Dr. Leonard Hess, DDS

Dr. Leonard Hess, DDS

Dr. Leonard Hess began teaching continuing education courses in 2005, and the topics include occlusion, smile design, treatment planning, preparation design, and practice integration of complete dentistry.

He’s taught full-day continuing education courses at the American Academy of Cosmetic Dentistry’s national meeting, The Greater New York Dental Meeting, AACD National Meeting, Pacific Dental Conference, Ontario Dental Association meeting, and The Yankee Dental Conference.

Dr. Hess also has taught courses in Japan, Germany, Poland, China, and Canada.

Dr. Hess is currently serving as the Senior Clinical Director at The Dawson Academy. He also owns Union County Center for Comprehensive Dentistry in Charlotte, North Carolina.

dawson academy complete dental examinations

Complete Examinations in Dentistry

By: Dr. Leonard A. Hess, DDSClinical Director, The Dawson AcademyThe Article Originally Appeared on TheDawsonAcademy.com. Dr. Hess…

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How To Track Key Dental Practice Performance Metrics

By: Dr. Leonard A. Hess, DDSClinical Director, The Dawson AcademyThe Article Originally Appeared on TheDawsonAcademy.com Measure What’s…

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Top Phone Greeting Tips for Dental Practices

By: Dr. Leonard A. Hess, DDSClinical Director, The Dawson AcademyThe Article Originally Appeared on TheDawsonAcademy.com In today’s…

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How to Master a Complete Dental Examination

By: Dr. Leonard A. Hess, DDS, Clinical Director, The Dawson AcademyThis article originally appeared on TheDawsonAcademy.com, Dr….

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How Do You Know If You Achieved Centric Relation? By: Dr. Leonard A. Hess, DDS Clinical Director, The Dawson Academy This article originally appeared on TheDawsonAcademy.com, Dr. Hess allowed igniteDDS to share with our readers. When we talk about utilizing bimanual manipulation as a way to get centric relation, one of the biggest misunderstandings we see is the tendency for dentists to think CR is achieved by forcing the jaw back to seat the condyles. When we are in a situation where we have a tight patient, or patients that are resisting, the worst thing we can do is force it. Bimanual manipulation provides verification of: The correctness of the physiologic position The alignment of the condyle-disk assembly The integrity of the articular surfaces Steps to Achieving Centric Relation Recline the patient so your arms are parallel to the floor and their chin is pointing up. Stabilize the patient’s head by cradling it between your rib cage and forearm. It is essential that the head be stabilized with a firm grip so it will not move when the mandible is being manipulated. Lift the patient’s chin to slightly stretch the neck, keeping your forearms parallel to the floor. Gently position the four fingers of each hand on the lower border of the mandible. The little finger should be slightly behind the angle of the mandible. The pads of your fingers should align with the bone and stay together as if you were going to lift the head. Bring the thumbs together to form a C with each hand. The thumbs should fit in the notch above the symphysis. Remember, NO PRESSURE should be applied. With a gentle touch, and with almost zero pressure from your hands, have the patient slowly hinge open and closed in rotation (an arc of 1-2mm is acceptable), never letting the teeth touch. Do not jiggle or load the joint at this point. The whole idea here is to let the condyles go to where they physiologically want to be – properly seated in each fossa. When the hinge movement is consistent, the mandible will retrude automatically and you should feel the jaw go back. At that point, hold the jaw firmly on that hinge point. With proper hand placement, there is a torque effect from the thumbs and fingers that loads the joints in an upward and forward direction. This allows upward pressure to be maintained through the condyles while still allowing them to rotate freely. Load the joint by applying firm (but gentle) pressure UP with the fingers on the back half of the mandible and DOWN with the thumbs in the notch above the symphysis (keeping the teeth separated). Note: Sudden heavy loading can injure retrodiskal tissue and cause considerable pain. Ask the patient, Do you feel any tension or tenderness in either joint? If yes, stop and determine the cause. If no, continue. Increase to moderate pressure, then firm pressure. With each increment of loading, ask the patient, “Do you feel ANY tension or tenderness in either joint?”. If tension or tenderness is experienced at any load interval, stop and determine the cause. The dense vascular connected tissue that makes up the disk will be able to handle enormous pressure through it without any sort of tenderness if you have a properly aligned condyle-disk assembly, and that condyle is completely seated. And if the condyle is seated completely, such that the medial aspect of the condyle is engaged with the medial aspect of the glenoid fossa with a properly inter-closed disk, then there can’t be any stretching of the muscle. What It Looks Like When the Condyle is Not Completely Seated in Centric When you load test, there will be a tension on that lateral pterygoid, and they will feel some tightness or fullness or a pull. Because of this feeling, they’ll have awareness in that joint. If there’s pathology in the joint or an intracapsular problem, they’re likely to have some sort of discomfort or tenderness. But also, remember that as we assess the joint, we’re relying on the totality of the exam; the questions that we ask, the palpation of the muscles, the load testing, the range of motion, doppler analysis, all these things that we do, to develop a visual picture of what’s going on there. But the short answer to, how do you know if you’ve achieved centric relation, is by load testing; by load testing in three pressure increments and making sure there is no tension or tenderness in either joint. If a Patient Has Had a Lower Block, You Can Still Put Them in Centric Relation Anesthesia locking the trigeminal nerve really doesn’t have any effect whatsoever on whether you can achieve centric or not. Those are sensory nerves and we’re not really messing with the motor. The fact is, we’re going to take bilateral manipulation to achieve centric relation, whether they’re numb or not. And the technique is going to be exactly the same. You can actually achieve centric relation even if the patient is asleep. We’ve done a number of bite records while the patients were under Pentathol. It’s exactly the same as when they’re awake. Just remember, when you’re putting a patient in centric relation, it’s the natural physiological hinge of the joint you’re looking for. If you’ve previously taken Core 2: Examination & Records with us, I encourage you to review all the principles in the book (Chapter 9: Determining Centric Relation) and in the manual, as well as what we taught in class. If you haven’t taken the Examination & Records course, we spend a day and a half doing load testing, so that students get very comfortable with the hand position and how to get repeatable precise results.

