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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How Dental Assistants Can Deal with Workplace Bullying

By Dianne Auger | July 26, 2022

By: Dianne Auger, RDH, BS Have you ever loved your position on the dental team, and then it starts to all go downhill? Have you ever thought that being in a profession such as this one that there are no conflicts or acts of workplace bullying? Well, there is! I was just as surprised as you are,…

How and Why to get Oral Appliance Therapy

By Teresa Power DeNike | July 25, 2022

By: Teresa DeNike If you’ve been diagnosed with sleep apnea, there’s a 90% chance your doctor recommended CPAP (Continuous Positive Airway Pressure). There’s a reason for that — CPAP is incredibly effective — but it might not be right for you, and the hose can be cumbersome to sleep in. If you can’t use CPAP,…

Five People You Want on Your Side as a New Dentist

By Tara Aboumahboub | July 19, 2022

By: Tara Abouhmahboub When you become a dentist, navigating the job market can be a challenge, and you certainlydon’t want to do it on your own. Top 5 People To Know When Starting Your Dental Career Here are the five people you want on your side as a new dentist: 1. Accountant This one is…

Sign-On or Stay-On Bonus?

By David Rice | July 19, 2022

By: Dr. David Rice The great resignation, team-turnover, call it what you will, is dentistry’s single greatest problem today and will continue to be for the next 1 to 1.5 years. With that, many practices have turned to sign-on bonuses in an attempt to attract top talent.  The problem is, that it’s not helping retain…

Top 5 Mistakes New Dentists Make

By David Rice | July 14, 2022

By: Dr. David Rice Read them. Digest them. Ask igniteDDS how to avoid them! 5 Mistakes I Made As A New Dentist Here are five common mistakes new dentists make (including me): Paying Off Student Debt Too Fast Not Building Board of Directors Soon Enough Buying a House before a Practice Not Asking Enough Questions…

Should You Consider a Dental Residency?

By Sable Muntean | July 13, 2022

By: Sable Muntean It can be tempting to jump right into the workforce after graduating from dental school, but finding a residency can be a hugely rewarding experience for new dentists — and those positions are often paid, as well. How Long Is Dental Residency? The residency process only takes a year, or potentially two,…

The Importance of Dental Photography

By Zach Sisler | July 8, 2022

By: Zach Sisler Photography is a skill that often gets overlooked by recent dental school graduates, but it can be an essential tool at every step of running your practice. If you’re an esthetic dentist or trying to advertise on social media, taking a good picture is a skill you need for obvious reasons. But…

7 Reasons Dentists Choose Their Dentists

By David Rice | July 7, 2022

By: Dr. David Rice Want to guarantee you’re seeing the right dentist? Here is how we dentists choose our dentist, and I’m thinking we have the inside scoop that will help you! 7 Ways Dentists Choose The Right Dentists Check out these seven reasons how we dentists choose our dentists: 1. Get in the know…

Advice for Third Year Dental Students Starting a Clinic

By Sable Muntean | July 2, 2022

By: Dr. Sable Muntean Starting third year clinical can be one of the most intimidating parts of dental school. Learning in a classroom is one thing, but it’s quite another to start applying what you’ve learned to real people and real situations. 4 Tips to Help Third Year Dental Students Succeed Here are some words…

How to Succeed in Aesthetic Dentistry

By Cappy Sinclair | July 2, 2022

By: Cappy Sinclair Aesthetic dentistry is one of the most exciting and rewarding niches in our industry, and a lot of young dentists find themselves wanting to move into the field. But breaking into that niche can be challenging! Finding success there requires certain skills which might not always be obvious. 4 Ways to Succeed…