Showing up, speaking out, and staying engaged matters—now more than ever.
Advocacy is more than just lobbying—it’s the power of citizens and professionals, like you, speaking out for what matters most. In this case, your patients, your practice, and the integrity of your profession.
We most often associate advocacy with lobbying corporations, such as Big Pharma, insurance, oil and gas, and tobacco, as these industries are known for influencing legislation through deep pockets and high-powered lobbyists. So we naturally associate ‘advocacy’ with negative connotations.
But that’s not the whole picture.
While it’s easy to think, “Why do I need to sign on to this? How can one endodontist affect policy on such a global scale?”, recent “wins” in dentistry demonstrate that meaningful policy change doesn’t always come from large industry—it often starts with individuals like you.
When Grassroots Advocacy Works: Ohio’s Specialty Law Scare
While large-scale lobbying dominates headlines, real impact often starts at the grassroots level. Such was the case in my own state of Ohio, where endodontists recently faced a quiet but serious threat to our profession.
An implant organization recently petitioned the state dental board to alter the definition of dental specialties. Their proposal would allow any dentist—regardless of formal postdoctoral training—to market themselves as a “specialist” after completing a weekend course and receiving a certificate. This change would blur the line between dentists who have undergone years of rigorous, accredited specialty training and those who have completed brief, non-accredited programs, often held at resort-style seminars. Under the proposed rule, a dentist could attend a short course on implant placement and then advertise themselves as an “implantologist”—despite the fact that no such recognized dental specialty exists.
Through local grassroots efforts, the AAE, the Ohio Association of Endodontists (OAE), and eventually other specialty groups and the ADA, mobilized quickly. Together, they petitioned the State Dental Board and the Governor to halt the changes. AAE provided template letters, built email campaigns, and made it easy for Ohio endodontists to speak out. The message: “This proposal was not aligned with the Board’s mission—to protect patient care” was clear, coordinated, and convincing—and it worked.
Ultimately, the dental board chose not to proceed with the change — for now. But make no mistake—it’s a temporary win. It’s important to recognize that if this were to pass in Ohio, other states would quickly follow in a snowball effect. The threat isn’t theoretical—it’s ongoing.
Advocacy at the Federal Level: PTET and Financial Equity
Another major advocacy effort came with the recent “Big Beautiful Bill” in Congress, which threatened to eliminate the pass-through entity tax (PTET) deduction. This deduction has been essential for most dental practices, especially in high-tax states like New York and California, where the state and local tax (‘SALT’) cap disproportionately affects small and mid-sized business owners. Preserving the PTET tax deduction matters because:
- Most endodontic practices operate as pass-through entities—solo or small group practices.
- PTET allows practice owners to reduce their federal taxable income, easing the overall tax burden.
- More capital remains in the practice allowing for reinvestment in equipment, staffing, continuing education, and patient care initiatives.
- It helps level the playing field with large dental service organizations (DSOs) and corporate dental models, which may already benefit from different tax structures and economies of scale.
In essence, this provision helps ensure that endodontists can remain competitive, independent, and focused on clinical excellence. Their financial sustainability is a public health win and a strategic reinforcement of the patient-centered dental model.
This legislative outcome underscores the power and necessity of professional advocacy. Organizations like the AAE and other dental coalitions played an active role in educating lawmakers about how tax policy directly affects access to specialty dental care. Thanks to AAE and ADA advocacy, members were encouraged to contact legislators using pre-filled forms and tailored messaging. It worked. The deduction was preserved.
This was the largest grassroots advocacy effort the AAE has ever participated in and it was successful — Because of you!
We Still Have Work To Do
Don’t misunderstand, there is still much work to do.
- Ohio’s dental board will revisit the specialty rule. As will other states.
- Two states have already removed fluoride from municipal water supplies. More will follow.
- Tax, regulatory, and access-to-care issues continue to emerge. And re-emerge.
These issues, and others, will require us to act again. To mobilize. To show up. To speak up. To spread the word repeatedly about what is best for our patients and our practices.
As the policy landscape continues to evolve, dental professionals must stay engaged—working together to amplify our voices on healthcare, regulatory, and tax issues that shape the future of our profession. So the next time you think, “Why should I bother?”, remember this:
You already made a difference. And you can again.
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 course 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 30, with a press release on July 14. 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, two 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 one, 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.
Disclaimer
The views and opinions expressed by authors are solely those of the authors and do not necessarily reflect the official policy or position of the American Association of Endodontists (AAE). Publication of these views does not imply endorsement by the AAE.