How Do You Know If You Achieved Centric Relation?

By: Dr. Leonard A. Hess, DDSClinical Director, The Dawson AcademyThis article originally appeared on TheDawsonAcademy.com, Dr. Hess…

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tmj patient

TMJ 101: The Best TMD Treatment Options For Dentists

By: Dr. Leonard A. Hess, DDSClinical Director, The Dawson AcademyThis article originally appeared on TheDawsonAcademy.com, Dr. Hess…

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What is Fremitus and Why Should You Check For It?

By: Dr. Leonard A. Hess, DDSClinical Director, The Dawson AcademyThis article originally appeared on TheDawsonAcademy.com, Dr. Hess allowed igniteDDS to…

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prepping second molars

Dentist Education: How Do I Predictably Prep Second Molars?

By: Dr. Leonard A. Hess, DDSClinical Director, The Dawson AcademyArticle originally appeared on TheDawsonAcademy.com, Dr. Hess allowed…

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Sequencing a Full-Mouth Rehab: Anterior or Posteriors First?

Sequencing a Full-Mouth Rehab: Anterior or Posteriors First?

The correct sequence to begin a full-mouth rehab is tobegin with the anterior teeth first, particularly the…

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patients who have more pain after wearing a b-splint

Q&A with Dr. Hess: Patients Who Have More Pain After Wearing a B-Splint

By: Dr. Leonard A. Hess, DDSClinical Director, The Dawson AcademyThe Article Originally Appeared on TheDawsonAcademy.com Question: What…

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do the right thing in dentistry for every patient

Dentistry and Spike Lee: “Do the Right Thing” 

By Mitchell Rubinstein D.M.D. | July 14, 2025

By: Mitchell Rubinstein D.M.D. I recently found myself channel surfing late at night, and I got sucked into a remote-drop favorite from the late ‘80s, Spike Lee’s Do the Right Thing.  The movie is both comedic and tragic, as the title alludes to a bit of advice offered to the protagonist early in the film:…

