Fitting the Patient with OJW?: Weight-control: THE DENTAL ASSISTANT’S ROLE

This Document is appended to the Advanced Course Flash Drive as "SDB36" (Ver. 050118) and may be amended/edited by those of my Dental Professional Students who have taken the course and have the Flash Drive.

FITTING THE PATIENT WITH OJW?: Weight-control: THE DENTAL ASSISTANT’S ROLE

ABOUT THE OFFICE IN SALEM OREGON

Owner: Dr. Ron Levine

Address: 1540 Commercial St., Salem, Oregon, 97302

Tel. no. 541 1111-1111

Email: [email protected]

Patient-care days: Sunday 1/mo. when needed.

Give as much advance notice as possible.

DIRECTIONS FROM PORTLAND

40 Miles South of Portland on I-5

Length of time from Portland: 65 minutes

NEAREST LARGE TOWN

Silverton—10 miles North of Salem

ASSISTANT’S GARB

Scrubs: (Shirt and Pants)

If female: minimal makeup and perfume

ENTERING THE OFFICE

Enter thru the back door by unlocking the top and then the bottom lock with the same key

Disarm the alarm: xxxx

Turn on the bank of six lights.

Turn on the light with the red switch.

All lights in the office come on and the Operatory is ready to use.

Plug in the Keurig Coffee maker

Call Dr. Levine 541 953 7458

CARING FOR THE PATIENT IN RECEPTION

Welcome patient effusively—they have flown from out of state in most cases.

Give them the OJW “Trouble Shooting” Document even though I have likely given it to them.

INSTRUMENTS AND SUPPLIES: OJW?: Weight-control (See also “Equipment Supplies with ordering information SDB6” in the Advanced Course Flash Drive)

·        THE PATIENT’S PANORAMIC X-RAY

·        EYE PROTECTION GLASSES (FROM MICRO-ETCHING POWDER)

·        12 BRACKETS:

Three for the UpperRight 2nd Pre-molar, 1st Pre-molar and the Canine (UR-543)

Three for the LowerRight 2nd Pre-molar, 1st Pre-molar and the Canine (LR-543)

Three for the UpperLeft 2nd Pre-molar, 1st Pre-molar and the Canine (UL-543)

Three for the LowerLeft 2nd Pre-molar, 1st Pre-molar and the Canine (LL-543)

DESCRIPTION OF THE BRACKETS

Each bracket has a vertical post with metal ball. Each bracket has a colored dot that disappears upon brushing. There are only two kinds of brackets:

The Brackets used on the UpperRight are identical to the Brackets used on the LowerLeft. The UpperLeft brackets are identical to the LowerRight brackets.

 View of the Right side

·        MICRO-ETCHING TOOLWITH BOTTLE CONTAINING ETCHING POWDER (aluminum oxide).

·        THREE CROSS-ACTION TWEEZERS TO HOLD THREE BRACKETS AT-A-TIME

·        ONE BRACKET POSITIONING TWEEZER/”Pliar”

·        1 EXPLORER (To remove excess adhesive “flash” that emerges when bracket is pressed onto tooth.)

·        1 SYRINGE OF UNITEK TRANSBOND OF PINK ADHESIVE (An adhesive offering maximum cohesion)

·        1 “L-POP” CONTAINING PREPARTION FLUID (Primer-Etch Base Coat) TO PAINT ON TEETH

·        1 SMALL BOTTLE OF METAL PRIMER *

·        1 SMALL BOTTLE OF PORCELAIN PRIMER*

·        1 SMALL SYRINGE OF YELLOW PHOSPHORIC ACID GEL*

·        1 CURING LIGHT AT HAND READY TO USE WHEN THE DOCTOR HAS POSITIONED THE THREE BRACKETS

·        ONE UNITEK MALLET-HAMMER: To Tap-in any vertical post that is leaning out excessively.

·        THREE AIDS FOR TEACHING WIRING: Shown in Advanced Course Flash Drive.

     The Brown wood block with brass nails

     The Clear plastic with brackets (photo)

     The Plastic articulating model with brackets on the Premolars and Canines

·        A ROLL OF .014” ROUND STAINLESS STEEL “DEAD-SOFT” WIRE (Rocky Mountain Orthodontics only).

