly touching each other...then separate them the "thickness of a piece of paper"...this is the ideal position of your jaws when they are wired together. As for speech, it will become less clear. However, after some practice you can sound almost normal. Here is the voice of Valerie Freeland just after being jaw wired. In my opinion the clarity of her voice is exceptional for a start-up OJW patient.
Question: Can the OJW cause harm to my teeth and gums.
Answer: Yes. but only when they are not properly maintained and cared for. I warn my patients to be aware of any unusual clenching or grinding or unusual tooth mobility and report them to me. I examine the teeth and gums each time the patients wires are removed and replaced (about once every 4 weeks) in order to evaluate whether the brackets or wire have done any harm. The orthodontist is the only provider of the service that can do it by bonding brackets (hooks) to the surface of the teeth...exactly like braces (braces) are attached to patients who are undergoing orthodontic treatment. Oral surgeons, unlike orthodontists do not see patients regularly as orthodontists do. Moreover, they use a technique that requires passing wires back and forth between the teeth, which usually requires using topical anesthesia. Orthodontic wiring is not invasive, and requires no anesthesia. The placement of brackets and wire takes 35 minutes.
Question: Would my breathing be affected, and in what way?
Answer: It might. Try pinching your nose closed as though it was stuffed like when you have a head cold. Now clench your teeth and continue breathing for the next five (5) minutes. Highly allergic persons might also have problems. I have also been told that rigorous cardio-vascular exercise may be more difficult because of the greater need to breathe more frequently and more deeply. OJW would hamper breathing that way.
Question: Are their any harmful consequences to being on a liquid diet?
Answer: Possibly, for some people the answer is yes. As with any diet, careful attention must be paid to having a balanced diet with proper amounts of vitamins, proteins, etc. For a more thorough answer to this question you should contact the makers of the liquid diet you would consider using. Using a search engine you will find copious information under "liquid diets." The Slim Fast website at http://www.slimfast.com might have a word or two on the subject. Another one is Ensure.com. Better yet, want to find a registered/accredited dietician nearby where you live? Then go to the website of the ADA (American Dietician's Association).
Question: Should I consult my physician before embarking on such an endeavor as OJW.
Answer: Indeed, (s)he is the one to help you make that decision. Bring along a copy of the material you are now reading. If you have not had your annual medical health examination it is highly recommended to do so at the start of OJW.
Question: If I have bridges or missing teeth would that prevent me from having my jaws wired?
Answer: It might be a hindrance in some cases.
Question: What is the fee for OJW?
Answer: Initial bracket placement and wiring is $2685 then $95-135/ visit to remove the wire, clean the teeth and replace the wire. At present an additional refundable surcharge of $125 is made for a kit of instruments and supplies you will need if you cannot return to my office for follow up. The kit can also be given to your dentist or orthodontist to do the rewiring. If necessary you (or some significant other) can do it for you.
Question: Any success stories?
Answer: Sandra Whyte (see interview) lost more than 40 pounds in 6 months. A.T. can also be considered a success. (Go to A.T.'s diary of her 10 weeks in OJW.) In addition, A.F.'s website documenting her weight loss can also be counted as a "success" story.
"Success" in weight reduction simply put is losing the amount of weight you set your goal for and maintaining it that way. OJW is highly successful in the goal of initially losing weight. Maintaining the desired weight is up to you. , I have had 35 patients who chose to go ahead with the method anyway. All weight loss methods have in common the problem of regaining weight. Those patients who come for OJW know full well that they have other issues beyond initially losing weight that need resolution in their life. You will see in the Informed Consent for OJW that you are asked to state the number of weeks/months that you will "dedicate passionately" to the OJW procedure. As with any approach it works for those who are committed. Fervor and tenacity help a lot, but adherence and perseverance produce the results that that OJW patients want and need to see. A low fat/salt, reduced calorie diet assisted by an increase in activity (exercise) is a formula that is bound to succeed. I am encouraged to continue delivering this service judging from the supporting letters I have received. Let us not make the error of throwing out the baby with the bath water. OJW works!
Question: Why should I consider OJW for weight loss?
Answer: Because your mental and physical health might be at serious risk unless get your eating under control, and you have tried medications and you dont like the side effects, or you fear the unknown harm they may bring you. Perhaps you need an excuse to stop talking. Most of all you're "fed-up" with your obsessed craving for snack food or your night-eating syndrome is getting you down.. You have reached panic proportions and are disgusted with yourself. You refuse to have bariatric surgery or cannot afford surgery. You are willing to try a liquid diet with a regime where your mouth is wired closed, but where you still have the ability to remove the wires should you want or need to. You have examined and tried all other methods and found them wanting this method seems right and it might work for you.
January 31, 2000
Ps. March 1, 2001
Question: How do I begin if I want to have Dr.Ted provide the OJW service for me?
Answer: Click here
Question: Who is not a good candidate for this procedure?
Question: I'm coming from out of town. Can you give me directions from the three major airports in and around NYC?
Answer: You can find very thorough directions Here. In addition you will find hints on lodging, and car service services.
Question: I live in a distant state from Dr. Ted's office. Doesn't that present problems?
Answer: It might be a hindrance is some cases. When I put the braces on for a OJW I teach the patient how it is actually done. If he or she brings a significant other I will show exactly how I do the bracketing and the wiring. I will supply that person with instructions and a kit of tools and supplies that permit the adept do-it-him/herself to rebracket and rewire the patient. If one is not comfortable doing it I can help find a dentist/orthodontist who will do it, however, finding a provider to rewire a patient is not guaranteed.
Professionally, Dr. Ted Rothstein
718 852 1551
Fax: 718 852 1894 Email: firstname.lastname@example.org
OJW DirectoryTed Rothstein DDS PhD
Specialist in Cosmetic Orthodontics
and Dentofacial Orthopedics
Adults and Children
Specialist in Orthodontic Jaw Wiring
American Association of Orthodontists
35 Remsen St., Bklyn, NY 11201
718 852 1551 Fx 718 852 1894
Title: About Weight Loss and Diet Information
Desc: Advice on weight loss programs and diets.
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