Editorial:

The Road Less Traveled

 

Robert Lee Frost was born March 26, 1874 in San Francisco. He was a very successful writer and poet. Having sold his first poem, My Butterfly, to “The New York Independent” for $15 in 1894, he was on his way to becoming the most celebrated poet in North America, winning the Pulitzer Prize four times (still a record). While all of Frost's poems have received wide acclaim, including the one he wrote for President Kennedy's inauguration, The Gift Outright, my favorite poem has always been The Road Not Taken. Over the years, because of the fourth and last stanza of this famous poem, it has come to be referred to as The Road Less Traveled because it states:

            I shall be telling this with a sigh

            Somewhere ages and ages hence:

            Two roads diverged in a wood, and I -

            I took the one less traveled by,

            And that has made all the difference

Perhaps it is my chronological maturity, but I understand this last stanza to recognize that throughout life we have choices. No matter which choices we make, there may be some regret for the choices we did not make. And each decision we make can have a huge impact on our lives and the lives of others.  

So why am I discussing the literary merits of Robert Frost in CRANIO? Because each of you who have devoted your career to understanding, teaching, and/or delivering patient care to address the many faceted pathways of craniofacial pain have made the choice identified in Frost's poem. The road you chose has had significant impact on your life, on the lives of individual students and patients, as well as on our wonderful profession.  The science of diagnosis and treatment of craniofacial pain has improved exponentially because of the choices each of you has made. One of the main purposes of this discussion then is to thank you for the decision you made to take the road less traveled, to implore you to continue your journey, and to encourage others to choose the same path. 

In the past, through written and verbal communication, I have suggested that the American Alliance of TMD Organizations take a leadership role in communicating the educational needs of our profession to dental school administrators. I am convinced that both the Alliance and their individual member organizations have done a good job of educating dental school administrators and faculty to the needs of our discipline of dentistry. However, our future, as we view it today, is still in serious jeopardy. It is in jeopardy not because of the ill-conceived plan to nationalize health care but because the number of practitioners entering the field of craniofacial pain is diminishing. Perhaps this is due, in large part, to the fact that most colleges of dentistry have failed to adequately prepare students to address the

challenges of treating patients that present with cranio-facial pain.

While I have historically been opposed to identifying craniofacial pain as a specialty entity, I recognize this as one approach to increasing the number of practitioners dedicated to the discipline. My reason for this opposition has been that I have always felt diagnosis and treatment of craniofacial pain is a critical part of every practice of dentistry, thus it should be a very strong entity within the undergraduate dental school curriculum. And though I still believe this is true, I have also come to understand that craniofacial pain has not received adequate priority in most dental school curricula in order to make this very important patient care necessity a viable undergraduate reality. I had envisioned that an equal amount of interest and energies would be generated in dental school faculty for the discipline of craniofacial pain as has been developed for other clinical sciences, i.e., cosmetic dentistry and implant dentistry, which is rapidly becoming a standard of care in dental practice. In a relatively short period of time, the undergraduate dental curriculum in most dental schools now includes not only adequate didactic courses, but also substantial clinical experiences in cosmetic dentistry and in the placement and restoration of dental implants. So why has craniofacial pain failed to attract the same interest and involvement from dental school faculty as some other clinical sciences? Perhaps it is greater patient interest and/or demand. After all, few patients volunteer to be treated for craniofacial pain, while appropriate diagnosis and treatment remains a critically important necessity to individual health and well-being. Also, lack of faculty involvement may exist because understanding and the science of diagnosis and treatment of craniofacial pain is very complex, time consuming, and often much less direct than some of the other clinical disciplines. While this observation may be accurate, it is not intended to demean the clinical skill, knowledge, and understanding required to successfully diagnose and deliver patient care in areas other than craniofacial pain. Nor is it intended to detract from the wonderful patient service and contribution to oral health through diagnosis

and delivery of care in the growing list of clinical science dentistry.

