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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choosing a dental cement

What Dental Cement Should I Use?

By Chad Duplantis, D.D.S, F.A.G.D | May 31, 2023

By: Dr. Chad Duplantis, D.D.S., F.A.G.D Have a patient and you need to decide which type of dental cement you should use? Here’s how I dealt with it:

searching your dental practice for seo

Hidden Pitfalls of Googling Yourself: Dentists & the SEO Performance Mirage

By Sean Hamel | May 31, 2023

By: Sean Hamel In this digital age, having a strong online presence is crucial for any business, including dental practices. Search engine optimization (SEO) plays a vital role in improving a dentist’s visibility in search engine results and attracting potential patients. While it’s natural for dentists to want to assess the effectiveness of their SEO…

dental kpis key performance indicators

10 Key Performance Indicators Your Dental Practice Should Track

By Dawn Patrick | May 29, 2023

By: Dawn Patrick Measure, monitor, and make go right, but what should you measure? As a dentist, it’s crucial to regularly track your dental practice’s Key Performance Indicators (KPIs). These metrics provide valuable insights into the health and success of your business, enabling you to make informed decisions and drive improvements. Top 10 Key Performance…

this should be an easy one

This Should Be An Easy One…

By Chad Duplantis, D.D.S, F.A.G.D | May 17, 2023

By: Dr. Chad Duplantis, D.D.S., F.A.G.D Ever have a case that you are sure should be an easy one to handle, then turns out it really isn’t? Here is my experience with just that!

moving on to another dental practice

Moving On To Another Dental Practice

By Bruce Bryen | May 15, 2023

By: Bruce Bryen After getting out of dental school and going to work as an associate at a dental practice, the feeling of having learned what was available to digest at that practice now seems like it has been fulfilled. It seems like it is time to either go to another dental practice to continue…

dental fuel

Dental Fuel Episode 4: Expert Advice with Dr. Tony Mennito

By Tanya Sue Maestas, DDS | May 12, 2023

In Dental Fuel episode 4, Dr. Mennito continues to master his craft in the realm of dentistry, where he offers some advice to our listeners. Dr. Anthony Mennito (Tony) is a private practice dentist as well as an adjunct faculty member at the MUSC College of Dental Medicine in Charleston, South Carolina. His dental practice,…

process of gettin your dental license

Process of Getting Your Dental License

By Savanah Craig | May 9, 2023

By: Savannah Craig If you’re anything like me, you’ve been following a variety of different checklists over the last 8-10 years to get you closer to your goal of becoming a dentist. You knew what it took to take the DAT and apply to dental school. Throughout your dental school career, you knew what classes…

bri torgerson enjoys dentistry to help make people smile

My Untraditional, Chaotic, and Beautifully Unique, Unpaved Path into Dentistry

By Dr. Bri Torgerson | May 8, 2023

By: Dr. Bri Torgerson A smile is so underrated, yet so widely sought after. The international language for happiness. A signal for a truce. In an instant, a  smile can be calming, reassuring, and safe. Even thinking about a smile, most of us think of someone we love and can feel our dopamine increase. Just…

dental fuel

Dental Fuel Episode 3: Team Mistake with Dr. Tony Mennito

By Tanya Sue Maestas, DDS | May 5, 2023

In Dental Fuel episode 3, Dr. Mennito shares about learning from the mistakes that a previous practice manager made that helped him learn how to best communicate with his team. Dr. Tony Mennito. Dr. Anthony Mennito (Tony) is a private practice dentist as well as an adjunct faculty member at the MUSC College of Dental…

congenitally missing tooth

Congenitally Missing Tooth #27

By Chad Duplantis, D.D.S, F.A.G.D | May 3, 2023

By: Dr. Chad Duplantis, D.D.S., F.A.G.D