By Ji Wook Jeong, DDS, MS
As endodontists, we are trained to diagnose and differentiate complex orofacial pain and periapical disease with precision. But every so often, a case reminds us that not all radiolucencies are endodontic—and not all toothaches are what they seem.
This was the case with a 57-year-old male patient who had previous root canal treatments in the teeth #26, #25, and #24 (Fig.1) because his TMD specialist requested root canal treatments before mouth appliance if any risk of pulpal infection. However, the patient continued to suffer persistent, radiating pain. He had no facial swelling or paresthesia, but he did report difficulty swallowing, ear pain, and limited mouth opening. These signs, while subtle in isolation, became more concerning when considered together.
A periapical radiograph revealed a poorly defined radiolucency from tooth #26 to #24 (Fig.1) and CBCT confirmed a through-and-through lesion (Fig.2A) with external root resorption at multiple apices (Fig.2B-D). The case mimicked symptomatic apical periodontitis, but with just enough inconsistency to raise suspicion. For instance, the patient continued to experience cold sensitivity even after root canal treatments on teeth #26, #25, and #24. In hindsight, I believe his extremely low pain threshold may have caused any light contact, including the cotton pellet used in our cold test with Endo Ice—to trigger pain.
Moreover, complicating the diagnosis was the patient’s extensive trauma history: a former boxer, he had suffered repeated dental injuries and head trauma from a previous car accident, followed by Gamma Knife radiosurgery. These factors, combined with his current medication regimen for chronic pain, initially pointed dentists toward a diagnosis involving temporomandibular disorder and persistent odontogenic pain.
I performed root-end surgery on the affected teeth and submitted the tissue for biopsy. The pathology report, which arrived a month later, was sobering: adenoid cystic carcinoma, a rare salivary gland malignancy known for its perineural invasion, slow progression, and late distant metastasis (1). The patient was promptly referred to oncology and underwent extensive surgical treatment. However, the adenoid cystic carcinoma had metastasized to the lungs, and he has since been enrolled in clinical trials.
Shift in the Clinical Decision
What made this case so deceptive was its mimicry. The lesion looked endodontic. The symptoms resembled persistent apical periodontitis, albeit with some red flags, such as trismus, dysphagia, and pain radiating to the ears. These were possibly interpreted as signs of temporomandibular disorder, especially given the patient’s complex medical and trauma history. But when the radiographic and clinical signs didn’t match the expected healing trajectory, we chose to biopsy. This decision turned out to be lifesaving.
Clinical and Teaching Lessons
This case reminds us of how we teach endodontic surgery, not just the technical aspects, but also the broader responsibility of differential diagnosis.
In residency programs, we emphasize flap design, root-end resection, ultrasonic device, bioceramic materials and so on. But just as critical is pattern recognition—the ability to identify when something doesn’t fit. In academia, the educators should discuss with residents and dental students the importance of listening closely to the patient’s description of pain, especially when it is constant, severe, and poorly localized. These are often red flags for something beyond the tooth.
Identifying malignancies that imitate endodontic conditions early is key to avoiding treatment delays. Salivary gland cancers represent the second most frequent malignancy mimicking endodontic lesions, with metastatic tumors being the most common (2). More than 80% of malignancies mimicking endodontic pathology cause cortical bone destruction, and adenoid cystic carcinoma often exhibits perineural invasion that contributes to atypical pain patterns (2).
In our case, the patient had no paresthesia or visible swelling, reminding us that the absence of classic signs doesn’t rule out serious disease.
Practical Insights for Clinicians
From this experience, here are five practical clinical tips for clinicians:
- When symptoms don’t follow the script, stop and re-evaluate. Pain that doesn’t respond to properly rendered treatment deserves deeper investigation.
- CBCT is valuable, but doesn’t replace clinical judgment. Radiographic features may suggest non-endodontic origin, but symptoms often provide the first clues.
- Trismus, dysphagia, and bilateral ear pain in an “endo case” should raise concern. These are atypical signs that merit a broader differential diagnosis.
- Always consider biopsy when treating periapical lesions surgically. Even if malignancy is low on your list, histopathology can catch the unexpected.
- We, endodontists, are sentinels of diagnosis, not just technicians. Our role often places us at the first point of contact for serious conditions that mimic dental disease.
Final Reflection
As endodontists, we pride ourselves on resolving pain and saving teeth. But sometimes, our most important contribution is not the procedure we perform, but the decision we make to pause, question, and look deeper into the case.
