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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Help…My Dental Assistant is Complaining About My Equipment!

By Ronda Holman | April 24, 2024

By: Ronda Holman Hi dear 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…

Buyer Beware: No Team Introduction Equals No Goodwill

By David Rice | April 22, 2024

By: Dr. David Rice  Buying a dental practice is multifaceted and as a buyer, you need to navigate through various aspects of potential purchases to make your most informed decision. I want to talk about one of the best lenders like Provide … and one that’s often overlooked … Get to Know the Dental Practice…

Navigating TMD: Exploring Practice Transformation

By Dr. Michelle Lee, DDS | April 19, 2024

How Studying and Treating TMDTransformed One Dentist’s Practice for the Better By: Michelle Lee, DDS When Dr. Michelle Lee embarked on her dental career, she felt like there was a missing piece in how she approached dentistry. Discovering the power of TMD ultimately made her work more fulfilling and effective. Dr. Lee relates her journey…

Unlock Your Dental Education Potential with The Ivoclar Academy

By Nicola Kowal | April 17, 2024

By: Nicola Kowal, Ivoclar Education Manager In the dynamic landscape of dentistry, continuous learning is paramount for professionals striving to deliver top-tier care. Enter The Ivoclar Academy, a trailblazing hub for comprehensive dental education, seamlessly blending traditional in-person learning with cutting-edge virtual resources. Easily Register for The Ivolcar Academy Online Gone are the days of…

Building a Strong Dental Team: Trusting Your Gut and Learning from Mistakes with Dr. Jennifer Bell

By Dr. Jennifer Bell, DDS, FAGD, FICD | April 15, 2024

Host: Dr. Tanya Sue MaestasGuest: Dr. Jennifer BellEdited By: Candy Velez CRDH We are back with Dr. Jennifer Bell as we explore the challenges of building a dental team and the importance of trusting your gut. Follow along as Dr. Bell shares her experiences and the valuable lessons she has learned throughout her journey. Trusting…

Q&A with Dr. Hess: Patients Who Have More Pain After Wearing a B-Splint

By Dr. Leonard Hess, DDS | April 12, 2024

By: Dr. Leonard A. Hess, DDSClinical Director, The Dawson AcademyThe Article Originally Appeared on TheDawsonAcademy.com Question: What can I do with a patient who has more pain after wearing a B-Splint? Answer: The first thing is, take it out. You knew that already. The point is – the pain got worse. Now I don’t know…

Navigating Tax Season for Dental Owners & Associates

By Todd Doobrow, CFP | April 10, 2024

By: Todd Doobrow, CFP Tax season can be a stressful time for both dental owners and associates. However, with careful planning and strategic decision-making, you can significantly reduce your tax burden and keep more of your hard-earned money in your pocket. 4 Ways to Lower Your Taxes & Improve Your Financial Situation Here are four…

New Research on Caries Management 

By Savanah Craig | April 8, 2024

By: Dr. Savanah Craig The American Dental Association defines dental caries as a; “Biofilm-mediated, sugar-driven, multifactorial, dynamic disease that results in the phasic demineralization and remineralization of dental hard tissues.” Dental caries affects 97% of the world population and the term is used to describe both the disease process and the lesion. Dental caries can…

A Dentist’s Perspective on Retainer Wear Time

By Dr. Lee Ann Brady | April 5, 2024

By: Lee Ann Brady DMDTopic Originally Appeared on PankeyGram.org Patients tend to want to spend as little time as possible in their retainers after orthodontic treatment. It’s common in my practice for patients to ask me how long they have to wear them, with the implicit understanding that an extended time period is undesirable. As…

Unlocking Precision and Comfort: The Optragate by Ivoclar

By Tara Aboumahboub | April 1, 2024

By: Tara Aboumahboub, DMD In the realm of modern dentistry, precision, and patient comfort are paramount. Among the myriad innovations aiming to enhance these aspects, the Optragate by Ivoclar stands out as a true game-changer. This ingenious device, developed by Ivoclar, has created a streamlined approach to access any tooth in the mouth, making it…