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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Complete Examinations in Dentistry

By Dr. Leonard Hess, DDS | December 6, 2024

By: Dr. Leonard A. Hess, DDSClinical Director, The Dawson AcademyThe Article Originally Appeared on TheDawsonAcademy.com. Dr. Hess granted permission for igniteDDS to share with our readers. Whether you’re a seasoned veteran in the dental industry or just starting on your journey, one thing is for sure: complete examinations have become a cornerstone of modern dentistry….

New Year’s Resolutions for Dentists: Get a Head Start Before the Year’s End

By Todd Doobrow, CFP | December 4, 2024

By: Todd Doobrow, CFP As the year winds down and we gear up for the holidays, many of us start thinking about New Year’s resolutions. For dentists, this is a great time to reflect on personal and professional goals, especially since the final weeks of the year can often be the most hectic. Instead of…

Dental Phobia & Anxiety: Helping Patients Overcome

By Savanah Craig | December 2, 2024

By: Dr. Savanah Craig A phobia is defined as an intense, irrational, and persistent fear of a specific object, situation, or activity that poses little to no actual danger. Fear of the dentist or dental phobia is no different and, in my experience, most patients know that their fears are irrational. However, the intensity of…

Meeting Patient Expectations in Dentistry

By Dr. Kelley Brummett, DMD | November 29, 2024

By: Kelley Brummett DMDThis topic originally appeared on Pankey.org. Dr. Brummett granted permission for igniteDDS to share with our readers. Meeting patients’ expectations requires excellent communication and understanding of their desires to look at what you can do to solve their problems. Once you understand their expectations, you will know which of the treatment plans…

Patient-Friendly Language: Explaining Treatment Plans without Jargon 

By Dawn Patrick | November 27, 2024

By: Dawn Patrick, Dental Coach and Director of Operations, IgniteDDS As dental professionals, one of the greatest challenges we face is explaining complex treatment plans to patients in a way that is clear and approachable. Often, our expertise can lead us to use industry-specific terminology that can confuse or even overwhelm patients. When patients don’t…

Help…My Dental Assistant Breaks Stuff!

By Ronda Holman | November 25, 2024

By: Ronda Holman As a dentist, you know how quickly the cost of running a dental office can add up. From high-tech dental equipment to everyday tools, every piece plays an essential role in delivering quality care. But what happens when you notice a pattern of things breaking—and it’s often the same person involved? Take…

A Six-Unit Anterior Bridge: Provisionals and Placement

By Dr. Lee Ann Brady | November 22, 2024

By: Lee Ann Brady DMDTopic originally appeared on Pankey.org: Dr. Brady allowed permission for igniteDDS to share with our readers My patient wasn’t satisfied with the aesthetics and feel of her previous restoration. Detailed planning enabled me to deliver a beautiful, functional result. Here is the conclusion of this case and the placement of the…

Navigating Dental Technology Investments: A Journey to Practice Growth & Finding Your ‘Why’ with Dr. Chad Duplantis

By Chad Duplantis, D.D.S, F.A.G.D | November 20, 2024

Host: Dr. Tanya Sue MaestasGuest:  Dr. Chad DuplantisEdited By: Candy Velez CRDH The world of dentistry is continually evolving as new technologies emerge, promising to revamp practice operations and patient care. However, incorporating these advancements isn’t always straightforward – it’s a journey that encompasses not only financial acumen but also a deep understanding of one’s…

A Practical Guide to Bonus Cylces in Dentistry: Building Accountability and Excellence

By Dawn Patrick | November 18, 2024

By: Dawn Patrick, Dental Coach and Director of Operations, IgniteDDS As a dental practice owner, you might wonder what a truly motivated team could bring to your practice. Imagine a team that performs well and is genuinely engaged, bringing energy, commitment, and productivity to the table every day. This level of motivation can transform your…

How To Track Key Dental Practice Performance Metrics

By Dr. Leonard Hess, DDS | November 15, 2024

By: Dr. Leonard A. Hess, DDSClinical Director, The Dawson AcademyThe Article Originally Appeared on TheDawsonAcademy.com Measure What’s Really Important and Accomplish What Really Matters In his groundbreaking book, Thriving on Chaos, Tom Peters proclaims, “What gets measured gets done.” He further explains, “Develop simple systems that encourage participation and understanding by everyone.” In other words,…