This case reminded me that the apex is not the end of our diagnostic duty. Sometimes, the real diagnosis lies just beyond it.
A full description of this case is available in my published case report (3).
References
- Coca-Pelaz A, Rodrigo JP, Bradley PJ, et al. Adenoid cystic carcinoma of the head and neck–An update. Oral Oncol 2015;51:652-61.
- Schuch LF, Vieira CC, Uchoa Vasconcelos AC. Malignant lesions mimicking endodontic pathoses lesion: a systematic review. J Endod 2021;47:178-88.
- Jeong JW, Varghese IA, Won YK, Vigneswaran N, Kirkpatrick T. Intraosseous adenoid cystic carcinoma mimicking endodontic periapical lesion along with orofacial pain: a case report. Aust Endod J 2025;0:1–5.
Figure 1
Figure 2
Ji Wook Jeong, DDS, MS, is Associate Professor, Department of Endodontics, UTHealth Houston School of Dentistry.
The American Association of Endodontists proudly announces the district director candidates for terms beginning in 2026. Terms are three years in length, unless noted otherwise. Members will approve the nominees at the General Assembly in Salt Lake City, Utah on April 17, 2026.
The AAE Board of Directors is responsible for the AAE’s policy, strategic, and governance matters. The board includes two representatives from each of the seven districts. Each year, the AAE district caucus nominating committees elect nominees to fill upcoming vacancies on the board. In addition to the directors, the board is comprised of six officers, the executive director, the Journal of Endodontics editor, and the Foundation for Endodontics president.
The following is the slate of nominees that will be voted on at the 2026 General Assembly:
District I
Nominee: Tadros M. Tadros, B.D.S, D.D.S, C.A.G.S, Hudson, NH
Nominating Committee Chair: Garry L. Myers, D.D.S., Midlothian, VA
District II
Nominee: Adrienne Korkosz, D.M.D., Schenectady, NY
Nominating Committee Chair: Lorel E. Burns, D.D.S., M.S., New York, NY
District III
Nominee: Christopher Walker Cain, D.D.S., Nashville, TN
Nominating Committee Chair: William D. Powell, D.D.S., M.S., Knoxville, TN
District VI
Nominee: Callee Clark, D.D.S., Grand Junction, CO
Nominating Committee Chair: Alejandro M. Aguirre, D.D.S., M.S., M.B.A., Plymouth, MN
District VII
Nominee: Mike A. Sabeti, D.D.S., Irvine, CA
Nominating Committee Chair: Yaara Y. Berdan, D.D.S., M.B.A., Calabasas, CA
Additional nominations for district director positions may be made in writing to the District Caucus Nominating Committee chairs. Such additional nominations must be made with the approval of the nominee and accompanied by a petition that includes the printed names and signatures of 25 voting members of that district. To be eligible, the nominations must be received by the District Caucus Nominating Committee chair no later than October 15, 2025.
The AAE thanks the following directors who are completing their terms on the Board of Directors in April 2026: Drs. Harold J. Martinez, District I; Lorel E. Burns, District II; Robert W. Heydrich, District III; Lauren E. Jensen, District VI; and Bryan F. Mansour, District VII.
For more information on this process, please contact Katherine Rouse, assistant director, executive operations, at 800-872-3636 (North America) or 312-872-0472 (International), or email krouse@aae.org.
As President-Elect of the AAE, I’m calling on you to help shape the future of our specialty by nominating passionate, dedicated members to serve on one of our 18 standing committees.
These committees are where the AAE’s most important work begins—from programs and policies to new initiatives. Their strength depends on the talent and diversity of our volunteers.
We have a limited number of openings for three-year terms (2026–2029), plus one-year resident appointments. If you or a colleague would be a great fit, complete the Committee Nomination Form.
Be sure to highlight the nominee’s AAE or local involvement in organized dentistry and why they would make a meaningful impact. All submissions are confidential and reviewed with care.
Let’s lead the way—nominate someone exceptional today.
If you have any questions, please reach out to our Executive Coordinator, Rebecca Clark, at rclark@aae.org or 312-872-0475.
All nominations must be submitted by October 31, 2025.
Thank you for your continued dedication to the AAE. It is through our shared commitment that we uphold the AAE’s position as the premier dental specialty organization.
