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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Transforming Professional Teeth Cleanings with Guided Biofilm Therapy

By Stephen Malone DMD | August 4, 2025

By: Stephen K. Malone, DMD and Michael Costa, DDS, MHSThis Topic Originally Appeared on PankeyGram.Org. Dr. Malone granted permission for igniteDDS to share with our readers. Dental hygiene has evolved significantly since the early 1900s. Gone are the days of sharp instruments and gritty polishing pastes as the primary tools for cleaning teeth. Today, modern…

The Big Question: Startup Or Acquisition?

By Nilesh Patel | August 4, 2025

By: Nilesh Patel, VP, Regional Business Development Officer, Bank of America Practice solutions I enjoy working with prospective dental practice owners to aid them to realize their dreams. Supporting these individuals is rewarding and inspiring because I get to help them answer crucial questions. This includes the most important question of all:  “Should I acquire…

The Dreaded Transfer Request (Part 2)

By Dr. Eric Recker | July 28, 2025

By: Dr. Eric Recker Your front desk sends a message to you in your treatment room. They need to have a word. You try to finish up your procedure, but you know this likely isn’t going to be good news.  You walk to the front desk and prepare (brace) yourself. They hand you a transfer…

3 Ways to Invest in Your Dental Assistant

By Ronda Holman | July 28, 2025

By: Ronda Holman What Dentists Can Learn from Chef Tina in The Bear In the TV series The Bear, one of the most compelling character arcs belongs to Chef Tina, played by Liza Colón-Zayas. Tina begins the series as a seasoned line cook who is resistant to change, doing things the way they’ve always been…

Unraveling the Etiology of Worn Teeth  

By Dr. Lee Ann Brady | July 28, 2025

By: Lee Ann Brady, DMDThis topic originally appeared on PankeyGram.Org. Dr. Brady granted permission for igniteDDS to share with our readers. The origin of a patient’s worn teeth may be deceiving. Is it physiological or pathological? This minor difference could spell major consequences for the lifetime oral health of your patients. We care about understanding…

Congratulations on Hiring a Dental Associate! Here’s What to Know About Insurance & Credentialing

By Angela Holland | July 28, 2025

By: Angela Holland Hiring a dental associate is an exciting milestone for your practice! As your practice grows, it’s essential to keep several key insurance-related aspects in mind to ensure smooth operations. One of the most important points to remember is that all claims where the associate is the rendering provider must reflect their credentials….

Sealants in Pediatric Dentistry: High‑Yield Guide for Dental Students

By Michael Eid | July 21, 2025

Sealants are one of the simplest yet most powerful tools you’ll use to prevent caries in kids. When placed correctly at the right time, they can protect a tooth for years. This guide breaks down when and how to place sealants with confidence—and why timing matters.  When Should You Place a Sealant?  Ideal Teeth:  Key…

The Dreaded Transfer Request (Part 1)

By Dr. Eric Recker | July 21, 2025

By: Dr. Eric Recker It’s a normal Tuesday, or as normal as they get in our world. You got some dentistry done, maybe a couple of crown preps, some restorative, a load of hygiene checks, a new patient exam or two. You are almost to lunch and feeling reasonably good about yourself. Day is half…

The Reason I Write Treatment Letters to Each Patient

By Dr. Laura S. Harkin, DMD | July 21, 2025

By: Laura Harkin, DMDThis topic originally appeared on PankeyGram.Org. Dr. Harkin granted igniteDDS permission to share with our readers. Trust is the cornerstone of dental care. It’s something I learned early on, sitting at my dad’s favorite lunch spot when he shared a profound observation: “Laura, isn’t it amazing? Our patients trust us so much….

The Four Areas of Wealth Accumulation for Dentists

By Dr. James Pitts | July 21, 2025

By: Dr. James Pitts Most people think of retirement planning or wealth accumulation as a “nest egg.”  It is a common misconception that wealth is built in one pile.  The reality of Dentists is more complicated. Typically, Dentists build their wealth in four different buckets. 1. Qualified Retirement Plan Savings The first bucket is qualified…