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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Variolink Esthetic System Review

By James Wanamaker | June 25, 2024

By: Dr. James Wanamaker When I became a dental practice owner, one of my goals was to simplify our systems. Prior to these changes, we utilized a variety of bonding agents from multiple brands, as well as different types of cements. This always made delivery appointments and training new assistants complicated. As my practice evolved…

Overlapping of Dental X-Rays & How to Avoid It

By Ronda Holman | June 24, 2024

By: Ronda Holman Dear Dental Reader, my name is Ronda Holman and I have been sitting across from a dentist for a living for the last 25 years. I thought it might be time to make some written confessions as to what I have been guilty of over the years and how my dentist was…

What is Fremitus and Why Should You Check For It?

By Dr. Leonard Hess, DDS | June 21, 2024

By: Dr. Leonard A. Hess, DDSClinical Director, The Dawson AcademyThis article originally appeared on TheDawsonAcademy.com, Dr. Hess allowed igniteDDS to share with our readers. What is Fremitus? Fremitus is the vibration or movement of a tooth when teeth come into contact together. If you were to take your fingernail and put it on the front surface of a…

Navigating the Challenges of Team Building in Dental Practice Management with Irene Iancu RRDH

By Irene Iancu | June 19, 2024

Host: Dr. Tanya Sue MaestasGuest: Irene Iancu RRDHEdited By: Candy Velez CRDH Building and managing a dental practice team encompasses many challenges, learning opportunities, and moments of unexpected growth. Irene Iancu, a seasoned dental professional and restorative hygienist, shares her journey and the lessons learned in creating a dynamic team within her practice. This article…

Three-Dimensional Printing in Combined Orthodontic & Restorative Treatment

By Dr. Julia Latham | June 17, 2024

By: Dr. Julia Latham, DDSThis article originally appeared on DentistyToday.com. Dr. Latham gave igniteDDS permission to share with our readers. The past 3 years of experience in our practice have made it clear that 3D printing provides numerous benefits for patients and practices alike. The digital impression-taking process is far more comfortable for the patient…

Increase Case Acceptance by Listening More to Your Patients

By Dr. Elizabeth Kidder | June 14, 2024

By: Elizabeth Kidder DDSThis topic originally appeared on Pankey.org. Dr. Kidder gave igniteDDS permission to share with our readers. The first few years after dental school are pretty difficult, and most dentists feel lost. It’s the time you have to turn that theoretical part of your studies into practical work, without having a mentor to…

Conquering the Financial Labyrinth of Dental Practice Ownership: Insights from Irene Iancu RRDH

By Irene Iancu | June 12, 2024

Host: Dr. Tanya Sue MaestasGuest: Irene Iancu RRDHEdited By: Candy Velez CRDH Embarking on the journey of dental practice ownership transcends the mastery of dental care. Diving deep into savvy business and financial management, Irene Iancu, a trailblazing dental hygienist-turned-practice owner, unveils her raw and enlightening expedition through the economic intricacies of establishing a dental…

A New Era in Dental Aesthetics: 3D-Printed Bleaching Trays and Micro-Invasive Solutions

By Dr. Anna Babczyńska-Staszewska | June 10, 2024

By: Dr. Anna Babczyńska-StaszewskaThis topic originally appeared on dmg-connect.com. Dr. Anna gave permission to igniteDDS to share with our readers. [click to open PDF] A female patient (age 25) with chalky white opaque areas covering the middle and incisal thirds of upper central incisors was looking for aesthetic treatment. (Fig. 1). Fig. 1: Initial situation…

Improving the Quality of Life for Patients with Sleep Apnea 

By Steve Carstensen, DDS | June 7, 2024

By: Steve Carstensen DDSTopic originally appeared on Pankey.org: Dr. Carstensen allowed permission for igniteDDS to share with our readers Sleep apnea is a serious sleep disorder in which breathing stops and restarts many times while sleeping. This will result in not enough oxygen taken by the body, so these patients sleep with their mouths open…

The Importance of Year-End Tax Planning for Dentists: Maximizing Financial Health

By Todd Doobrow, CFP | June 5, 2024

By: Todd Doobrow, CFP “Why does my accountant tell me in March what I should have done last November?!?”  It is a common complaint we hear from dentists when it comes to their tax planning, and it needs to change now. Tax planning is a critical aspect of financial management for dentists. As the year…