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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What I Wish I Knew Before Starting Dental School

By Savanah Craig | May 17, 2022

By: Savanah Craig Before “Day in the Life” Instagram posts, there wasn’t a lot of information about what being in Dental School was like. I had spent many hours shadowing dentists for my application, but none of them ever talked about their four years of school. I felt confident that I could become a great…

Dental Patient Communication: Learning to meet your patients where they are

By Savanah Craig | May 17, 2022

By: Savanah Craig One of the biggest challenges I face while beginning my career in dentistry is patient communication. I have spent the last 4 years learning a whole new language of technical jargon to be able to communicate with my colleagues and read research articles. However, much of my day is spent in communication…

How Much Should You Pay For Malpractice Insurance?

By lucas.shapiro | May 12, 2022

By: Dr. Luke Shapiro I just got off the phone with my insurance sales rep and they informed me that it would now cost me almost $11,000 to have malpractice insurance in New York City! What?! I thought I misunderstood. Is it even legal to increase malpractice by this much? Turns out it is. They…

Dental Mentorship: Benefits + How to Find One

By Savanah Craig | May 12, 2022

By: Savanah Craig If you attend enough ASDA events, you’ll hear about the importance of finding a mentor to help support you on your journey towards a career in dentistry. However, there isn’t much explanation about how to find a mentor or why it’s so important. How to Find a Dentist Mentor Here are steps…

How to build your brand and reputation as a new dentist

By Jennifer Murphy | May 7, 2022

By: Jennifer Murphy Everyone wants to be liked and we all want to be thought of in a positive light, especially when it comes to us as dentists and our dental practices. How does a dental school graduate entering into a whole new world develop that? How can a new and/or young dentist build a…

DSO or OSO: What Every Dentist Should Know

By Bruce Bryen | May 4, 2022

By: Bruce Bryen Once out of dental school, you begin looking at various choices regarding how to approach the job market. Knowing which decision to make may develop into a lifelong process, especially if the idea is to be an owner/operator of a solo or partnership practice. The reason for this statement is that DSOs…

Personal affairs curtailing the potential of the associate

By Bruce Bryen | April 27, 2022

By: Bruce Bryen Like much of the general population, dental school graduates also face challenges while ascending to more lucrative and clinically challenging positions in professional dentistry.  One major problem with personal growth in this field is the toll it takes on the home life of the dentist. The stress of the job does not…

How to Resign From A Dental Office

By Jennifer Murphy | April 27, 2022

By: Jennifer Murphy, DDS, FAGD You’ve been working at an office for a while now and things are just not working out the way you imagined or were promised. What do you do now? First, let’s acknowledge this is never an easy position to be in. There is also no right or wrong answer, but…

4 Promises of Leadership Development That Will Transform Your Dental Career

By Edwin McDonald | April 23, 2022

By: Dr. Edwin “Mac” McDonald The development of leadership competencies is about developing yourself. As you look outward with the desire to influence and inspire, consider what you would gain from looking inward instead. Becoming a great leader is about your own capacity for change, as hard as change can be. In the dental practice,…

How can dental students save for their own practice?

By Ava Guzman | April 19, 2022

By: Ava Guzman After graduation, dentistry students might immediately want to start working in order to get a return on their educational investment and earn a living. However, between student loans and the money needed to open up a clinic, the costs are steep. Saving Money for Your Dental Practice The American Dental Association (ADA)…