Advocating for Prevention: An Endodontist’s Role in Safeguarding Water Fluoridation

Compiled by Elisabeth Lisican

When you think of community water fluoridation advocacy, an endodontist might not be the first professional who comes to mind. But Dr. Brandon Barnett is helping to change that. A Diplomate of the American Board of Endodontics and member of the AAE’s Resident and New Practitioner Committee, Dr. Barnett brings a unique blend of clinical expertise and public health training to the table. He completed dental school at the University of New England College of Dental Medicine, a GPR at UT Houston, endodontic residency at Rutgers School of Dental Medicine, and earned a Master of Public Health degree in Health Policy from the Yale School of Public Health. During Connecticut’s 2025 legislative session, he played a key role in supporting—and ultimately helping to pass—landmark legislation safeguarding water fluoridation. In this conversation, Dr. Barnett shares how a class project turned into state policy impact, how endodontists can contribute to prevention efforts, and what advice he has for colleagues interested in advocacy.

Lisican: Can you walk us through your involvement in the effort to preserve water fluoridation in Connecticut—how did it begin, and how did your role evolve?

Dr. Brandon Barnett: There were really two events that were pretty central to my involvement with my efforts to preserve water fluoridation in Connecticut. A health law project, and a fellowship with the Connecticut Oral Health Initiative (COHI)

During the Fall of 2024 in my masters at Yale, I was tasked with making a legal “toolbox” as a major project in a course on health law—since as we all know well, the law can be a powerful tool in public health both for better and for worse. Basically, the goal of this project was to identify a problem in public health and come up with strategies in which the law, or policy, could be used to address said problem. I had fully intended to write about medicaid reimbursement in dentistry and access to care for procedures like root canals, but when the 2024 election ended and it became clear that vocal critics of water fluoridation might be taking key positions in public health, I very quickly shifted gears to discuss some of the ways we could preserve water fluoridation using the law instead.

The first part of the project which pieces together the legal and historical landscape of water fluoridation really became a robust analysis of fluoridation in nearly every major aspect, from 1945 until the now-infamous and deeply flawed California decision in Food & Water Watch, Inc. v. EPA, which alleged that water fluoridation presented an unreasonable risk of injury. Long story short; it was well received. So with the suggestion and guidance from my professor Shelley Geballe, we circulated this first part of my paper as a memo to the Connecticut Department of Public Health, and to a fellow grad student who worked with Sen. Anwar, one of the co-chairs of the Connecticut General Assembly’s public health committee. This was done under the correct assumption that water fluoridation would likely come up as a central issue in the upcoming legislative session.

When the 2025 legislative session came around I started working directly with the Connecticut Oral Health Initiative (COHI) at the state capitol. In addition to lobbying for quality, affordable oral health, COHI also saw water preserving fluoridation as a priority. So there, not only was I able to share my memo with the members of a rapidly growing oral health coalition from around the state, I was able to use what I learned from working on the topic of water fluoridation to function as a subject matter expert. So throughout the legislative session, I was able to talk about the importance of water fluoridation at length in every opportunity I had, at legislative breakfasts, conferences, zoom calls and of course in public health hearing testimony. In February, Sen. Anwuar introduced the fluoride bill (SB1326) which codified water fluoridation in Connecticut at a range 0.7 of a milligram per liter with a deviation limited to 0.15mg/L upper and lower limits which has long been proven to be a safe and effective dose. The language of this bill eventually made it to the state’s budget implementer and was signed into law by Gov. Lamont on June 30th, with a press release on July 14th. It was a huge win for everyone involved, a real team effort.

Lisican: What motivated you personally or professionally to take up this cause?

Dr. Barnett: As endodontists we often feel very isolated from the realm of public health. We’re interventionists, so by all accounts the work we do is not necessarily considered preventative. I was already doing an MPH in health policy with a major focus on quality of care, and increased medicaid coverage  for endodontic procedures… but I was motivated to shift gears towards the topic of water fluoridation because for one, I wanted to prove to myself that even endodontists have a role to play in prevention, and two because we are at a critical moment in time for the future of water fluoridation.

