Dr. Fleur A. Blethen

Empathy, tenacity, and perseverance are keys to this clinician’s flourishing practice 

What can you tell us about your background?

I was born and raised in Seattle, Washington, and lived there until I was 13 years old. My family relocated to Danville in the Bay area of San Francisco when I was a freshman in high school, and we lived there for 4 years. My family returned to Seattle where I attended college and subsequently dental school and my endodontic residency. 

I obtained my Bachelor’s Degree in Biochemistry from the University of Washington in 2001. I graduated Summa Cum Laude with Departmental and College Honors. I attended dental school at the University of Washington as well and graduated second in my class. Upon graduation, I received the American College of Dentists Outstanding Student Leader Award, the Washington State Dental Association Student Award, and the Washington Association of Women Dentists award. At this time, I was invited to membership in Omicron Kappa Upsilon. I obtained my Endodontic Certificate and Masters of Science in Dentistry from the University of Washington under the direction of Dr. James J. Johnson, DDS, MS, FICD. During my residency, I was awarded the Dentsply Student Award for Oral Research Presentation at the AAE Annual Session. I did the research for my Masters Thesis under the direction of Dr. Martha Somerman, the current director of the National Institute of Dental and Craniofacial Research (NIDCR). My Masters project led to a publication titled “Ablation of systemic phosphate-regulating gene fibroblast growth factor 23 (Fgf23) compromises the dentoalveolar complex” in the journal The Anatomical Record Advances in Integrative Anatomy and Evolutionary Biology. I am in the process of board certification with the American Board of Endodontists and am currently board-eligible. I am Clinical Affiliate Faculty at the University of Washington and have instructed in both the graduate and undergraduate endodontics clinics.

When did you become a specialist and why?

I completed my specialty training in endodontics in 2008. During college, I volunteered at the University of Washington Medical Center and the School of Dentistry. I was placed in the endodontic clinics as a volunteer, and this was my first exposure to the specialty. I was fascinated by the art and science of endodontics, and my interest expanded from there during dental school when I experienced treating patients. I wanted to focus on one aspect of dentistry, and endodontics was a good fit for me because it requires thought, empathy, and strong fine-motor skills.

Is your practice limited solely to endodontics, or do you practice other types of dentistry?

Yes, my practice is limited solely to endodontics.

I had always dreamed of living in a sunny climate, so I relocated to Phoenix, Arizona in 2009. I have worked in several endodontic practices in the Valley of the Sun and have settled at Valley Endodontics and Oral Surgery at the Glendale, Arizona office. Our company has 10 specialty practices in Arizona. Three of our practices are a combination of endodontics and oral surgery, four are solely endodontics, and three are solely oral surgery. Our company prides itself on providing quality treatment to patients and accepting a variety of insurance plans to accommodate patients as much as possible.

Why did you decide to focus on endodontics?

I went into dental school with an open mind. I believed I wanted to specialize because I wanted to narrow my focus and become really proficient in one area. I was drawn to endodontics because of the diagnostic challenges we face in clinical practice, the attention to detail required to successfully treat cases, and the emergency-based nature of the specialty. I have always enjoyed working with my hands, and a high level of motor skill is required in endodontic practice. Sometimes patients present with complex symptoms and present a formidable diagnostic challenge. I find these cases especially interesting and enjoy solving the puzzle. Many patients have anxiety because they have never had root canal treatment, or they have had a bad experience during root canal treatment. I feel that I am empathetic to my patients’ needs and can put them at ease. I also had wonderful mentors in the Department of Endodontics at the University of Washington who encouraged me to pursue further training to enhance my skill set. I am so grateful for the opportunity because I truly enjoy what I do, and not many people can say that.

Do your patients come through referrals?

Yes.

How long have you been practicing endodontics, and what systems do you use?

I have been practicing endodontics for 6 years. I routinely perform a hybrid instrumentation technique using ProTaper^® and Vortex^® rotary files. During retreatment, I use ProTaper^® Retreatment files and GT^® Series X^® files. I obturate using a warm vertical technique. I downpack with the System B heat source and backfill with the Calamus^® obturation unit in most cases.

Our office has three operatories dedicated to endodontics and three to oral surgery. Our endodontics operatories are equipped with microscopes, rotary motors, ultrasonics, and digital radiography. We utilize EndoVision^® and DEXIS^® software. Our office has an office manager, receptionist/patient coordinator, and two dental assistants specific to endodontics.

What training have you undertaken?

