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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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: 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…

We Can All Wear A Cape!

By Dr. Eric Recker | April 29, 2025

By: Dr. Eric Recker Monday morning 8 AM. First patient of the week. Maybe our mind is on what happened this past weekend or the crazy schedule we have in front of us. Maybe it is just spinning. Spinning with all the things we do and all the hats we wear as general dentists. What…

Help! My Dental Assistant Keeps Giving My Patients Dirty Glasses

By Ronda Holman | April 28, 2025

By: Ronda Holman It might seem like a small thing, but when a dental assistant hands a patient safety glasses that are smudged, dusty, or have splatter marks, it sends a loud message: “We don’t pay attention to the details.” In a clinical setting where cleanliness is everything, dirty safety glasses can instantly create doubt…

Rubber Dam Isolation: Maximizing Bond Strength to Enamel

By Christopher Mazzola, DDS | April 23, 2025

By: Christopher Mazzola, DDSTopic Originally Appeared on PankeyGram.org. Dr. Mazzola granted permission for igniteDDS to share with our readers. Advantages of Utilizing Rubber Dam  Rubber dam isolation has a lot of advantages to be used in dentistry, that are supported with many clinical studies. By making our everyday procedures easier, without having to worry about…

Why Updating UCR Fees Annually is Best Practice for Your Dental Practice

By Angela Holland | April 22, 2025

By: Angela Holland In any dental practice, one of the most critical components of financial health is the establishment and management of Usual, Customary, and Reasonable (UCR) fees. UCR fees are essentially the fees a dental practice charges for services based on what is typical for the area and within industry standards. These fees play…

Your License, Your Reputation, Your Responsibility: Lessons from Dr. A.R.

By Candy Velez - CRDH, BSDH | April 21, 2025

Closing the Series & Applying These Insights to Your Practice By: Candy Velez – CRDH, BSDH When you started this series, did you ever imagine you would gain so much insight from a single disciplinary case? The case of Dr. A.R. wasn’t just about one dentist’s mistakes—it was a window into the standards, expectations, and…

Obstructive Sleep Apnea Treatment: Oral Appliances And CPAP

By Todd Sander, DMD | April 16, 2025

By: Todd Sander, DMDTopic Originally Appeared on PankeyGram.Org. Dr. Sander granted igniteDDS permission to share with our readers. Patients suffering from obstructive sleep apnea (OSA) look for alternatives to continuous positive airway pressure (CPAP) or an integrated approach that would improve the quality of their lives and is easier to adapt. Clinicians struggle because most…

Ghosted by Your Dentist: When Poor Communication Becomes Patient Abandonment

By Candy Velez - CRDH, BSDH | April 15, 2025

Understanding Patient Abandonment – Lessons from Dr. A.R. By: Candy Velez – CRDH, BSDH Imagine calling your dentist’s office to schedule an appointment, only to discover the office is permanently closed with no way to retrieve your records. Suddenly, you are left without a provider, without guidance, and without access to your dental history. This…

No More Drama: How Clear Agreements Create a Thriving, Accountable Dental Team 

By Dawn Patrick | April 14, 2025

By: Dawn Patrick, Dental Practice Coach + Director of Operations IgniteDDS  Managing a dental practice comes with its fair share of challenges—especially when it comes to holding your team accountable. Too often, practice owners and managers find themselves frustrated when tasks aren’t completed, patient care falls through the cracks, or team members don’t meet expectations….