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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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 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 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…

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 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 #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

New Dental Practice Owner? What Responsibilities Come Next?             

By Bruce Bryen | May 1, 2023

By: Bruce Bryen The dental practice purchase that you recently made was like a dream come true. After working as an associate for a number of years, it seemed like the pinnacle in dentistry was reached when you became an owner.  Learning as an associate certainly assisted in understanding relationships with patients and staff.  The…

Dental Fuel Episode 2: Financial Mistake with Dr. Tony Mennito

By Tanya Sue Maestas, DDS | April 28, 2023

In Dental Fuel episode 2, Dr. Mennito talks about how financial mistakes can be big and how he moves the focus to keep the patient at the forefront of his mind! Dr. Tony Mennito. Dr. Anthony Mennito (Tony) is a private practice dentist as well as an adjunct faculty member at the MUSC College of…

Choosing the Best Business Structure for a Dental Practice

By Bruce Bryen | April 25, 2023

By: Bruce Bryen The young dentist has gotten the training and skill sets that he or she needs to acquire a dental practice. How To Choose Which Type of Business Structure is Best for the Practice and the Dentist? After what seemed like years at the associate level, the time has come for the ownership…

Why I Invested in 3D Printing

By Dr. Julia Latham | April 24, 2023

By: Dr. Julia Latham When it comes to living in a tech-driven world, I consciously decided to jump in headfirst and add 3D printing to my practice. How did I do it, you might ask? Well, here’s how I decided. Deciding If You Should Invest in 3D Printing for Your Dental Practice Assess Your Practice…