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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Breathing and Airway Support in Pediatric Dentistry

Breathing and Airway Support in Pediatric Dentistry

By Steve Carstensen, DDS | June 9, 2025

By: Steve Carstensen DDSThis Topic Originally Appeared on PankeyGram.Org. Dr. Carstensen granted permission for igniteDDS to share with our readers. I want to share a clear example of how bad sleep directly affects the anatomical structures dentists pay a lot of attention to—the mandibular condyles.   Sleep Disruption Disrupts Jaw Bone Regeneration  We’ve all seen on X-rays…

a-dec operatory

First Practice? Get Savings, Support for a ‘Smart Start’

By David Rice | June 9, 2025

By: A-decTopic originally appeared on DentalProductShopper.com, they granted permission for igniteDDS to share with our readers. A-dec program offers equipment savings, expert guidance, and complimentary services to ensurefirst-time practice owners get off to a smooth start Struggling with a lengthy wish list of equipment for your first practice? For many dentists, it’s an experience that likely…

Your new team member wants to succeed—your onboarding plan helps them do it.

Stop the Revolving Door: Rethink Your Onboarding Strategy 

By Dawn Patrick | June 2, 2025

By: Dawn Patrick, Dental Practice Coach + Director of Operations IgniteDDS  In a busy dental practice, it’s easy to assume a new hire will “figure things out” after a few shadowing shifts. But that’s a fast track to burnout—for the new team member and for the team trying to train them on the fly. Onboarding…

relationship based dentistry

Relationship-Based Dental Practices: Avoiding Judgmental Stories About Patients

By Michael Rogers, DDS | June 2, 2025

By: Michael Rogers, DDSThis Topic Originally Appeared on PankeyGram.Org. Dr. Rogers granted ignitedds permission to share with our readers. Near my dental office, there’s a small strip center that includes a realty group and a small church that creates a significant daily line of cars that go through a drive-through window. Cars line up waiting…

pros and cons of dental insurance tpas

Understanding Dental Insurance Third-Party Administrators: How They Benefit and Hinder Your Practice

By Angela Holland | June 2, 2025

By: Angela Holland Dental insurance third-party administrators (TPAs) play a significant role in managing insurance claims and processing reimbursements between dental practices and insurance companies. TPAs are third-party entities hired by insurance companies, employers, or health plans to manage dental insurance plans and the claims process. Their goal is to streamline the administrative side of…

class I preparation

Class I Preparation and Restoration: High-Yield Guide for D1 Students

By Michael Eid | May 28, 2025

By: Michael Eid As a D1 student, learning the fundamentals of cavity preparations in sim lab is your first step toward clinical success. This guide will help you bridge the gap between lab exercises and real patient care by teaching you how to think clinically from day one. You’ll gain insights on handpiece control, bur…

best treatment is none at all

Sometimes the Best Treatment is None At All 

By Savanah Craig | May 28, 2025

By: Dr. Savanah Craig One of the biggest contributors to burnout in dentists, in my opinion, comes from decision fatigue. Constantly we are faced with our patients’ problems that we did not create and are expected to find a solution to this problem. We must evaluate the problem, excavate possible causes for this issue, determine…

Authenticity in Dentistry

Authenticity in Dentistry: Embracing Personal Integrity for Professional Growth

By Dr. Paul Henny, DDS | May 27, 2025

By: Paul A. Henny, DDSThis Topic Originally Appeared on PankeyGram.Org. Dr. Henny granted permission for igniteDDS to share with our readers. Clinical efficiency and business systems often take the spotlight. But during all that, it’s easy to overlook something fundamental: your individuality. I love this quote from Ralph Waldo Emerson “Nothing is at last sacred…

5 secrets to building wealth in dentistry

5 Secrets to Building Wealth in Dentistry

By Dr. James Pitts | May 27, 2025

By: Dr. James Pitts As a practicing Dentist, your career will last around 30-35 years on average. During this time an average Dental Practice will have about $30,000,000 pass through collections.  One would think that this would be enough for all Dentists to retire Financially Independent and debt free. However, ADA statistics tell us that…

dental assistant becoming an EFDA

What’s Keeping Your Dental Assistant from Becoming an EFDA?

By Ronda Holman | May 26, 2025

By: Ronda Holman If you’ve ever found yourself wishing you had two pairs of hands during a procedure, chances are you’ve already imagined the value of an EFDA—an Expanded Functions Dental Assistant—on your team. So, what’s holding your current assistant back from stepping into that role? For many dental assistants, the barrier isn’t capability—it’s clarity,…