The Histology and Dental Research of Dr. Charley Cox

Dr. Charley Cox was one of the early contributors to adhesive dental research, specifically in the field of histology. During the development of adhesive dentistry, Dr. Cox studied long-term pulp health in non-human primates, identified immune responses that confirmed Martin Brannstrom’s hydrodynamic theory of pain and connected internationally with adhesive dental researchers like Takao Fusayama, Stefan Paul and Sema Belli. 

Dr. Cox’s dental research contributions are to this day still largely unincorporated into adhesive dental applications. In creating his Six Lessons Approach to Biomimetic Restorative Dentistry, Dr. David Alleman found Dr. Cox’s research to be instrumental in answering questions about preserving pulp health and preventing reinfection. 

2025 training programs:
Biomimetic Mastership - class starts May 12. Learn more and register at allemancenter.com/mastership

In-Person SLA Workshop Dates:

• August 8-9
• October 24-25
• December 12-13

Learn more and register at allemancenter.com/training

Instagram
@david.alleman.dds
@davey_alleman_dmd
@allemancenter.com

YouTube
@allemancenter

Transcript

0:33

All right. Welcome to season three, episode ten of the Six Lessons podcast. Today we're going to be talking a little bit of history. And the history will center around how research from one field spills over to another field. So this episode talks about how we have what's called heuristic knowledge. And so heuristic knowledge means if you do one thing and you do it really well, it might help you to do something else. It's not related. For example, music near and dear to my heart. I'm not a musician. I sing in choirs, but I don't play instruments. But the discipline that you might learn from playing and perfecting an instrument could help you in the discipline of another field. That's called heuristic knowledge. Charley Cox is a very interesting character. He passed away two years ago. Good friend of mine for. Oh, I first met him in 1998. Man, that's, 27 years ago at, the dental convention in San Francisco, the American Dental Association convention, national convention in San Francisco, 1998. My first mentor, Ray Bertolotti who I had been receiving lectures from for three years. We met at San Francisco and we had lunch together, and he gave me a history of some of the leaders in adhesive dentistry. Now, the one that he brought up first was to Takao Fusayama So Takao Fusayama with the invention of caries detecting dye and pioneering work with early adhesive systems with Kuraray company. Fusayama really was the father of adhesive dentistry internationally. And the second name that he gave me was the name of Charley Cox. Charley Cox I did not know the name. I did not know his person, but he was giving a lecture at the convention. So I attended that lecture. should name the other two that Ray put, because it was, John Kanca II and Ray Bertolotti And so he made a nice little slide. It was a takeoff on a movie that was called Pulp Fiction. And I think there's still some people that follow Pulp Fiction. Quentin Tarantino is a director, but pulp Fiction had four heads on an advertisement. Anyway, he had replaced John Kanca and replaced the slide with pulp Truth. And the truth was coming from Takao Fusayama Charley Cox, Ray Bertolotti and John Kanca. And so at that lecture that I heard from Charley Cox met him that day, continue to have a friendship until he died. And we were on many stages together. We had conferences where we invited him as a featured speaker. But Charley Cox, I got to know him. I found out that his basic personality trait was a rebel. Now, Charley Cox was from a family of dentists. His father was a successful dentist in Adrian, Michigan. Now, unless you're from Michigan, you don't know where Adrian is. But there's a college there called Adrian College. And, that was Charley’s undergraduate, and his plan was to follow his father's and his older brother's footsteps, become a dentist. But again, he was the rebel in the family. The father was successful. The older brother going to the same dental school as the father, University of Michigan Charley really didn't want to be exactly like his father's, but he did decide, okay, I'm going to be a dentist. And his undergraduate, major was zoology. That's pretty common. Undergraduate major. Microbiology, zoology, biochemistry. You can have many majors debut as an economics major. Undergraduate. But, Charley didn't want to go to the same dental school as his father's brother because he didn't want to be, you know, pigeonholed into. Okay, here comes another Cox. He wanted to make his own way. So he went to the other dental school in Michigan, which is called Detroit Mercy. But anyway, he thought he would be better there. So he went to, one year. But the regimentation of dental school made him crazy. So after one year of dental school, he quit. I can't do this. They're telling me what to do. They don't tell me why I'm doing it. I don't see a real vision of being a dentist. Anyway. He wasn't motivated. He wasn't inspired by his first year of dental school. So he quit, you know, impulsively, not really thinking what next, but what he did coming to the conclusion he had to do something. He came to the conclusion that the course that he understood and liked the most at Adrian College undergraduate was a histology course. And so in histology you're looking at cells, you're looking under a microscope. But he actually got involved with preparing some of the slides for histologic, examination. And he had a few mentors there. his main mentor in 1959 was doctor Miles Peele. How do I know that? Well, Charley wrote a little history of his life in adhesive