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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Dental Practice Ownership: Critical Mistakes New Dentists Make with Jonathan Miller

By Tanya Sue Maestas, DDS | October 31, 2023

Interviewer: Tanya Sue Maestas, DDSInterviewee: Jonathan MillerEdited By: Candy Velez – CRDH, BSDH In this article, Jonathan Miller shares valuable insights into the critical mistakes he has observed dentists make and provides guidance on navigating the startup and acquisition process. Mistake 1: Not Understanding the Importance of Where to Start One common mistake dentists make is…

Don’t Let The “What Ifs” Deter You From Success In Your Dental Career

By Dr. Hannah Crowell | October 25, 2023

By: Hannah Crowell Why is it so hard to commit to or even consider buying a dental practice? It boils down to fear. Fear of failure and all the negative “What ifs?”  Negative “What Ifs” to Avoid What if I can’t handle the stress? Dental school and those first few years out in the real…

Dental Admission Test (DAT): Tips to Prepare

By Dr. Bri Torgerson | October 23, 2023

By: Dr. Bri Torgerson Hi friends! My name is Dr. Bri Torgerson and I am a General Dentist currently working in St.  Louis, Missouri. I have written some advice on applying to dental school, what to do when you graduate, and finding an associate position right for you, but I wanted to dive into something…

Dr. Sable Muntean Appointed as Chief Editor of Get Lit Newsletter

By David Rice | October 20, 2023

Get Lit Newsletter Welcomes Dr. Sable Muntean as Chief EditorIgniting Success for New Dentists with Enhanced Content and Expanded Reach [St. Petersburg, FL] – Get Lit Newsletter, the go-to resource for new dentists seeking success in their careers, is delighted to announce the appointment of Dr. Sable Muntean as its Chief Editor. As a young…

Occlusal Wear: Is It Advancing? How Fast?

By Dr. Lee Ann Brady | October 17, 2023

By: Lee Ann Brady DMD I ask the question “Is wear normal?” at almost every lecture I do on occlusion. Usually, the response is a small number of mumbled replies. A good follow-up question is “How many eighty-five-year-old patients have you seen with mamelons?” I hope you are thinking not many if any at all….

Dental Startups vs. Practice Acquisition: Making the Right Decision

By Tanya Sue Maestas, DDS | October 16, 2023

Interviewer: Tanya Sue Maestas, DDSInterviewee: Jonathan MillerEdited By: Candy Velez – CRDH, BSDH As a dental professional, the decision to start your own practice or acquire an existing practice is a crucial one. Both options have their pros and cons, and it ultimately depends on your personal goals and vision for your dental career. In…

High Employee Turnover? What’s Going Wrong? 

By Dr. Hannah Crowell | October 10, 2023

By: Hannah Crowell A dental office may experience high employee turnover for various reasons, which can negatively impact the overall functioning of the practice. Top Causes of High Employee Turnover Here are some potential reasons why your dental office may have high staff turnover: 1. Low Compensation Dentists and hygienists invest significant time and money…

10 Steps to Starting a Dental Practice

By Dawn Patrick | October 9, 2023

By: Dawn Patrick Are you a dental student with dreams of one day starting a dental practice? The journey from dental school to practice ownership is an exciting and rewarding one, but it also requires careful planning and diligent execution. 10 Steps to Start Building Your Own Dental Practice Here are the top 10 steps…

Facing Times of Transition in Your Dental Career

By Savanah Craig | October 2, 2023

By: Savannah Craig Throughout our lives, we all face times of change and transition. While reflecting on the completion of my dental residency program and the end of my formal education, I’ve been thinking about how many periods of change I’ve encountered on my journey. The big milestones of life were met with celebration but…

You Want to Apply to Dental School, Now What?

By Dr. Bri Torgerson | September 25, 2023

By: Dr. Bri Torgerson Hi! I’m Dr. Bri Torgerson and this month, I wanted to touch base with those applying to dental school. My background in applying to dental schools is that I applied three times to dental school. Now, I ended up getting in on my second application cycle 10 days before orientation, but…