Lisican: How did you go about drafting the fluoride memo? What key points did you want lawmakers to understand?

Dr. Barnett: So as you probably gathered my initial project wasn’t necessarily intended to be a memo. While writing for my project I certainly had imagined decision-makers reading it some day and hopefully taking something away that they could use to affirm that water fluoridation was indeed important. Given how far this memo circulated,  I certainly hope it helped lawmakers and stakeholders the way I intended. The main points in the memo that I wanted readers to understand is that we know that community water fluoridation is safe because there are well-documented side effects from fluoride exposure at levels that we can already prove. Moreover, if we hypothetically did want to truly limit “excessive” fluoride exposure in a legislative capacity one day, eliminating community water fluoridation would still not be the answer. I cite a study done on maternal urinary fluoride that shows that community water fluoridation may only account for only 43 – 50% of overall fluoride exposure. Unlike levels in the water supply, which are very strictly regulated and maintained, these other sources are almost entirely unregulated!

Lisican: What strategies did you use to build support among legislators and stakeholders?

Dr. Barnett: The first thing I did at the start of the legislative sessions was participate in several small virtual and phone meetings with legislators. This was the first time I had done something like this and it was part of my work with the Connecticut Oral Health initiative. The strategy of COHI, their policy director Sandra Ferreira-Molina and COHI Executive Director Rep. Gary Turco, was well thought out and involved these small meetings early on to build a sense of familiarity and to discuss our legislative priorities. We’re talking about meetings that were not even 5 minutes long in some cases. These initial meetings later expanded to invitations to several events that we organized, like legislative breakfasts, virtual town halls, and the COHI annual meeting. Simultaneously we held coalition meetings with representatives from oral health organizations across the state to come to discuss what we felt was really important to the cause, who then attended these events with legislators as well. It really built a sense of familiarity and brought all relevant stakeholders together. As the legislative session went on and the bills relevant to use evolved, the discussions at these meetings were able to maintain a real sense of continuity and you began to see support for our oral health initiatives like preserving water fluoridation grow.

Lisican: How did you leverage your clinical expertise to influence policy conversations?

Dr. Barnett: My clinical expertise really helped give me credibility. As dental providers we are as close as it often gets to being experts on fluoride and as endodontists we are certainly familiar with the consequences of what might be inadequate fluoride exposure. I often would share an anecdote from my clinical experience about the difficulties patients often have in accessing our services and tie in the fact that the fluoride from their water supply is actually the only real dental “intervention” many actually get in a given year, especially for those facing cost or access barriers to treatment.

Lisican: You gave testimony and participated in legislative breakfasts and Zoom calls. What messages did you prioritize in those settings?

Dr. Barnett: In each of these settings I reminded participants that, while not being the first state to have fluoridated water, Connecticut has a proud history of being the first state to require community water fluoridation by law—so a little state pride was thrown into the mix. I highlighted data showing that maintaining the optimal 0.7 mg/L level cuts tooth decay about 25 %, which helps mitigate roughly two million emergency-room visits due to dental emergencies nationally—so we’re saving money by continuing to fluoridate our water. Of course, highlighting the access-to-care component was big too. Medicaid funding as an access-to-care modality is always an issue in the legislature, and many lawmakers struggle to find room in the budget to accommodate this. Framing community water fluoridation as sometimes the only dental “treatment” available to low-income residents gives legislators the opportunity to promote access to care without a heavy financial burden, since water fluoridation is quite inexpensive. I also frequently brought up the statistic I mentioned earlier about sources of fluoride exposure external to community water systems, which really seems to resonate with folks.

Lisican: Were there any moments during those testimonies or calls that stood out to you—positive or challenging?

