The principal
contributors to this Website are
Graham J Mount , Wyatt
Rory Hume and Brian Monteith.
Graham
J Mount
Graham graduated with a BDS from the University of Sydney
in 1945 and joined his Father in general practice in Adelaide,
South Australia.
If you read further on in the website and check out the
status of the practice of dentistry in the year he graduated
you will understand that there has been considerable change
since that time.
He was taught strictly according to GV Black and he had
to purchase a full kit of hand instruments as designed by
the Master.
His first contact with a patient was in the Exodontia Clinic
followed closely by work in Prosthetics on full dentures.
Conservative treatment of caries came quite late in the
study routine and a standard part of cavity toilet included
sterilisation with either silver nitrate or thymol.
Cavity design was strictly related to form wherein a flat
floor was essential to withstand the forces required to
pack amalgam and the walls had to be undercut with sharp
angles to retain the material against the negative forces
exerted by sticky food stuffs. Cavity linings were zinc
oxide and eugenol to sedate the pulp and this was protected
by zinc phosphate cement because it was strong enough to
withstand packing pressure.
Prevention was entirely in the hands of the patient because
it was understood that sugar in all forms was the cause
of the problem and food debris had to be removed following
eating any time.
The population of Australia was then about 7 mil. people
and there were approximately 1 mil. toothbrushes sold annually.
Caries was rampant and uncontrolled.
It was understood that fluoride may have some bearing on
caries because the Kingston/Evanston experiment was under
way and early results suggested that the investigation should
continue.
Subsequently it was decided that fluoride should be prescribed
in one form or another for children up to the age of twelve
years only – thereafter it was a waste of resources
and there may be an element of danger.
From that beginning he observed and took part in the ongoing
revolution that has lead to today’s understanding
of the problem of dental caries and the progressive outlook
which is described elsewhere in this website.
He watched while the role of bacteria was more clearly
defined and the concept of the involvement of the strep
mutans and
other species was revealed.
It became progressively clearer that the saliva plays an
important role but sadly this has not been properly understood
until very recently.
The part played by fluoride has also taken time to be revealed
but it is now obvious that all age groups benefit by the
presence of a low level of fluoride in the saliva at all
times.
The materials used in the repair of damaged tooth structure
have changed also over these years and he has played a significant
role in the development of the glass-ionomers in particular.
Adhesion of restoration to tooth structure has overcome
one of the major problems in all restorative dentistry although
this property should not be overstated. After all, amalgam
seals it own margins against microleakage and survives extremely
well if properly placed.
One of the problems that is becoming apparent in the present
drive to maintain aesthetics in the oral environment is
the apparent loss of techniques for the placement of gold
inlays and crowns. If it is necessary to rebuild a functional
occlusal pattern following extreme loss of tooth structure
then there is no doubt the indirect construction of gold
restorations is the proper form of long lasting treatment.
As is apparent in the Bibliography Graham Mount has played
a significant role in the development of new approaches
to the repair of the carious lesion as well as the prevention
of lesions in the first place. The current trend is explained
well in the section on the “Modern Understanding of
Caries” and all the modifications in cavity design
discussed in the section on the “New Classification”
have been utilised by him and successes and failures have
been observed and corrected.
The two main text books – “Preservation and
Restoration of Tooth Structure” and the “Atlas
of Glass-ionomer Cements” are testimony to his skills
and dedication to advances in the science and art of the
treatment of the disease of caries.
Over the last 20 years his work has been acknowledged through
Fellowship in the Royal Australasian College of Dental Surgeons
and the award of the degree of DDSc by the University of
Adelaide.
Rory Hume graduated with a BDS from
the University of Adelaide in 1969 and immediately continued
his studies in Pharmacology.
He achieved an MDS and then for a few years entered private
practice and Government Service in Mount Gambier – a
country centre south of Adelaide.
His need for a better understanding of his profession lead
him to Los Angeles for further study in Physiology although
this was always related to dentistry.
He also proved his skill in teaching because on two successive
years he was voted “Best Teacher” by the students
at the Dental School.
Subsequently, with two small children to educate, he returned
to Adelaide and a slightly quieter life style as a member
of Faculty teaching primarily restorative dentistry.
He already understood the caries process in some detail
and recognised the need for further investigations. He
evolved a technique for observing the transition of various chemical
ions through the dentine into the pulp chamber and through
this developed a greater understanding of the resilience
of vital pulp tissue.
