Weight Control the Thirteenth Dental Specialty--Definition and scope:

Weight Control is that specialty of Dentistry that recognizes the right and responsibility of dentists to provide adjunctive services with Intra-oral appliances as part of a Healthcare team to the obese/becoming obese patients to control excessive/compulsive eating patterns that can exacerbate certain Dental and Medical problems such decay, periodontal disease, sleep apnea and type 2 Diabetes among others.

Overcoming Hesitancy to Provide a Weight-Control Service in the Dental Professional’s Office-Clinic

Whether it’s concern over safety and effectiveness, unwillingness to break norms or fear of taking on a process that may be beyond them, Dental Professionals are hesitant when it comes to providing a weight-control service in their practice. Why? Are their reasons based in reality? The time has come for them to begin embracing the newest specialty that Dentistry offers today—Weight Control, as I have defined it.

From my perspective, as the inventor, developer and leading provider of one such service, OJW?: Weight-Control, it is clear that their hesitancy is built around a number of myths and constraints that have permeated our Dental Profession. Let’s have a look at some of those and demythify them. We’ll show how specious each one is, and that nothing is truly preventing us from providing this worthy service to those who would welcome us and benefit from our efforts on their behalf.

Myths and Constraints #1: Tradition

How is it that cleanings, fillings, crowns, dentures, some root canals and removing teeth have become pillars standing in the way of progress? It’s not the services themselves that are at fault; it is the narrow view of Dentists who believe there is a limit to the services they “ought” to provide beyond those “traditional” ones. Doubtless, we all find our comfort zone when standing on familiar ground, but once we see that the new ground is a smooth road that has been bridged, we can reap its rewards. In fact, I look at my work as a Superhighway, one that I have created to make the trip both safe and inviting for others to travel on.

It is understandable why Dentists would perceive Weight Control as a service far beyond the scope of the ones they “should” provide or feel comfortable providing. Admittedly, any such service would fall outside of a Dentist’s comfort zone, especially because it’s not taught in dental school. So where do they begin their education? At “Weight Control 101” (see Ebook2 and Video3). If you see yourself in the above description, my words will help quell your apprehensions and show the way to introducing a Weight-Control Service in your office-clinic. To escape the shackles of “tradition”, you must be prepared to rebut the raft of criticisms you are likely to encounter—including derision—even from your colleagues. I will remind you that the inception of Orthodontics was greeted with roars of opprobrium.

I was not cast in a traditional mold, and my example should help you break yours. I was a bit of a renegade from the start and unafraid to stretch the rules without fear of retribution from the District Dental Society or my colleagues. Moreover, my practice was in Downtown Brooklyn, NY where it was possible to express a measure of nonconformity.

It was only by chance that I was introduced to the concept of providing Weight Control. However, even then, a voice in me persisted in repeating, “This is something that is worth developing; it will benefit me, enrich my life as a dental professional and the demographic I serve”. I was never deterred by criticism. I even encouraged others to voice theirs. Indeed, I fielded each critique, examined it—weighed its reasonableness and rationality or lack of import—and moved on, satisfied it was not an impassable obstacle. Finally, there were none left. I am now reaping the fruits of my labor and determination sowed over the last 25 years.

Myths and Constraints #2: The “Scope” of Dentistry

Dentists erroneously believe that Weight Control is not a service included in the “Scope” of Dentistry. That’s exactly what I thought. Consequently, I contacted Dr. Milton Lawney who wrote to me saying:

Referring to NY Article 133 §6601: Dr. Milton Lawney, the Executive Secretary of the State Board of Dentistry NY—2004: “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.” 

Those who already “treat” the symptoms of Sleep Apnea will recognize this pathway, and those who are looking to travel in this direction should know that it is legal to provide this new service in every state of the union bar none—just like treating Sleep Apnea. Once the physician makes the diagnosis, that is your imprimatur to make an Appliance that can aid in the treatment of the condition.

Myths and Constraints #3: Acceptance as a Weight-Control Provider

We’ve knocked down two myths and constraints already, however, I can hear you saying to yourself “But the general public will not accept me as a credible Weight-Control Provider”. Again, that’s exactly what I thought. Until I conducted a study (N=100) and found just the opposite! Witness my own experience with 350 patients from everywhere in the United States. We must first believe in ourselves—believe we have the knowledge and skills with oral appliances that can make a difference for our patient with Weight-Control issues — just like we did with TMJ and Sleep Apnea. Fear itself is the major obstacle.