Dr. Barnett: One positive moment during testimony that really surprised me was the broad support from the Public Health Committee at the original hearing for SB 1326. My testimony was fairly short because the committee members seemed strongly in agreement that community water fluoridation was still a good idea. This first hurdle of getting the bill out of committee was much simpler than anticipated, almost certainly because they had this consensus. Most committee members had read up on the topic prior to the hearing, benefiting from materials that others and I had submitted beforehand, so the heated debate one might expect never materialized. Instead, the hearing floor became a place for questions on water fluoridation to be answered on the public record.

Lisican: Did misinformation or public misconceptions around fluoride come into play? How did you handle that?

Dr. Barnett: It certainly did. Misinformation is really at the root of how this anti fluoridation sentiment has begun to gain momentum. The best way to combat this was to mention that the studies linking fluoride exposure to IQ were done in areas with fluoride over four times the amount we add to water here in the U.S. It’s also important to remember that many people with strong opinions against community water fluoridation are also just trying to stay healthy too, using that fact as common ground before combatting misinformation is a great place to start.

Lisican: How did it feel to learn that the bill had officially passed into law?

Dr. Barnett: I only played a small part, but seeing the payoff from being a part of a combined effort like this was really great. With all of the upsetting developments in anti-fluoride sentiment, it gave me hope that preserving community water fluoridation is doable.

Lisican: What do you think this legislation means for the future of public health in Connecticut—and potentially beyond?

Dr. Barnett: This is a big win for public health in Connecticut. Prior to this, fluoride levels were tied directly to recommendations from the department of health and human services. I imagine the idea at the time was that it would allow Connecticut to automatically adjust to new levels determined by emerging evidence at the federal level. But as a consequence, if the federal government were to stop recommending community water fluoridation altogether, this would have meant that Connecticut would instantly lose water fluoridation at the state level. The new law sets fluoride at 0.7mg/L but this concentration is actually the same level that has been in place since 2015. In other words, the law doesn’t create a new standard, it safeguards one that is tried and true.

Beyond Connecticut, and with all the buzz around Utah and Florida recently banning fluoride you might be surprised to hear that community-water fluoridation is actually only required by law in 13 states. Despite this around 66% of the United States has access to fluoridated water. What this means is that there is actually a lot of flexibility in how individual water systems can implement, and protect community water fluoridation, through local referendums, health department regulations, and city council resolutions just to name a few.

The public health implication of this is that a powerful strategy in the immediate short term to protect community water fluoridation might be to uncouple as many of these local and state level fluoride recommendations from the department of health and human services as possible. Previously, 2 of the 13 states with community water fluoridation mandates had “coupled” recommendations. Now that Connecticut has officially set 0.7mg/L as the standard we are down to 1, leaving just Illinois still tethered to HHS guidance, so water fluoridation there is still quite vulnerable. At the local level, Albuquerque, NM, and Philadelphia, PA are in a similarly precarious situation.

Lisican: What advice would you give to other AAE members who want to make an impact through advocacy?

Dr. Barnett: This might sound like a lot, but I would suggest that any AAE member who wants to make an impact through advocacy needs to find out when your state legislature is in session, use the site’s search tool to look for any bill related to “oral health”, “dentistry”, “fluoride” and sign up to testify on the day of a relevant bill’s public hearing. This is an awesome and impactful first step. We are not all public health experts, and you don’t always need to write an op-ed or a memo. But during these public hearings you will quickly realize that you are often the only dentist in the room for important laws that relate to our profession. It may seem intimidating at first, but the committee members holding these hearings are really thankful to have us in the room because they trust our subject matter expertise. Even before a public hearing, discussions have paused mid-sentence for a person to turn and ask me, “…but, what do the dentists think?” There are registration deadlines, but literally almost anyone can sign up to testify, and if you don’t want to speak in front of the room you can always just submit written testimony too.

It also is a great idea to partner with a local oral health nonprofit like the Connecticut Oral Health Initiative. These groups are very happy to have dentists on board at all, let alone specialists, and can help you steer your efforts in the right direction. Notifying you about hearings, getting you in touch with legislators, and overall being a great resource to learn about the legislative process in your local community.

Elisabeth Lisican is the AAE’s assistant director of communications & publishing.