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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Embracing Growth Through Mistakes: Lessons from Dr. David Rice

By Tanya Sue Maestas, DDS | February 10, 2025

Host: Dr. Tanya Sue MaestasGuest: Dr. David RiceEdited By: Candy Velez CRDH In the world of dentistry, where striving for precision and perfection is common, acknowledging mistakes can feel uncomfortable. Yet, these moments often hold the most significant potential for growth and improvement. Dr. David Rice, founder of igniteDDS, joined Dr. Tanya Sue Maestas on…

Medications that Interfere with Accurate Endodontic Diagnosis

By Dr. Lee Ann Brady | February 7, 2025

By: Lee Ann Brady DMDTopic Originally Appeared on PankeyGram.Org. Dr. Brady granted permission for igniteDDS to share with our readers. Endodontic diagnosis is critical to proceed with a successful treatment plan. Therefore, an accurate pulpal and periapical diagnosis should be made by combining clinical and radiographic examinations. Evaluate Patients Systemically We must evaluate patients systemically…

Embracing the Journey of Growth in Dentistry

By Dr. Gabriela Flores | February 5, 2025

Cultivating Clinical Excellence and Business Acumen Final Advice with Dr. Gabriella Flores Host: Dr. Tanya Sue MaestasGuest: Dr. Gabriela FloresEdited By: Candy Velez CRDH Dentistry is a unique profession that merges science, art, and business. As dental practitioners, the journey towards clinical excellence and savvy business management is continuous. It involves constant learning, adapting, and…

Self-Determined Future

By Savanah Craig | February 3, 2025

By: Dr. Savanah Craig Most of us had a very specific plan to get us where we are today. To achieve the goal of becoming a dentist, you have to follow a certain path. For me, becoming a dentist was always the goal. While other kindergarteners drew pictures of astronauts and teachers on their “what…

Simple Tip For Cementation of Crowns on Implant Abutments

By Dr. Lee Ann Brady | January 31, 2025

By: Lee Ann Brady, DMDThis Topic Originally Appeared on PankeyGram.Org. Dr. Brady granted permission for igniteDDS to share with our readers. A challenging part of crown cementation for implant abutments is matching the cement color, particularly in the anterior region to achieve a seamless restoration. For a while, I struggled to match the color of…

Are You in a Non-Covered Service State? (What It Means for You)

By Angela Holland | January 29, 2025

What Is a Non-Covered Services State (NCS) in Dental Insurance?Understanding the ADA Guidelines By: Angela Holland Navigating dental insurance can often feel like deciphering a complex puzzle. One key concept that dental practices and patients alike must understand is what a “non-covered services state” is and how it relates to insurance coverage, specifically when it…

Help Your Dental Assistant Understand Raises Are About Contribution – Not Just Time Served

By Ronda Holman | January 27, 2025

By: Ronda Holman In any workplace, the idea that “time served” automatically warrants a raise can create misunderstandings. While tenure shows loyalty, raises should reflect the value added to the dental practice. Helping your dental assistant understand this principle is crucial to maintaining a positive work environment while emphasizing performance and growth. Shift the Conversation:…

Careful Prescription of Medications for Geriatric Patients

By Dr. Lee Ann Brady | January 24, 2025

By: Lee Ann Brady, DMD This topic originally appeared on PankeyGram.Org. Dr. Brady granted permission for igniteDDS to share with our readers. Geriatric patients are more prone to systemic diseases and usually are on medications that can interfere with oral diagnosis and treatment outcomes or have potential side effects. Screen Medications of Geriatric Patients It’s better…

Future Proof Your Operatory

By David Rice | January 22, 2025

By: A-dec With a history steeped in innovation, reliability, and customer care,A-dec® has unveiled cutting-edge technology that makes it easy for dentists to optimize patient care, improve ergonomics, and grow the dental practice. Download the PDF version now Improved Connectivity: A Better Patient Experience The new A-dec Pro delivery system and its A-dec+ software open…

Cultivating Excellence Through Team Dynamics with Dr. Gabriella Flores

By Dr. Gabriela Flores | January 20, 2025

Host: Dr. Tanya Sue MaestasGuest: Dr. Gabriela FloresEdited By: Candy Velez CRDH In today’s competitive dental world, creating a successful practice goes beyond technical skills. Success often hinges on mastering team dynamics and building a cohesive, positive work environment. This article, inspired by insights from Dr. Gabriela Flores, a newer practice owner, explores key strategies…