Myths and Constraints #4: Jeopardizing Your Dental License

There is a belief among Dentists that Weight Control is a Medical, not a Dental service and consequently a threat to their Dental License. Nonsense—totally incorrect. Weight Control is a Dental procedure first, last and always. In fact, it closely parallels providing treatment for Sleep Apnea: the Physician diagnoses the condition permitting the Dentist to fabricate an Appliance to relieve the symptoms of it. Indeed, Weight Control is often the treatment for the etiology4 of Sleep Apnea and Type 2 Diabetes-- viz. obesity.

Myths and Constraints #5: Peer Perception and Reception

It is legitimate for Dentists to fear they will be castigated, rebuked or even ostracized by their colleagues or other people they may well respect. This is especially true in small-town solo practices, less so in urban centers and multi-specialty clinics. This world is replete with people who will naysay whatever you do. Nevertheless, YOU have to believe in what YOUR dreams tell you feels right for you and YOUR practice. You have to believe in yourself and feel confident that you can fend off the criticisms you might have to endure at the start. Once you begin to realize the good you are doing and the positive effects of being a provider of Weight Control, ignoring the naysayers becomes a piece of cake. Indeed, you will teach them.

Myths and Constraints #6: Obesity has a Multifactorial Etiology

Is the etiology of Obesity so multifactorial that any efforts to treat it may be misguided or misdirected and cause harm? “No” is the answer. But a good many Dentists are frightened of that anyway. And that’s fair enough. However, upon examination of the Five-Part Application Form2 (Informed consent, Med-Dent history, Poor candidates, etc.) that I devised for my prospective patients with weight-control issues, you will rest assured that the patients you carefully choose to treat will be the ones you feel confident in having in your practice. In essence, I have opened up yet another lane along our OJW Superhighway for you to follow confidently by my side as we continue to our destination. Isn’t that exactly what you do with all the Dental patients you treat? You screen them, obtain their Informed Consent, and decide which ones you feel you can treat and meet their expectations without causing them harm.

Myths and Constraints #7: Device Safety and Effectiveness

A prime concern going through your mind right now: “Any devices I use must be Safe and Effective.” Of course! “First, do no harm” is the Ultimate dictate of Medicine and Dentistry.  I invented OJW: Weight-Control—an appliance and protocol—and refined it over the course of twenty-five years. Try to find a bad review — there are none. The worst that has been said is that when the appliance is removed, the patients regain weight; however, that is axiomatic with all Weight-Control methods—bar none.

Myths and Constraints #8: TMJ Ramifications

Dentists have apprehensions that an intra-oral device for Weight Control may initiate or exacerbate TMJ problems ditto sleep apnea appliances. Nothing could be farther from the truth. I refer you to my 2009 research paper (see earlier). Not one respondent in my study reported a TMJ problem. Indeed, I have treated more than 350 patients without a single report of a TMJ concern. Moreover, the position of the Mandible in OJW is physiologic, as it approximates the rest position: Rothstein’s OJW Position of Mandibular Weightlessness (ROPMW). The wiring does not suspend the jaw—it simply limits how far the patient can open their jaw beyond the rest position. Finally, the protocol for my method —55-LCLD5 (five weeks wired; five days unwired)—further ensures there will be no problem.  Nevertheless, I always take a Pan X-ray showing the condyles, get a Med-Dent history and do an Oral and TMJ exam at the start.

Myths and Constraints #9: Nothing to Gain

The same way you make investments in other areas of your practice and enjoy the resulting profits, providing Weight Control can also have an appreciable ROI. Dentists must begin to envision Weight Control as a “Profit” Center” for their office-clinic. Do you remember that movie with Kevin Costner “Field of Dreams”? 1. Build it. They will come. 2. Nothing ventured; nothing gained. You will gain: a potentially substantive revenue stream, the respect and recognition of your colleagues in Dentistry and Medicine, and finally gratitude from the patients who you help with their Weight-Control issues.

