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

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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phone greeting tips for dental offices

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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dentist checking patient for fremitus

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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airway dentistry

Airway Dentistry: Making a Difference for Patients’ Wellness

By Steve Carstensen, DDS | May 21, 2025

By: Steve Carstensen, DDS  This Topic Originally Appeared on PankeyGram.Org. Dr. Carstensen granted permission for igniteDDS to share with our readers. “Hypoxic burden” is the challenge that the body faces due to low levels of oxygen on an intermittent basis. Our physiology has an adaptive capacity to manage hypoxic burdens. When that adaptive capacity is exceeded,…

dmg's ecosite elements

Case Using DMG’s Ecosite Elements: Class II Caries on #4

By Mohammed Hammoud | May 21, 2025

By: Dr. Mohammed Hammoud Today’s case: Radiographic caries on #4D, extending into the occlusal. A well-sealed, properly contoured Class II restoration was the goal. Here’s how I approached it: Step-by-Step Breakdown: 1. Anesthesia ½ carpule Citanest Plain + 1 carpule Septocaine for patient comfort and profound numbness. 2. Preparation Conservatively removed decay while preserving tooth…

you hired an associate

You Hired an Associate, Congratulations! Now what?

By Angela Holland | May 20, 2025

By: Angela Holland As a dental practice owner, you may reach a point where the demand for your services outpaces your ability to handle it all on your own. Whether you’re struggling to manage an influx of new patients, dealing with burnout from working long hours, or simply looking to scale your practice, hiring an…

Patient Care in the Age of 2 Day Shipping and Social Media 

Patient Care in the Age of 2 Day Shipping and Social Media 

By Savanah Craig | May 19, 2025

By: Dr. Savanah Craig We live in a world of instant gratification. Social Media shows us before and after photos and leaves out the hours, days, months, years it took to achieve that outcome. Patients are inundated with advertisements for “Teeth in a day” and dental tourism that promises to fix all their problems in…

Achieving the Ideal Shade for Complex Restorative Cases

Achieving the Ideal Shade for Complex Restorative Cases

By Dr. Kelley Brummett, DMD | May 14, 2025

By: Kelley Brummett, DMD This Topic Originally Appeared On PankeyGram.Org. Dr. Brummett granted permission for igniteDDS to share with our readers. Often we have cases where one shade from VITA guide doesn’t seem to match the case due to different shades of adjacent teeth. A situation occurred in my office when I was working with a…

solving workforce challenges

Solving Workforce Challenges by Extending Careers

By Garrett Wilson | May 13, 2025

By: Garrett Wilson The dental industry has been navigating a complex workforce puzzle: how do we retain great people, care for current team members, and plan for the future? Much of the conversation rightly centers around mental and physical exhaustion and how to support team members who are feeling burnt out. We’ve seen innovative strategies…

you can have this but not that

You Can Have This But You Can’t Have That

By Dr. Eric Recker | May 12, 2025

By: Dr. Eric Recker Don’t take me back too far! I need that neck pillow. That’s too far. I can’t breathe. Are you going to dump me back off the chair? All said as the patient is reclined to 65 degrees. This is going to be a heck of a procedure. I am going to…

Benefits Of Collaborating With An In-House Dental Lab

3 Benefits of Collaborating with an In-House Dental Lab 

By Stephen Malone DMD | May 7, 2025

By: Stephen Malone, DMD This Topic Originally Appeared On Pankeygram.Org. Dr. Malone granted permission for igniteDDS to share with our readers. Running a successful dental practice nowadays involves close collaboration with the dental lab. This is easily possible if you have the dental lab in-house because this simplifies the dentist-lab communication. Everybody can give their best…

hidden tactics of dental insurance companies

Unveiling the Hidden Tactics of Dental Insurance Companies: How to Protect Your Practice and Your Patients

By Angela Holland | May 6, 2025

By: Angela Holland Dental insurance companies have long been criticized for their complex and sometimes opaque practices, especially when it comes to their Explanation of Benefits (EOB) documents. For both patients and dental practices, these documents can often be a source of confusion, frustration, and financial loss. Insurance companies, in their pursuit of profits, often…

Quicksplint

QuickSplint: Predictable Diagnostics and Restorative Success 

By David Rice | April 30, 2025

By: PankeyGramTopic Originally Appeared on PankeyGram.Org, who granted igniteDDS permission to share with our readers. Temporary occlusal splints are a great chairside solution, with a wide range of applications in our practice. An easy and effective splint that can be customized for each patient is QuickSplint, it fits in the anterior teeth only, from canine…