Warm regards,
W. Craig Noblett, D.D.S.
President-Elect
American Association of Endodontists
By Dr. Priscilla L. Carpenter
As we welcome August, I want to take a moment to offer a huge congratulations to the incredible Class of 2025! You’ve done it. All the long nights, early mornings, tough cases, and moments of doubt have brought you here. Take a deep breath, you earned this.
Right now, it’s so important to really soak it in. This is more than just the end of a chapter, it’s the beginning of everything that’s next. Whether you’re planning to move, start your new position, or simply take a well-deserved break, remember: now is the time to celebrate. Take a trip. Go somewhere you’ve never been. Spend time with the people who helped get you here. When I graduated, I took a few months to travel, recharge, and settle into my next adventure. It was exactly what I needed, and I hope you give yourself permission to do the same.
For those of you have just entered your next (or first!) year of residency: enjoy every second. I know it can feel like the days are long, but trust me, the years are short. Each case, each lecture, each breakthrough is shaping you into the clinician you are becoming. Don’t rush it, relish it.
And as you look ahead, mark your calendars for APICES, coming up August 15-16 in New Orleans! This is your meeting: built for residents, by the RNPC, and it’s going to be an unforgettable experience.
We can’t wait to see what you’ll do next. Your time is now.
See you in NOLA!
Priscilla L. Carpenter, DDS, MS
Diplomate, American Board of Endodontics
Chair, Resident and New Practitioner Committee
By Kevin W. Yu, DMD, MS
“Ready in room 5!”
I check the schedule for a third time. I know what I’m doing… right? I start making my way down the hall toward the operatory, lingering in the doorway for a moment before stepping inside.
That was my first day seeing patients as a newly minted dentist. Several years have passed since then, and I now recognize that my time as a general dentist not only developed my ability to deliver comprehensive care, but also taught me how to communicate effectively with patients, how to navigate the chaos of everyday clinical practice, and how to advocate for patients and the profession. As I reflect on my early clinical experiences, I can clearly see how much my clinical skills have improved. More importantly, I can see how general dentistry shaped a more well-rounded understanding of what it means to be a healthcare provider, a sentiment I carried with me into residency.
One of the earliest lessons I learned as a general dentist was that patients rarely present with just a dental issue. Patients came not only for routine cleanings or urgent extractions but often brought with them expectations, anxieties, financial concerns, and complex medical and dental histories. Learning to see the bigger picture beyond just the tooth helped me provide more strategically planned and thoughtfully executed care. This perspective stayed with me throughout residency, where the nature of endodontics can make it easy to focus narrowly on a single tooth. Our CBCT scans are often limited to only capturing a few teeth, and our operating microscopes offer such high magnification that our field of view may be reduced to just a few millimeters. Despite this microscopic focus, my general dentistry background helped me maintain a wider clinical lens. I routinely considered how each case fit into the patient’s overall restorative plan, whether the treated tooth needed an immediate restoration or could tolerate a brief delay, and how the long-term prognosis of that specific tooth aligned with the health and function of the rest of the dentition and the patient as a whole. This mindset allowed me to anticipate restorative challenges, collaborate more easily with referring providers, and build trust with patients by connecting endodontic treatment to their overall oral health goals.
But seeing the bigger picture defined more than just the treatment plan, it also deepened my appreciation for the emotional toll dental treatment can bring to patients. In particular, I saw how root canal therapy often triggered feelings of anxiety and fear in patients, fueled by previous traumatic experiences, horror stories shared by family or friends, or negative portrayals seen in the media. While some patients preferred not to hear the details, many wanted to understand what the treatment involves, why it was necessary, and whether they were making the right decision regarding their treatment. My time in general dentistry prepared me for the nuanced, patient-centered communication required in daily practice. General dentists are often the first to see a patient in a dental emergency and with that comes the responsibility of delivering difficult news, explaining the diagnosis, presenting treatment options, and translating radiographic or clinical findings from dental jargon into terms patients could easily understand. Over time, I learned how to assess a patient’s dental literacy level, emotional state, priorities, and expectations in order to communicate more effectively. Whether I was explaining procedural steps and risks or providing reassurance during treatment, these skills helped me build rapport and manage expectations. Ultimately, this foundation in communication reduced patient anxiety, streamlined procedures, and improved the overall patient experience.