In addition to my undergraduate and graduate studies at the University of Washington, I have taken several endodontic-specific training courses, including “The Art of Endodontics 2-day Laboratory Course” with Dr. Stephen Buchanan and “Nonsurgical Retreatment” with Dr. Cliff Ruddle. Of course, I also regularly take continuing education courses in a variety of aspects of dentistry.

Who has inspired you?

Although many people have inspired and influenced me, my biggest inspiration was my mother. She was a single mom with two children and a successful career in Commercial Real Estate. She put herself back through school obtaining her MBA and CPA when I was in grade school. My mom had an especially great challenge because my sister is disabled with Cerebral Palsy and other developmental disabilities, and thus required more time and attention than the average child. My mom never complained about her “lot in life.” She always emphasized the importance of a positive attitude and taught me that I could do whatever I put my mind to with effort. She was able to balance family and career and still make time for her personal interests. My mother passed away in 2001, but she played an integral role in laying the foundation for me to have a successful educational and practice career.

What is the most satisfying aspect of your practice?

I find helping people very fulfilling, and receiving a genuine thank you from a patient makes my day. Every patient is different, and I enjoy assessing patients’ needs and accommodating them to the best of my ability. Some people want to know every detail about the treatment you are providing and the science behind it, whereas other people don’t want to hear the intricacies as it increases their anxiety. I believe I have great responsibility to the patients I serve, and I make every attempt to provide quality treatment in a caring environment. A close second favorite aspect of my practice is seeing the final radiograph after completing a beautiful case.

Professionally, what are you most proud of?

I am most proud of myself for my academic accomplishments. I had significant chal-lenges on the road to where I am today. Both of my parents passed away during my first year of dental school, and I became the guardian of my younger sister, who is disabled. This undertaking consumed a fair amount of my time during my dental school career which required significant planning and time management on my part.

What do you think is unique about your practice?

I practice in an office that provides both endodontics and oral surgery services for patients. I have the privilege of working with an oral surgeon 3 days a week, which I have found to be tremendously helpful and educational. If a tooth cannot be retained due to non-restorability or other factors, my patients can often see the oral surgeon for consultation and sometimes treatment the same day. 

What has been your biggest challenge?

Finding a work-life balance has probably been the hardest part of career development for me. In endodontics we are often faced with seeing patients early in the morning or at the end of the day to accomodate their schedules or fit them in on an emergency basis. With time and experience, I have learned techniques for time management in practice that have helped me to maintain a social life, a healthy lifestyle, and a flourishing practice.

What would you have been if you didn’t become a dentist?

Probably a physician. I love science and math, and enjoy working with people. Medicine and dentistry are both problem-solving professions where these areas intersect.

What is the future of endodontics and dentistry?

Despite the advances in implant technology and their high success rate, most people are motivated to save their natural teeth when possible. The future of endodontics and dentistry is in tandem. Technology and education have empowered the patient to make an informed decision as to how to successfully maintain oral health. Technology has not only enabled the patient to receive better care but has also improved its access through enabling both specialists and general dentists to provide a standard of care that continues to improve. As endodontists, we need to embrace that general dentists are able to provide various levels of endodontic treatment, which is enhanced by a continued improvement in training and technology. Specialists are not only the general dentists’ partners in treating referred patients, but we are also there to provide feedback and guidance regarding patients they are treating whom we may never see in our practice. Long-term, this approach not only benefits my practice and relationships with dentists who entrust their patients’ care to me, but it improves the overall patient experience and access to quality dental care.

What are your top tips for maintaining a successful specialty practice?

There are several important aspects to maintaining a successful endodontic practice. It goes without saying that you must provide a high quality of care. Establish and maintain good relationships with your referring dentists. This leads to more than just a working relationship and often to great friendships. Developing trust with those who refer to you is important as you are often considered an extension of their practice. Always accommodate emergencies to the best of your ability. If you are available and establish that as a precedent, you will be at the top of your referring offices’ list. To this end, it helps to hold time aside in your schedule each day for emergencies, have accommodating office hours, and be available Monday through Friday.   

What advice would you give to budding endodontists?

Don’t rush. Focus on quality, and efficiency will come with time. Try to learn something from every case, especially your “mistakes.” Take the time to hire and train good staff as it has a huge impact on your daily experience in practice.

What are your hobbies, and what do you do in your spare time?

I am very active and enjoy snow skiing, wakeboarding, yoga, and running. I am learning how to golf, but that’s a work in progress. I enjoy traveling, reading, and going out to dinner with friends. I get a lot of personal satisfaction from philanthropic pursuits and hope to devote more time in the upcoming years to volunteering. Specifically I would like to spend more time working with special needs patients and others with lack of access to care issues.