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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How to Improve Communication with Dental Patients for Better Treatment Acceptance 

By Dawn Patrick | November 13, 2024

By: Dawn Patrick, Dental Coach and Director of Operations, IgniteDDS  Effective communication plays a crucial role in any dental practice, not just for patient satisfaction but also for ensuring high treatment acceptance rates. When dental teams communicate clearly, compassionately, and in a patient-centered way, patients are more likely to feel understood and trust the treatment…

Why Dentists Shouldn’t Be Afraid to Ask for Financial Help

By Todd Doobrow, CFP | November 11, 2024

By: Todd Doobrow, CFP In today’s fast-paced world, dentists face numerous challenges, from human resources, to maintaining the latest technology to managing rising operational costs. Despite their expertise in oral health, many practitioners find themselves hesitant to seek financial help when needed. No two doctors are alike, so just copying what peers have done can…

2 Ways to Increase Dental Case Acceptance

By Dr. Mark Murphy, DDS | November 8, 2024

By: Mark Murphy DDSThis topic originally appeared on Pankey.org. Dr. Murphy granted permission for igniteDDS to share with our readers. It can take years to gain the experience of increasing your case acceptance. You have to be consistent in doing your job. The fact that a patient’s genuine intentions might not be immediately clear is…

The Power of Consistency: How Processes Can Transform Your Practice 

By Dawn Patrick | November 6, 2024

By: Dawn Patrick, Dental Coach and Director of Operations, IgniteDDS  Running an efficient and profitable dental practice requires more than just clinical expertise. Consistent, well-implemented processes are key to ensuring smooth operations, reducing stress, and enhancing patient satisfaction. Daily, weekly, and monthly routines create the foundation for a thriving practice, leading to increased efficiency and…

Hospital Dentistry

By Savanah Craig | November 4, 2024

By: Dr. Savanah Craig During my residency training, I learned about a new aspect of dentistry that was completely foreign to me: Hospital Dentistry. With our societal separation of dentistry and medicine from each other, we have also removed the idea of oral care in conjunction with the care of the rest of the body…

Empowering Continuing Education with Study Clubs

By Denison E. Byrne, DDS, MAGD | November 1, 2024

By: Denison E. Byrne, DDS, MAGDThis topic originally appeared on Pankey.org. Dr. Byrne granted permission for igniteDDS to share with our readers. In the realm of continuing education, it’s important to have the right support and encouragement that can transform our aspirations into achievements. My colleague Nancy and I embarked on a relentless pursuit of…

Daily Dental Practice Routines That Lead to Long-Term Success 

By Dawn Patrick | October 30, 2024

By: Dawn Patrick, Dental Coach and Director of Operations, IgniteDDS  Running a successful dental practice requires more than just clinical skills. It takes effective daily routines, attention to detail, strong leadership, and a commitment to patient care. By establishing consistent routines that promote efficiency, patient satisfaction, and team well-being, you can build a practice that…

Help…My Dental Assistant is Always On Their Personal Cell Phone While On the Clock

By Ronda Holman | October 28, 2024

Tackling Cell Phone Distractions in the Dental Office By: Ronda Holman Dr. Smith is preparing to see her next patient, but as she heads toward the operatory, she notices the patient has not yet been seated. Curious about the delay, she checks the sterilization area and finds her dental assistant scrolling through social media on…

Top Phone Greeting Tips for Dental Practices

By Dr. Leonard Hess, DDS | October 25, 2024

By: Dr. Leonard A. Hess, DDSClinical Director, The Dawson AcademyThe Article Originally Appeared on TheDawsonAcademy.com In today’s competitive dental market, creating a lasting first impression is more important than ever. One of the simplest yet most effective ways to do this is through an excellent phone greeting. Dental practices, often preoccupied with patient care and…

Time to Look Beyond Index Funds

By Todd Doobrow, CFP | October 23, 2024

By: Todd Doobrow, CFP Index funds have gained immense popularity in recent years, often lauded for their low fees, diversification, and ease of use. However, while they offer a straightforward investment strategy, it may be time for investors to consider alternatives that may provide enhanced returns, tailored strategies, and unique opportunities. Why Look Beyond Index Funds?…