Just as strong communication helped me navigate difficult conversations and procedures, a commitment to learning became vital as I encountered more and more complicated clinical situations. While practicing as a general dentist, I quickly realized that although dental school had provided the fundamentals, it was my responsibility to build on that knowledge in order to respond confidently to whatever situation walked in the door. This sparked a commitment to lifelong learning that I carried into my endodontic residency at Marquette University School of Dentistry. There, I benefited from faculty mentorship, national conferences and symposiums, and study clubs that exposed me to a wide range of philosophies, technical insights, and clinical strategies that helped refine my approach to endodontic treatment. However, what surprised me most during residency was how much I learned through teaching. Preparing lectures and mentoring predoctoral students in both clinic and sim lab forced me to clarify my thinking and articulate the biological principles and clinical rationale behind each decision. Whether explaining a diagnosis, instrumentation technique, or material choice, I had to ensure my reasoning was both clear and sound. Watching students grasp complex concepts and improve their procedural technique under my guidance was rewarding and reminded me that teaching benefits both the learner and teacher.
As I grew clinically and academically, I also began to appreciate the impact I could have beyond the operatory through leadership and advocacy in organized dentistry. After graduating from dental school, I became involved with the Berkeley Dental Society, eventually serving as President. I brought a public health perspective to the board of directors as the only member treating California’s Medicaid population, and helped organize volunteer opportunities with the Berkeley Free Clinic, a nonprofit organization that offers free medical and dental care to the underserved. As Chair of the Continuing Education Committee, I curated general membership meetings that featured diverse speakers from both academia and private practice. These experiences showed me how organized dentistry can influence both clinical practice and public policy. During residency, I had the opportunity to serve on the Practice Affairs Committee of the AAE, where I gained insight into efforts to advance the specialty on a national level. I have also come to appreciate that advocacy happens not only through formal roles, but in daily clinical practice. Endodontists advocate every day by challenging the outdated perception that root canal treatment is inherently painful. By educating patients, delivering compassionate care, and sharing evidence-based practices, we help shift the narrative around endodontics one patient at a time.
Whether through clinical care, teaching, or advocacy, my experiences helped me answer the question of what it means to be an endodontist. Endodontic residency refined my technique, improved my understanding, and taught me how to manage complex cases with confidence. But it was general dentistry that gave me perspective on the patient experience and the realities of practice outside the specialty. Now, as I enter my career as an endodontist, I am thinking not only about how to tackle challenging canal morphologies, but also about the person attached to the tooth. I am thinking about how to bridge the gap between specialty care and general practice. I am thinking about how to continue growing, not just as a clinician, but as a communicator, collaborator, and educator. Each step in my journey has laid the foundation for the next, shaping not only how I practice, but who I am becoming as an endodontist.
Compiled by Dr. Priscilla L. Carpenter
Dr. Simran Sarao is currently a final year Endodontic resident at The Ohio State University. Dr. Priscilla L. Carpenter caught up with her to learn more about her and her journey to endo.
The Paper Point: Dr. Sarao, thank you so much for taking time out of your busy schedule to chat with us! You’ve lived in both Canada and the U.S., grew up in Colorado, and went to dental school in Alberta. Can you walk us through your cross-border journey and what inspired you to pursue dentistry — and eventually Endodontics?
Dr. Simran Sarao: Thank you so much, Dr. Carpenter, for the opportunity to share a bit about my journey. I’ve certainly lived in a few corners of North America—it’s been kind of a cross-border relay race. I grew up in Colorado and Virginia and then headed north for undergrad and dental school at the University of Alberta in Canada. So yes, I’m proudly bilingual—in both Celsius and Fahrenheit. Now, if you are picturing -40°C winters (that is cold enough to get frostbite on your eyeballs!) and daylight till 10 pm in the summers, then that’s the right place. By the way, -40°C is as cold as -40°F, which is a not-so-fun fact I learned upon my arrival to Alberta from Colorado. Moving so often throughout my life helped me learn how to adapt quickly, connect with people in new environments, and stay grounded even when everything around me was changing.
When I was figuring out what I wanted to do, I knew healthcare was in the cards. I grew up watching both my parents work in the dental field and I saw firsthand the kind of quiet, meaningful impact they had on people’s lives. That kind of service really inspired me. Interestingly, I was torn between veterinary medicine and dentistry — two paths where you occasionally get bitten, although only one involves patients that can talk back! I shadowed a veterinarian in high school, and while I adore animals, I realized I’d spent the entire appointment cooing at them instead of doing any actual work. So dentistry it was, and I’m endlessly grateful that it led me here.