dentistry. that he prepared for a lecture that he gave here in Utah. And he brought them out, for a mastership course, in, Utah, 2017, 2018. when you read this history of his life as he decided now to not be a dentist and become a histology, meaning someone who would teach cell histology in schools, and of course, the expertise in preparing slide loads of different, tissues microscopic investigation became part of his, training. He took a two year master's program at Wayne State in Michigan. then after he got his master's degree started, he started he started looking for jobs. You know, after you graduate from school, it's. Oh, now I got to get a job. I've got this advanced degree. What am I going to do with it? you know, I'm a believer in God. I think God has a sense of humor. The only job that came available to Charley Cox was at the dental school that his dad, his father and brother graduated from University of Michigan. So he got the job, but he's teaching hygienists, you know, part of the dental profession. The hygienist need to understand cells and biology, and they have to take a course in histology. And he was teaching the hygienist, I mean, this is, you know, so funny. But he's there basically for 20 years at University of Michigan. he's making connections around the world with other like minded histology who are in the dental field. And during this time, dental histology actually starts to become important because we are doing in-vivo research on non-human primates. We I say, you know, there's only three schools that I really have had intimate contact with that have done that type of work. University of Iowa. When I was interviewing for dental school, I got accepted. University of Iowa, and the person who interviewed me was in charge of the monkey dental patients. In other words, at University of Iowa, I'm having my interview. You know, I'm dressed in a suit and tie, kind of smells like a zoo where I'm having this interview because the doctor and I, apologize. I don't remember his name. I just wanted to make a good impression on anybody. But anyway, he he interviewed me in the area where the, rhesus monkeys were being kept, and they would, experiment with dental materials on their teeth. And then these were evaluated histologically that he was in connection. I didn't know at this time with a very small group in Scandinavia, Japan and Michigan that were doing this initial research, biological evaluation of these new adhesive materials on non-human primates. So Charley Cox became a dentist to monkeys and did it for 15, probably almost 20 years and became a world expert In this type of animal research. And the other leading group was in, Tokyo, Japan. Two universities there, Sumi University and Tokyo Medical and Dental University, had monkey labs and Charley would go there every year. He learned Japanese Sema Belli that we've talked about in earlier lectures. One of the real leaders in advanced adhesive dentistry. But that's where she met Charley Cox originally. And Charley Cox, they did a training, Japan and stayed in contact over the years. But Charley Cox, was the first one to understand that if you're going to have success in any type of dentistry that's close to the pulp, then it's not the type of base or liner that you put on the pulp. If it's a direct pulp cap, it's whether the direct pulp cap can be sealing out bacteria so that the reinfection of the pulp doesn't happen. So the idea of comparing direct pulp caps to indirect pulp caps. The in-vivo research was done by Charley Cox, Doctor Akimoto in Japan. several doctors in Sweden that I don't know personally, but Martin Brannstrom was part of that, that group. And then he brought money into the University of Michigan, because of these research connections. And so he is bringing money into the university. But if you're a faculty member at a university and you go for a contract year to year year, it's not real long term security. Charley was married, had a family at that time. He would like to have job security. So he applied for what's called tenure. And most universities have systems where when you've really proven yourself your worth to the school, then they guarantee that you can't be fired unless you do something of great moral turpitude. So there was protections for tenure that he sought. And when he did this, you know, he put in his resume everything he'd been doing for 20 years. And basically they said, well, you only have a master's degree, you're not a dentist, you don't have a PhD. We can't give you tenure. He was like, what? I'm an internationally known, I mean, superstar, maybe not the word, but an internationally known leader. There's only four people that would be my equivalent. And this field of it, he said. Dentistry is the future. So he tried to correctly predict what would happen in the next 30 years in dentistry. He's right at the birth with Fusayama with adhesive dentistry. I mean, he's going to Japan. He's talking with them every year in Japanese, But all of the Japanese researcher Charley knew and, When they rejected his application for tenure, one of his friends, a university in North Carolina who's a faculty tenured faculty member in North Carolina, he just started laughing. And Charley goes a little funny. He says, bring your monkeys to North Carolina in two years, we'll give you a dental degree, you know, and then you can get tenure at some other university anyway. So that's a Charley did. He became a dental student at age 50. And he goes to North Carolina in two years. They give him his DDS degree. And then he looks for, another job, and he gets a full time faculty position at University of Alabama, Birmingham. After that, he went to UCLA. And then after that he went into the