Myths and Constraints #10: Self-Consciousness

Perhaps you perceive YOU have a Weight-Control issue and prefer not to draw attention to it? Or, your staff as well? Any of these factors may make you think twice about providing a Weight-Control service. On the other hand, you might use it as an opportunity to place it on yourself or your staff–gratis. Imagine the wealth of publicity that could attract. Provide the service gratis to a staff member as a real-life example of how well the method works. This is one of the various tools I have recommended to Doctors learning how to provide the service. 

Myths and Constraints #11: Weight Control Not Supported by Educators and Researchers

True—in the past. At the 2019 International meeting of the AAO in Los Angeles, two preeminent leaders in the field of Orthodontics, and Chiefs of leading Orthodontic Departments in the most outstanding dental schools in the country, doctors Rolf G. Behrents and J. Martin Palomo, made it clear that Obesity is the single most important contributing risk factor for Sleep apnea. Dr. Palomo even cited my work on the OJW Appliance and Protocol as significantly advancing the treatment of Obesity.

Myths and Constraints #12: The Mystery of Weight-Control Appliances 

Most Dentists are at ground-zero with any Weight-Control appliance. OJW: Weight-Control, which I invented and have continued to develop, has been shown through my work to be Safe and Effective. It has been applied successfully over the course of 25 years to more than 350 patients. It consists of an APPLIANCE and PROTOCOL and simple inexpensive instruments to fit the appliance on the teeth. OJW is provided by the Dentist as part of a Healthcare Team where the Physician supplies a release for the patient to begin a Low-Calorie, Liquid diet; the Dentist fits the OJW on the patient's teeth and the Patient, by adherence to a Low-calorie, Liquid Diet (55-LCLD), assumes responsibility for their weight loss. Not a single state prohibits it. It is not a Medical procedure as many Dentists misconstrue it to be. Dentists can and should use it as an alternative option to treating Sleep Apnea. The patients are typically very grateful, and even if they regain the weight, they will applaud your efforts. 

Myths and Constraints #13: Liability Insurance Coverage

“Liability” issues and the problem/cost of obtaining adequate insurance coverage are serious considerations. Providing a service like OJW: Weight-Control is an issue that demands thoughtful discussion with your liability insurance carrier. While I was practicing Orthodontics in NY, the insurance company that covered me added my Weight-Control service to their policy after I described my research and the method I was using, and convinced them it was safe and effective with no untoward events or claims. When I retired from practicing Orthodontics, they covered me for the Weight-Control service alone. When I moved to Portland, Oregon I located a company that agreed to cover me for the Weight-Control service alone at a reasonable price. I paid for it with my fee from the first patient. In your insurance deliberations, you are welcome to reference my work, research, website and experience.

As you can see, the path for you to provide Weight-Control service, and to use my OJW: Weight-Control method to do it, has been cleared of all obstructions over the last 25 years, through the work I’ve done and the investments I’ve made. The myths and constraints are gone and you are now liberated to make a similar investment and provide the newest service that Dentistry offers—Weight Control—and reap the rewards that come from it. The Superhighway I’ve created is yours to travel down. Ready to take the entrance ramp?

This photo shows how the jaws are interlaced into a position that permits the mandible to move 6mm in all directions permitting normal speech, while maintaining the health of the TMJ. Typically I use .007" deadsoft stainless steel wire. Here I was experimenting with .3mm nylon monofilament thread for the first time. To effectuate the lacing after much experimenting I learned how to knot the ends together to create a complete loop of wire and then how to guide the the thread into the 3D printed bracket slots.

OJW: Weight-Control Gets Ultralite: Youtube video showing the Evolution, Attributes and Function of Ultralite (The Appliance that Whispers)

https://www.youtube.com/watch?v=UW8Dhrrg9T4

#TedRothsteindds, #OJW, #ojwweightcontrol, #OJWweightloss, #Nonsurgicalweightcontrol, #jawwiringweightcontrol, #ojwforweightcontrol, #orthodonticjawwiring, #weightcontroljawwiring, #OJWUltralite

Ted Rothstein DDS 

Retired from Active Practice Orthodontics

Specialist OJW?: Weight-control

OJWforweightcontrol.com

Brooklyn, NY ● Salem, OR

(718) 808-2656, [email protected]