Working with a number of other skilled operators within
the Dental School he expanded his understanding of the
caries process and the effect of the fluoride ion in relation to
remineralisation.
He vigorously supported investigations in to cavity modifications
as well as the development of the newly available adhesive
restorative materials – the composite resins and
glass-ionomers.
During this period he and Graham Mount sat down and seriously
discussed the concept of a new classification of caries lesions.
It was apparent that the existing classification, as evolved
by GV Black, was, in fact, a classification of cavities
rather than lesions and if the profession was to make any
progress in understanding the disease and its repair then
it was necessary to think conservatively.
Considering caries in terms of cavities is to think from
the wrong end.
The cavity is the ultimate sign of an active disease – not
the initial sign.
A demineralised 'white spot' lesion is the first sign following the invasion
of the pathological bacteria and the very earliest signs will not necessarily be easy to detect.
It will then progress from there and under normal circumstances
it will take anything from three to four years to penetrate
through the enamel into dentine beneath.
In other words by the time it is necessary to cut a cavity
the disease has been present for that length of time.
With this in mind they contemplated the need to describe
the disease from the other end.
It was apparent that there are only three areas on the crown
of a tooth that are subject to active caries and generally
all lesions arise in these sites. From there it was a small
jump to decide a ranking for the size of a lesion to simplify
the description of the restoration required to repair it.
This is necessary for the operators records and also, at
this time, to facilitate reimbursement of the patient by
third party funding bodies.
As Rory expanded his knowledge and his methods of presentation
of this new approach he became sought after in the teaching
environment.
He was offered the Chair of Operative Dentistry at the University
of Sydney and from this position he became Dean of the School.
He was then persuaded to accept a similar Chair at the University
of
California, San Francisco.
He was instrumental in changing their approach to the problem
of caries as a disease and was then invited to do the same
in Los Angeles.
Since then he has been promoted to the position of Vice Chancellor at the University of California and at the present time is Acting Chancellor of that institution. He still maintains his deep interest in dentistry and continues to be a guide and mentor to his alma mater.
Hopefully one day he will return and continue his research into the continuing advances in the discipline of Operative Dentistry.
Born and bred in Pretoria, South Africa, Brian attended Pretoria Boys’ High School. His principal interest was music: he made his musical debut at the age of 13 years as soloist in a Mozart Piano Concerto with the High Schools’ orchestra. His father was a dental technician which possibly had an influence upon Brian’s decision to join the profession upon leaving school. After qualifying he had his first clinical experience in the National Health Service in England for a year and a half. After returning to South Africa he spent the next 15 years in private general practice. For the last seven of those he was studying part time in the specialty of Prosthodontics at the University of Pretoria from which he graduated cum laude in 1978. For the next three years he divided his time between specialist prosthodontic practice and teaching appointments at the Universities of the Witwatersrand and Pretoria whereafter he was offered and accepted the position of Founding Chair of Prosthodontics at the Medical University of Southern Africa. After 14 years in this position Brian was appointed to the Chair of Restorative Dentistry at the University of Otago’s Faculty of Dentistry, Dunedin, New Zealand, in September 1996.
His research interests have centred on the application of computers in dental education and in particular, the development of disease taxonomies in collaboration with the State University of NewYork at Buffalo. He also furthered an interest in Artificial Intelligence (AI) applications in diagnostic prediction. He has been actively involved in international collaborations in both Prosthodontics and Dental Informatics, and served as Co-President of the International College of Prosthodontists for the years 2000 and 2001. Most recently, Brian has engaged in designing a self-learning approach to cariology teaching that employs an algorithmic construct (borrowed from AI) called Heuristic Reasoning. He is a passionate proponent of the idea that Operative Dentistry is a subset of Cariology – rather than the other way around – and that the purpose and practice of operative dentistry should rest upon a clear understanding of the cause and natural history of the carious process. This has led him to develop an approach to caries management that, taking the Mount & Hume classification as a basis, sets out to reference the appropriate treatment choice to the observed phase of a patient’s disease – Phase Referenced Intervention (PRI). He has written quite extensively in these areas with a number of significant papers and two book chapters.
His spare time activities still involve music, he plays the organ in his church and is active in amateur theatrical productions – particularly Gilbert & Sullivan Operas. |