Navigating Tooth Decay Conversations with Geriatric Patients

Navigating Tooth Decay Conversations with Geriatric Patients

By Dr. Lee Ann Brady | July 14, 2025

By: Lee Ann Brady, DMDThis topic originally appeared on PankeyGram.Org. Dr. Brady granted igniteDDS permission to share with our readers. Have you ever noticed a confused look on the face of a geriatric patient when you tell them they have tooth decay? Many people falsely assume that only small children develop cavities. When I let older…

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What Many Dentists Do Not Know About Insurance Credentialing as a First Time Owner

By Angela Holland | July 14, 2025

By: Angela Holland I’d imagine starting a dental practice is a thrilling experience, whether you’re acquiring an existing practice, opening a startup, or starting as an associate at an established location. One of the most critical aspects of growing and sustaining your practice, especially in the early stages, is revenue management and if you’re accepting…

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Clinical Based Case As A D4 Student 

By Michael Eid | July 7, 2025

By: Michael Eid As you continue in your clinical journey, you quickly find yourself becoming proficient at the physical aspects of dentistry. What can be tricky is finding a proper treatment plan, individualized per patient based on their definition of success. Being able to find a solution to their chief complaint to cater towards finances,…

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Supercharge Your Dental Practice with AI & Automation: Top Tools for Efficiency & Growth 

By Dawn Patrick | July 7, 2025

By: Dawn Patrick, Dental Practice Coach + Director of Operations IgniteDDS  In today’s evolving dental landscape, Artificial Intelligence (AI) and automation are no longer just buzzwords, they’re essential tools for building smarter, more profitable practices. Whether you’re a solo practitioner or managing multiple locations, these technologies help improve diagnostic accuracy, streamline daily operations, and create…

Removing Dental Cement Inside A Zirconia And Lithium Disilicate Crown

Removing Dental Cement Inside A Zirconia And Lithium Disilicate Crown

By Dr. Lee Ann Brady | July 7, 2025

By: Lee Ann Brady, DMDThis Topic Originally Appeared on PankeyGram.Org. Dr. Brady granted permission for igniteDDS to share with our readers Sometimes a crown comes off and if it’s not damaged and the tooth structure is healthy still without any caries lesion, we can recement the same dental crown to the patient without needing to…

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No Compensation Strategy? You’re Contributing to Turnover

By Garrett Wilson | July 7, 2025

By: Garrett Wilson Payroll might be your biggest expense, but turnover is what’s really bleeding your practice. Every time a team member walks out the door, it costs you time, money, and momentum. And if you don’t have a plan for compensation, you’re likely making the problem worse. Let’s be clear: people don’t leave just…

modernize your dental office

The Elevated Experience: How Modernizing for Patient Convenience Boosts Your Dental Practice 

By Dawn Patrick | June 30, 2025

By: Dawn Patrick, Dental Practice Coach + Director of Operations IgniteDDS  Today’s dental patients are more than health consumers, they’re informed, tech-savvy, and expect a service experience that matches what they get from top retailers and service providers.  From how they book appointments to how they pay bills, patients want streamlined systems, clear communication, and…

dental office teams that learn together

Why Dental Teams Should Learn Together

By Ronda Holman | June 30, 2025

By: Ronda Holman In the fast-paced world of dentistry, continuing education (CE) is essential, not just for dentists, but for the entire dental team. When a practice chooses to learn together, something special happens: skills are sharpened, communication improves, and the entire office culture levels up.  But beyond the clinical gains, team learning sends a…

facts about zirconia

Making Informed Decisions When Choosing Zirconia Restorations 

By Christopher Mazzola, DDS | June 30, 2025

By: Christopher Mazzola, DDSThis topic originally appeared on PankeyGram.Org. Dr. Mazzola granted permission for igniteDDS to share with our readers. The purpose of looking at recent research data is to see how we can improve our clinical outcomes. Different scholarly journals inform us of ways to decrease risk and hopefully increase the longevity of the services…