company that his son had founded, making a an anti, sensitivity agent called Super Seal. Anyway, he did that for the rest of his career, but he also stayed in contact with Ray Bertolotti John Kanca Takao Fusayama until he died. Akimoto who's still alive, some of Belli his network of early researchers in adhesive dentistry was stronger than anybody. Anybody. Period. as you went to university Alabama, there were politics being played, and half the faculty thought adhesive dentistry should be promoted. And a half the faculty decided that it was too new, too experimental, that they wouldn't take the risk of doing it on patients in dental school. I mean, the whole politics of that, he's explained that to me Anyway, these two faculty members became his enemies, and it got to be really ugly politics in a dental school. And finally Charley went to, the West Coast, where all rebels should end up right where I grew up. University of California, Los Angeles dental school. And he was there at the same time with another European leader named Stefan Paul from the University of Zurich. So Stefan Paul and him published several papers in universities. Zurich had been always a leader and still is coming back now. It's a long history there. There was politics in Zurich But the idea is that every dental school has different faculty members with different knowledge sets. But Charley Cox, his knowledge set in histology made him unique. So he's got a dentistry background, but he understands the histology that has to be done to prove that are adhesive. Dentistry is not toxic to the pulp, which was the dogma, the myth. When I went to dental school. If you acid etched the dentin It was going to kill the pulp. That was what I was taught in dental school. if we were using a bonding to enamel, which was taught in our dental school, all dental schools still believe the bonding to enamel is very important and doable. But at university of the pacific we had to cover all the dentin with dycal The worst possible selection for a liner base, because nobody knew at that time that it dissolved under pulpal fluid pressure and became basically mush. You can get away with that on front teeth or you don't chew on them. It's a disaster on the back teeth. I mean, how many dentists have I trained who want to put dycal underneath the restorations so they don't have sensitivity? In other words, they don't understand anything about the source of pain. Charley Cox not only worked with Martin Brannstrom but he amplified Brannstrom’s hydrodynamic source of pain into the theory that now is knowledge that we actually know that not only do you have ondontoblastic processes that are surrounded by fluid, that can move in and out of the tubule around the process, but these processes have little flagella. And those flagella were discovered and named by Charley Cox. And they're called nociceptors. And so these nociceptors were first visualized. But Charley described, I've never found anybody that knows the nociceptors because you can publish 400 papers in obscure journals that only specialists read, and they never get the knowledge to that next level of a faculty member who's not an expert. And then to a student who's just learning this profession of dentistry, but pulpal fluid movement, nociceptors, ondontoblastic process size, hydration, all these things that have to be done on a biochemical, basis. Fusayama was the first one to biochemically break down collagen and do it with spectrometers that would analyze the sequence of the different peptides were being broken down from the collagen proteins. I mean, it's very sophisticated science. It doesn't ever start in dental school. Almost everything that's of worth in dental school started originally on somebody who was looking under a microscope, not in a tooth, but the tools can be heuristically applied to a tooth, because a tooth is a part of your body, and you can slice it thin enough and you can look at it and then you can even go beyond that into chemistry, biochemistry, and this interaction between living two structure and chemical compounds polymerize able basically plastics. You know, it's hard to realize how old I am. But you know, I actually can remember things that weren't made of plastics that are now made of plastic, including cars, you know, like, I mean, including golf clubs, shafts that were always steel and made out of wood. But these polymerize all fiber carbon fiber combinations. We actually use those in the most expensive jet planes in the world. And the things that I've learned from people who are expert in things, not dentistry, but things that could be applied to dentistry, have been very valuable to me. And so the idea of a heuristic contribution from an expert in one field coming into our field dentistry, that brings it together. But at some point, everybody has to, come to terms with there's a history, there's an evolution. It doesn't all come at one time. There isn't one person that can do all the research, teach all the research, and then popularize the research. This is something that it takes hundreds and thousands. And right now, we're probably getting into a thousand people who are competent in advanced adhesive dentistry around the world. And I hope every dentist is listening to this, podcast will understand that how privileged you are, how blessed you are to be able to do what you can do. You can help so many people have better lives. And that's the whole purpose of the Hippocratic Oath. You know, if you can't make some of these life better, don't make it worse. So do no harm. That's the first thing you know. But, hopefully we can all inspire each other to do the best we can. So until next time, get bonded. Stay bonded. Thanks for listening.