The fact remains, however, for many reasons, craniofacial pain has, thus far, failed to attract the interest, let alone the dedication, of a reasonable number of dental school faculties. At the present time, only a relatively small number have a good understanding of the craniofacial complex, and an even smaller number have the time and/or energies necessary to master such understanding. The shortage of dental school faculty nationwide only compounds this problem. Additionally, it is apparent that there is not enough time in the present dental school curriculum to continue teaching historic but dated topics, to incorporate new topic information, and to allow adequate time for the appropriate dispersion of craniofacial pain information . It also seems apparent that the dental school accreditation process does not encompass an adequate priority and understanding of

the discipline to support significant undergraduate curricular change.

For all these reasons and more, I am convinced that for the advancement of the discipline of craniofacial pain, multiple existing avenues must be maximized and others developed to assure quality education and to increase the number of practitioners in the discipline. First, individuals and organizations with common interest in craniofacial pain must continue to work with dental schools to improve their undergraduate curriculum. While there is limited evidence that the efforts of individuals and organizations have improved formal undergraduate dental education in craniofacial pain, there are still glimmers of hope. For example, the University of Tennessee is working cooperatively with the American Academy of Craniofacial Pain (AACP) to establish a curricular model for undergraduate dental students. Other dental schools may have similar developments or other efforts underway. Second, individual members and organizations of the American Alliance must continue to increase their continuing education efforts. Third, individual members and organizations of the American Alliance must work with dental schools to increase the number or nonspecialty, postdoctoral programs, and fourth, individual members and organizations of the American Alliance must come together to establish a consensus specialty entity focused on the diagnosis and treatment of craniofacial pain.

For education of future practitioners in the field of craniofacial pain and for the advancement of 21st century patient care, we should not ignore any of the above. Improving undergraduate education, increasing nonspecialty, postdoctoral positions, supporting individual and organizational education efforts are all immensely important. I believe that it is equally important to collectively focus on establishing a specialty entity to address the diagnosis and treatment of craniofacial pain. To succeed, such effort must be built on consensus and focus on outcomes and not dwell on procedure. This is the next logical step for progress in the field of craniofacial pain. I am well aware that attempts have been made in the past to establish a specialty in craniofacial pain through the American Dental Association. While I applaud the efforts of those who spent endless hours developing and promoting these applications, it appears that many practitioners and/or academics felt left out or under-represented in those applications. That being the case clearly points to the necessity of developing a future joint consensus application for a speciality in craniofacial pain. Therefore, I urge the American Alliance, as the umbrella organization, to bring together collective representation of all its member organizations for the purpose of working toward development of a specialty. I assure you that  without such an effort, the field of craniofacial pain will never receive the recognition it deserves.    

Like Frost's poem, there are always choices to be made and different paths to take. On the pathway of

our personal and professional lives, we should always make careful, informed decisions. While it is human nature to wish we could see how our lives would be if we had done something differently, we rarely have that opportunity. Having been given the opportunity to earlier support the application for specialty status in craniofacial pain, I too wish I could have traveled both roads at one time but since that is not possible, I am thankful for the opportunity to now take a road, which hopefully leads to the establishment of that specialty. I hope that all individual members and organizations under the umbrella of the American Alliance of TMD Organi-zations will dedicate their energies to establishing the specialty for craniofacial pain for the betterment of our dental discipline, improvement of patient care, and elevation of the dental profession. Let's each of us concentrate on the road less traveled as opposed to the road not traveled. I believe the time has come.

Following is the four stanzas of Robert Frost's A Road Not Taken. Please enjoy, as I have over the years.

                        William F. Slagle, D.D.S.

                        Seminole, Oklahoma

 

                        The Road Not Taken

 

            Two roads diverged in a yellow wood,

            And sorry I could not travel both

            And be one traveler, long I stood

            And looked down one as far as I could

            To where it bent in the undergrowth;

 

            Then took the other, as just and fair,

            And having perhaps the better claim,

            Because it was grassy and wanted wear;

            Though as far that the passing there

            Had worn them really about the same

 

 

            And both that morning equally lay

            In leaves no step had trodden back.

            Oh, I kept the first for another day!

            Yet knowing how way leads on the way,

            I doubted if I should ever come back.

 

            I shall be telling this with a sigh

            Somewhere ages and ages hence:

            Two roads diverged in a wood, and I-

            I took the one less traveled by,

            And that has made all the difference.

 

Robert Frost, 1915 from the collection “Mountain Interval”