As for Endodontics, patients often walk through our doors full of anxiety, pain, and fear. They’ve heard the horror stories or they’re reliving a traumatic dental memory. And then we get this chance—within just a few minutes of meeting—to disarm them and make them feel safe, seen, and cared for. There’s something transformative about earning a patient’s trust through gentle, effective care—especially when they walk in terrified and leave saying, “Wait… that wasn’t so bad?”
The Paper Point: I love that! Okay, so you’ve completed both the Canadian and American dental boards — now you’re prepping for the Endo boards in both countries. That’s no small feat! What’s it been like navigating licensure requirements across two systems, and what advice would you give to others considering a similar path?
Dr. Simran Sarao: Licensing requirements are truly a beast of their own. Navigating two entirely different systems meant digging through websites, decoding conflicting guidelines, and figuring out what to take, where, and when—and feeling like the rules change every time you refresh the webpage.
Thanks to some incredibly open and supportive mentors, I’m now a licensed dentist in both the U.S. and Canada. That journey included a lot of written and practical exams (memories that I’ve since repressed for my own wellbeing). Right now, I’ve completed parts of the Canadian and American Endo boards, with one last exam lined up before the year’s end. And then, fingers crossed, I can officially retire from standardized testing.
Trying to navigate boards and licensure can feel like you’re stuck behind a slow-moving snowplow on the highway — you can’t get around it and every minute feels like it’s slowing you down. You find yourself scanning for detours and hoping to still make it to your destination in time. Fortunately, there are mentors along the way who’ve been stuck behind the same snowplow but are ready to offer guidance (and commiserate about the traffic).
I try to reframe my mindset from obligation to gratitude: instead of something we’re forced to do, I try to see it as a privilege that we get to become Endodontists. The path is tough, yes; but at the end of it, you join a pretty incredible community.
And while it is a grind, board certification is absolutely worth it—not just for licensure, but because it sharpens our skills, deepens our understanding, and ultimately strengthens our specialty.
My biggest piece of advice for anyone navigating this process would be to not hesitate to reach out. I leaned heavily on cold emails, cold phone calls, and even cold DMs—yes, actual “Hi, I don’t know you, but I heard you took this exam…” messages to a small but mighty group of folks who’ve walked the dual-country path before me. Our Endo community is generous, tight-knit, and full of people who genuinely want to help. You never know who will respond or how those connections will carry you through board prep and even your career.
If you’re reading this and in the thick of it, please don’t hesitate to reach out. I’ve been there, and I’d be glad to help however I can.
The Paper Point: That’s so sweet of you! Talk to me about your path to endo. You joined The Ohio State University as their Endodontic Intern for one year right out of dental school and then transitioned to the Residency program. Can you tell us a bit more about that experience?
Dr. Simran Sarao: When I was applying to Endo programs in my third year of dental school, I was mostly aware of the traditional residency route. I hadn’t really considered the intern path; honestly, I didn’t even know it existed at OSU until interview season.
I still remember the moment I got the call from Columbus inviting me for an interview. I was in the middle of a dental school appointment, saw the Ohio area code, and started tearing up in the clinic. They graciously offered me a Zoom interview because of the challenging COVID travel restrictions at the time; but I thought, no way. If OSU was giving me a shot, I was going to show up no matter what it took. So I took four COVID tests over a three-day cross-border journey from Edmonton to Columbus just to be there in person. My nose may have been raw from the swabs, and I may have spent more time in transit than actually in Ohio, but it was so worth it.
After my interview, I sat by Mirror Lake on the OSU campus and had this gut feeling: This is the place. That gut feeling only deepened after my other interviews. I chose OSU’s internship route and haven’t looked back since.
The intern year changed everything for me. It was this perfect blend of academic structure and real-world application. I ran the Ohio State Dental Center’s Walk-In Emergency Clinic — helping triage dozens of patients, guiding wide-eyed dental students, and learning how to collaborate with the very people who would eventually become my referral network.
The learning curve was steep but incredibly rewarding. I was in the thick of it; working shoulder-to-shoulder with faculty and other residents, absorbing clinical pearls, and sharpening my diagnostic skills (arguably the crux of our specialty). And teaching dental students? Let’s just say it prepared me for any question that might come my way in practice… and for a few I hope to never hear again!
It also happened to be my first real job. Earning a paycheck after years of paying tuition felt surreal and it conveniently coincided with adopting a golden retriever (Ms. Maple), but more on her later.
