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

December 6, 2024 |

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

November 15, 2024 |

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

October 25, 2024 |

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

October 4, 2024 |

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?

August 23, 2024 |

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

July 12, 2024 |

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?

June 21, 2024 |

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?

May 31, 2024 |

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?

April 26, 2024 |

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

April 12, 2024 |

By: Dr. Leonard A. Hess, DDSClinical Director, The Dawson AcademyThe Article Originally Appeared on TheDawsonAcademy.com Question: What…

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Swishing to Wellness: Oil Pulling for Oral Radiance

By David Rice | November 29, 2023

By: Dr. David Rice In the quest for natural and holistic oral care, you might have come across the ancient practice of oil pulling. This age-old technique, rooted in Ayurvedic traditions, involves swishing oil in the mouth for several minutes – as you’ll see below – several being an understatement. Let’s delve into the details,…

Navigating Dental Excellence with Jonathan Miller

By Tanya Sue Maestas, DDS | November 27, 2023

Interviewer: Tanya Sue Maestas, DDSInterviewee: Jonathan MillerEdited By: Candy Velez – CRDH, BSDH Welcome back to Dental Fuel, where we unlock the keys to dental success. In this episode, we explore pivotal concepts that will reshape your dental journey. Discover the art of effective delegation, empowering your team for unparalleled efficiency, and the transformative impact…

My Favorite Occlusal Deprogrammers

By Dr. Lee Ann Brady | November 24, 2023

By: Lee Ann Brady DMDTopic Originally Appeared on PankeyGram.org Deprogramming of the lateral pterygoid muscle is generally done by placing something in the anterior that eliminates posterior occlusal contact. I have two “go-to” deprogrammers. One is a leaf gauge or what is often referred to as a Lucia jig, and the other is a little device…

Boost Your Credit & Build a Savings Cushion Before Practice Ownership

By Dr. Hannah Crowell | November 22, 2023

Tips to Build Credit & Savings for a Thriving Future of Dental Practice Ownership By: Dr. Hannah Crowell Improving your credit and saving money before buying a practice are important steps in your financial journey. Here are some tips for both. Tips for Improving Your Credit Before Buying a Practice Here are essential tips to…

Mastering Dental Practice Financing with Jonathan Miller

By Tanya Sue Maestas, DDS | November 20, 2023

Interviewer: Tanya Sue Maestas, DDSInterviewee: Jonathan MillerEdited By: Candy Velez – CRDH, BSDH Welcome back to Dental Fuel, your compass in the intricate world of dentistry! In our previous article, we delved into the startup and acquisition intricacies, focusing on the pivotal juncture of engaging with banks. Today, we’re honored to have Jonathan Miller, an…

When Your Occlusal Clearance Disappears

By Dr. Lee Ann Brady | November 17, 2023

By: Lee Ann Brady DMDTopic Originally Appeared on PankeyGram.org It can be an incredibly frustrating clinical situation when you have been meticulous about preparing a posterior tooth, (most commonly a molar) for a crown and things aren’t predictable. Using your burs you created depth cuts to ensure adequate occlusal clearance. After the impression you allow…

Common Dental Myth: Charcoal Toothpaste

By Dr. Bri Torgerson | November 13, 2023

By: Dr. Bri Torgerson Hi there! My name is Dr. Bri Torgerson and I am a General Dentist practicing out of St. Louis,  Missouri. I graduated in the really fascinating year of 2020 from The Herman Ostrow School of Dentistry of the University of Southern California. I have worked in Scottsdale, AZ, Fort Lauderdale, FL,…

An Occlusion-Focused Hygiene Exam

By Dr. Bill Gregg, DDS | November 10, 2023

By: Dr. Bill Gregg DDSTopic Originally Appeared on PankeyGram.org During an occlusion-focused hygiene exam, there are certain things the hygienist should pinpoint. This will help them develop a deeper relationship with the patient as well. A Hygiene + Occlusion Exam What the hygienist should look for: The Hygienist Role in a Hygiene + Occlusion Exam…

Why Study Occlusion?

By Kevin Muench | November 7, 2023

By: Kevin Muench DMD, MAGDTopic Originally Appeared on PankeyGram.com I’m a restorative dentist with a passion for occlusion. I’m a firm believer that our patients deserve our best efforts to eliminate deleterious stomatognathic forces that impact comfort, function, smile aesthetics, and whole health. So, I encourage all dentists to wrap their minds around the area…

How Residency Can Lead You Toward Your Self-Determined Future 

By Savanah Craig | November 6, 2023

By: Savannah Craig At IgniteDDS we’ve built a belief that to be in control of your life and your destiny you must have systems and procedures in place to give you control over 3 big things in your life and practice. Those three things are People, Process, and Production. If you can take control of…