·        10 pieces of 9” precut .014” wire for demonstrating and practicing wiring

·        A “Straw” to create inter-occlusal distance when using the straw method of wiring

·        12 Cotton Rolls

·        12 2 X 2 Cotton Sponges

·        2 PIECES OF TOWEL PAPER WITH CENTERHOLE CUT OUT TO PLACE OVER PATIENT’S MOUTH WHEN USING MICROETCHING POWDER

·        1 BACK-LOCKING WIRE-TWISTING INTRUMENT (MATHIEU NEEDLE HOLDER)

·        1 WIRE CUTTING INSTRUMENT

·        1 PLASTIC LIP-RETRACTING INTSTRUMENT

·        1 PATIENT TAKE-HOME KIT (PrecutWire, twister instrument, ligature-cutter, lip-retractor, straws to create interocclusal distance, wax, Other?

·        1 Digital camera/Cell-Phone TO TAKE PHOTOS AND VIDEO when desired/as needed/if helpful

PREPARING THE OPERATORY

Gloves and Mask for Assistant-3 pair

Gloves and Mask for Doctor-3 pair

Attach the Micro-etching tool to the air-pressure source with the “Qwik-attach” clip-on

Insert a white plastic saliva suction straw the suction instrument

Insert a water straw in the water-air spray instrument

PREPARING THE PATIENT

Have patient sit and using foot controls auto adjust height and recline positions of Dental Chair

Bib the patient

Teach patient how to use finger to notify discomfort and to-“stop”)

Turn on the dental-light (Avoid focusing in the patient’s eyes)

Constantly ask them if they are ok and feeling comfortable

EXAMINING THE PATIENT

Doctor does a thorough intra-oral and extra-oral exam with reference to the Panoramic X-ray

THE TEETH THAT WILL BE BONDED

UR 543;  LR 543;  UL 543;  LL 543

SEQUENCE OF THE BONDING

UR 543

LR 543

UL 543

LL 543

PREPARING THE BRACKETS FOR BONDING TO THE TEETH

Micro-etch (in the BACK LAB inside the micro-etching box) the back of the bracket: it will turn from shiny to a mat finish

Paint the mat finish surface of the three brackets with the fluid from the L-POP (two blisters are squeezed into a mixing chamber and purple brush rod extends from it).

* For a bracket to be bonded to a PORCELAIN SURFACE: Paint the back of the bracket with the METAL PRIMER LIQUID wait 20 seconds then apply the L-POP fluid

PREPARING THE TEETH THAT WILL BE BONDED

Clean teeth (UR-543) with wet cotton and dry with dry cotton

Place toweling with hole over patient’s mouth

Place glasses on patient

Micro-etch UR543 takes about 20 seconds

Mix the fluids in the L-POP

Hand doctor wetted brush that comes in the L-POP

Doctor paints the UR-543 teeth with the L-POP fluid

*With Porcelain surfaces: Micro-etch with powder then Micro-Etch with YELLOW PHOSPHORIC ACID GEL FROM SYRINGE FOR (Five) 5-minutes. Then paint the porcelain with PORCELAIN PRIMER FLUID AND ALLOW TO AIR DRY 30 SECONDS. Then paint the porcelain with the L-POP fluid.

ASSISTANT WIPES ON A DAB OF PINK ADHESIVE ON THE UR5 BRACKET AND HANDS IT TO THE DOCTOR;  DOCTOR PLACES THE BRACKET ON UR5. MAKING SURE THE BRACKET IS FIRMLY AND EVENLY SEATED ON THE SURFACE OF THE TOOTH. THEN USES EXPLORER INSTRUMENT TO CLEAR AWAY EXCESS ADHESIVE, ESPECIALLY WHERE THE WIRE IS GOING TO PASS UNDER THE VERTICAL POST.

ASSISTANT WIPES ON A DAB OF PINK ADHESIVE ON THE UR4 BRACKET AND HANDS IT TO THE DOCTOR;  DOCTOR PLACES THE BRACKET ON UR4 MAKING SURE THE BRACKET IS FIRMLY AND EVENLY SEATED ON THE SURFACE OF THE TOOTH.