By the time residency started, I had the confidence, clinical mileage, and interpersonal insight to hit the ground running. The experience made me grow into the clinician I wanted to become— sharper, more grounded, and more prepared. I wouldn’t trade it for anything.
The Paper Point: Every opportunity, challenge, etc. truly does bring us closer to where we were always supposed to be! You are extremely accomplished. You’ve been on the Dean’s List, published in peer-reviewed journals, worked as the Assistant Editor for Dental Traumatology, and presented internationally. You also mentioned you were awarded the prestigious Ohio State University Graduate School Fellowship. What drives your commitment to academic and clinical excellence?
Dr. Simran Sarao: My motivation is the responsibility I feel to show up as prepared and well-informed as possible for my patients, my community, and the specialty. That drive started in dental school where I aimed to explore as many aspects of dentistry as I could by getting involved in research and volunteering with outreach foundations. Serving as Assistant Editor for Dental Traumatology was an incredible opportunity that shaped my path, even before I understood its full impact. Dr. Liran Levin trusted me with that role early on and I am deeply grateful that he gave me the chance to step into that responsibility. Looking back, that experience played a pivotal role that shaped the academic side of my career and opened doors I didn’t even know existed. Throughout my journey, I have been incredibly lucky to have mentors, such as Dr. Yuli Berlin-Broner at University of Alberta, who have recognized my work ethic and channeled my dedication into opportunities that defined my career.
My research experience has refined how I think clinically and has deepened my understanding of the science behind our treatments. Delivering thoughtful, evidence-based care is critical, especially in a world where every patient consults with Dr. Google before coming to see you!
I’ve also been incredibly fortunate to receive recognition along the way. One of the greatest honors and financial reliefs was receiving the Ohio State University Graduate School Fellowship. This University-wide award prevented residency tuition from piling onto my dental school debt. And the savings were strategically rerouted to Ms. Maple’s veterinary bills and puppy training classes.
At the end of the day, everything I’ve done academically and clinically has been about showing up fully for the patients who trust me with their care. Endodontic excellence doesn’t come from just one lane, it’s built at the intersection of clinical skill, academic curiosity, mentorship, and a willingness to keep learning. I’m thankful for every stop along the way.
The Paper Point: That’s amazing! You’ve had quite the ride. From ethics committees to student leadership, you’ve taken on roles beyond the operatory. How has your leadership journey shaped you as a resident and future Endodontist?
Dr. Simran Sarao: As Endodontists, we naturally step into leadership roles. Whether it’s guiding patients through tough clinical decisions or supporting our dental colleagues during challenging cases, our community looks to us for more than just our technical expertise.
Leadership, annoyingly, doesn’t show up overnight like an Amazon Prime package; instead, it needs to be cultivated intentionally. Residency has been a masterclass in leadership, from collaborating with the dental team to building respectful relationships with dental students. We’re trained to stay calm under pressure. This comes in handy when leading teams, managing anxious patients, or defusing a student’s fourth “quick question.” That resident-student relationship lays the groundwork for the future Endodontist-referring dentist dynamic—so I’ve made it a priority to understand and invest in that connection.
I’m also incredibly grateful to the dedicated full-time and part-time faculty at OSU who share their perspective on how to not turn into the office drill sergeant. Their mentorship has been invaluable in shaping my clinical skills and in teaching me what thoughtful, patient-centered leadership really looks like.
Special thanks to Dr. Melissa Drum, who has taught me what it means to be a level-headed yet passionate leader—someone who can advocate fiercely for patients and confidently make her voice heard, even in rooms where that voice might be the unexpected one.
The Paper Point: Absolutely, mentorship is absolutely essential to our journey. What advice would you give to students or international graduates considering a U.S. residency program, especially in a competitive specialty like endo?
Dr. Simran Sarao: My advice is to just apply and put yourself out there. I know what it feels like to apply to a system you’re not fully part of. I was coming from Canada, which (despite being known as America’s polite upstairs neighbor) is still a different country with a different process. Navigating the American system as an international applicant came with a lot of question marks and “am I even doing this right?” moments.
It’s easy to feel like an outsider, especially when you’re a fresh graduate without an extensive network. And there will be plenty of well-meaning people ready to list off every reason why the odds are stacked against you. But here’s the thing: haters gonna hate. You’ve got to keep your eyes on the goal and keep showing up. Know that what you’re striving for is difficult but not impossible, and perseverance is going to make all the difference. Give it your best shot, gather as much mentorship and information as you can, and don’t be afraid to reach out. Best case scenario is you find incredible mentors who will help you through the process – just as I was fortunate enough to experience. Worst case scenario is you get ghosted—and honestly, that’s just a character building exercise for private practice.
