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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Technology Investments

By Ann-Marie DePalma, MEd, RDH, CDA, FAADH, FADIA | December 12, 2022

By: Ann-Marie DePalma, CDA, RDH, MEd, CDIPC, FADIA, FAADH Technology is around us 24/7. Whether in our everyday lives or in our practices, technology is an essential part of today’s society. As the old saying goes “we can’t live with it, and we can’t live without it”, technology has changed the way teams interact with…

People Pleasing: Characteristics of Being a People Pleaser

By Sharon Dolak | December 6, 2022

By: Sharon Dolak People Pleasing is not about being kind. It is about someone trying hard to make others feel better, driven by deep-seated insecurity to be needed and receive approval. Society thinks it is a good thing to please others, but people pleasing has a dark side when we do it to our own…

Confronting Denial is No Small Task

By Sharon Dolak | December 5, 2022

By: Sharon Dolak Denial is a coping response that gives us time to adjust during shocking, distressful situations and avoid anxiety. We refuse to see the truth because we are trying to protect ourselves from a painful, overwhelming situation. Some things, many things are simply hard to accept all at once and we need time…

The Difficulty With Treatment Planning

By Savanah Craig | December 1, 2022

By: Savanah Craig Treatment planning is one of the most difficult parts of my job as a new dentist. Often, I am meeting a patient for the first time and trying to access the problems that need to be addressed and learn about their desires all in an hour-long appointment. Patients’ wants and desires are…

What is Toxic Positivity and How to Avoid It

By Sharon Dolak | November 28, 2022

By: Sharon Dolak Do you notice that as soon as you walk into the office you are ON? Like someone pushed a button in your head that said, “OK, you are to have no emotions, no needs and you are to be positive, energetic, smile, and bright ALL DAY LONG.” In a normal healthy life,…

Ameloblastoma: Case Study

By Dr. Jennifer Bell, DDS, FAGD, FICD | November 23, 2022

By: Dr. Jennifer Bell, DDS, FAGD, FICD Have you ever had a patient with ameloblastoma? Here is a case study of my experience with it.

Tax Return Preparation for Dental Professionals

By Bruce Bryen | November 21, 2022

By: Bruce Bryen As a dentist, when you are ready to file your first substantial tax return, it is best to find a dental CPA who can prepare the personal tax return but can also be the first advisor that you use for your future in the dental profession. As a young dentist, it’s probable…

Life after Graduation: Excel in Your Clinical Setting

By Savanah Craig | November 17, 2022

By: Savanah Craig I graduated from dental school in March 2022 and I’m currently in a general practitioner residency program. I’m writing to offer some advice for young dentists out there who are about to graduate on how to manage in a clinical setting after graduation. Tips to Excel in Your Clinical Setting After Graduation…

Tonsilloliths: Case Study

By Dr. Jennifer Bell, DDS, FAGD, FICD | November 16, 2022

By: Dr. Jennifer Bell, DDS, FAGD, FICD Have you ever had a patient with tonsilloliths? Here is a case study of my experience with it.

Spontaneous Bone Spurs: Case Study

By Dr. Jennifer Bell, DDS, FAGD, FICD | November 9, 2022

By: Dr. Jennifer Bell, DDS, FAGD, FICD Have you ever had a patient with spontaneous bone spurs? Here is a case study of my experience with it.