ASSISTANT WIPES ON A DAB OF PINK ADHESIVE ON THE UR3 BRACKET AND HANDS IT TO THE DOCTOR;  DOCTOR PLACES THE BRACKET ON UR3 MAKING SURE THE BRACKET IS FIRMLY AND EVENLY SEATED ON THE SURFACE OF THE TOOTH.

ASSISTANT HANDS DOCTOR THE BRACKET POSITIONING TWEEZER (“PLIAR”) AND THE DOCTOR POSITIONS EACH BRACKET PRECISELY (TAKES ABOUT 30 SECONDS FOR ALL THREE)

CURING THE ADHESIVE WITH THE BLUE-LIGHT CURING LIGHT

Assistant places glass rod of curing light NEAR bracket and shines light 5 seconds on the North, East, South and West sides of the bracket--this action causes the adhesive to immediately set like cement.

LR543 ARE MICROETCHED: BRACKETS ARE THEN PLACED ON LR-543 POSITIONED AND CURED.

STOP: SIT PATIENT UP TO RINSE AND RELAX FOR 5 MINUTES, THEN FINISH BONDING.

UL543 ARE MICROETCHED: BRACKETS PLACED ON UL-543 POSITIONED AND CURED.

LL543 ARE MICROETCHED: BRACKETS PLACED ON LL-543 POSITIONED AND CURED.

TEACHING THE PATIENT TO PLACE THE WIRING AND REMOVE THE WIRING

Dr. Rothstein uses the three teaching tools noted above and the twisting instrument and the ligature along with the roll of wire and precut pieces of wire.

PLACING THE WIRE

Doctor shows patient how to place wire on demo tools then lets patient do same. Doctor shows how wire is cut and peeled and how wire can be tightened and loosened. Using the non-straw and the straw methods. Doctor shows how wire can be slid around to perfect the fit..

If patient came alone-- make video ON THEIR CELL PHONE OF DOCTOR DOING THE WIRING.

If patient came with friend or relative have them take photos and video of wiring.

Especially make video to show them how the wiring looks in open and closed positions in the final wiring..

https://www.youtube.com/watch?v=_cR2h8latyE

FOLLLOWING COMPLETION OF WIRING

• ·        Remember the patient has NEVER been in this position before, even though they have read about it and seen the video. They may feel anxious. So engage them in relaxed conversation and assure them they will be fine.
• ·        Give them the OJW Trouble Shooting guide and emphasize the “important” parts:
• ·        Remind them not to “play” their jaw right or left or up or down lest they unwittingly put undue pressure on the bracket and cause it to “detach”.
• ·        Remind them their Low-calorie, Liquid diet should not exceed 1000 Calories/day.
• ·        Remind them to keep the wiring on for 5 weeks then remove it for 5 days during which time they should use the freedom to exercise the jaw, and then rewire themselves (if they cannot return to your office) if their jaw feels completely comfortable.
• ·        During the five-day period they are unwired they must continue the <1000cal/day liquid diet.
• ·        Have patient stand up and engage them in conversation. This will allow them to hear that their speech is not affected. Indeed, encourage them to practice reading out loud at home.
• ·        Remind them that they should not “LOOK” for any particular position because “Rothstein’s OJW Position of Mandibular Weightlessness (ROPMW)” approximates with their own natural rest position. The wires have one function: To limit the opening beyond the patient’s own rest position. Their lower jaw is being supported solely by their own muscles of mastication—NOT the wires.
• GIVE THE PATIENT THE KIT THE OFFICE PREPARED FOR THEM.

RECEIVE PRE-AGREED PAYMENT.

PACK OUR INsTRUMENTS AND SUPPLIES

PROCEDURE FOR LEAVING THE OFFICE

Make CERTAIN the FRONT door is locked!

Clear off and clean operatory desk and floor

Unplug the Keurig coffee maker

Turn off the bank of six lights near the back door

Turn off the light with the red switch

Arm the alarm: xxxx

Call Dr. Levine: 541 111 1111

COURTESY CALL THE PATIENT THE NEXT DAY AND ONE WEEK LATER .

Teddy Rothstein DDS PhD 

AAO--Life-active member/PCOS, ADA

Specialist OJW?: Weight-control

Brooklyn, NY ● Portland, OR

OJWforWeightControl: FORMS for patients

(718) 808-2656, [email protected], 

LinkedIn: (OJW Dental Professionals)