And when the day finally comes that you achieve the goal you thought was out of reach, take the time to celebrate and reflect on your hard work and dedication. But most importantly, take the time to thank the people who helped you get there—the mentors who cleared paths, lifted you up, and believed in your potential long before you saw it yourself.
The Paper Point: What’s your dream for your career post-residency? Private practice? Academia? A blend of clinical, research, and leadership?
Dr. Simran Sarao: For now, I’ll be joining a private practice in a small Canadian town. A place where the 8-foot snowbanks in the 6-month long winter make you feel like you don’t have neighbors. And where patients call from their summer time lake island cottages to confirm appointments… with the caveat that they might be late if their jet ski runs out of fuel.
That said, I’m open to wherever this path leads. One of the best things about Endodontics is its versatility. You can blend clinical care, research, and leadership in so many meaningful ways. I feel grateful to have built a strong foundation in those areas and I’m excited to see how they’ll shape my career in the years to come.
The Paper Point: You adopted your first dog when you moved to Columbus — love that! Tell us about your pup and what life’s been like balancing residency with dog mom duties.
Dr. Simran Sarao: This is easily my favorite question! I kick off every clinic week with the Monday Morning Maple Pupdate, complete with a collection of dog photos from our weekend adventures. I’ve wanted a dog since childhood. In fact, my very first “publication” was a third-grade drawing of a golden retriever. It took a few decades but when I began residency, I finally adopted an eight-month-old golden retriever, Maple (formally, she’s Ms. Maple—because she’s a true lady). Her name is inspired by her rich red-golden coat, reminiscent of sunlight shining through maple syrup on a cold Canadian day.
Maple’s early life is a bit of a mystery. I rescued her from a rather rough situation in Middle-of-Nowhere, Ohio where she was abandoned without proper food or veterinary care. Even adopting her involved a bit of tug-of-war, but that’s a story for another day. Understandably, she carried some anxiety from her past; but she’s made incredible progress now that she’s safe and loved. Since coming home, she’s become healthy, tick-free (quite the contrast from the dozen or so we found initially), and is a true example of self-lessness.
Adopting Maple has been life-changing. She’s taught me resilience: when something startles her on a walk, she acknowledges it, shakes it off, and keeps trotting forward. She’s incredibly friendly (sometimes preferring humans over other dogs) and reminds me daily to “play well with everyone,” whether at the dog park or in the clinic. She is already fluent in English, Panjabi, and Spanish (although “Attention” and “Treats” are her favorite languages!)
On difficult clinic days, she greets me with a smile, kindness in her eyes, and a wag in her tail. She is a constant reminder to pass along positivity. Her calm demeanor (post Zoomies, of course) would make her an excellent comfort to anxious patients. We’re currently working on her therapy certifications so she can become the CFO (Chief Furry Officer) at the Endodontic practice I join. She’ll be there to ease nerves and bring joy, one belly rub at a time.
Pet a dog before and after your root canal? That’s the best pre-op and post-op protocol I can imagine—for both healing and happiness!
The Paper Point: There’s nothing better than some puppy/animal love! Dr. Sarao, it’s been such a pleasure learning about your journey. As we wrap up, are there any final words you’d like to share with our readers?
Dr. Simran Sarao: I am sincerely grateful and humbled to have had the opportunity to share my journey. One key lesson I have learned is that life rarely unfolds according to the carefully measured plans we make under the microscope, even when we’ve tried to account for every millimeter.
However, it often leads to greater growth when we remain open to new opportunities and keep a sense of humor on hand. We are privileged to be a part of this profession. I strive daily to serve with humility and remember that we have been given a unique opportunity to uplift those around us.
Dr. Priscilla L. Carpenter is chair of the AAE’s Resident and New Practitioner Committee.
Dr. Katz authored an article on KevinMD.com about the dangers of removing fluoride from drinking water, outlining the benefits of fluoride and dispelling uninformed misconceptions. KevinMD is a leading physician voice online, boasting 3 million page views monthly. Read the article.
In his hometown of Cleveland, OH, Dr. Katz interviewed on live television, emphasizing the expertise of endodontists and sharing the importance of saving natural teeth. New Day Cleveland airs on WJW FOX 8, the predominant news station in the Cleveland-Akron area, and averages 40K viewers per show. Watch the segment.
