By Beth Leach, President, Orthodontic Revolution. Beth has marketed orthodontic practices since 1995.
Most orthodontists pick a marketing agency the way they would pick a dentist for their dog: someone they met at a meeting, a referral from a study club friend, or whoever sent the nicest proposal. Then a year later they are paying every month and still cannot say whether it worked.
This guide is the list of questions I would want a practice owner to ask any agency, including mine. At the end I will tell you how we answer them, so you can hold us to it.
1. Do they actually specialize in orthodontics?
A general dental marketing firm can build a fine website. But orthodontics runs on different math. Your patient is often a parent deciding for a child, the decision takes weeks, the case value is high, and a big share of new patients still come from general dentist referrals. An agency that treats you like a hygiene-recall practice will chase the wrong numbers.
Ask how many orthodontic practices they work with right now, not how many dental clients they have in total. Ask them to explain the difference between a new patient exam and a started case without looking it up.
2. Can they show results from practices like yours?
Logos on a website are not results. Ask for a practice in a market similar to yours, the service they used, and a number that the doctor will say out loud. Better still, ask to talk to that doctor.
Be wary of results that are all traffic, impressions, or followers. Those can go up while your starts stay flat.
3. What exactly do they report, and to whom?
This is where most relationships go wrong. If the monthly report ends at clicks and calls, nobody can tell you what it costs to start a case. Ask whether they track an inquiry all the way to a booked consultation, a kept consultation, and a start. Ask who reviews it with you, and whether that is a person on a call or a PDF in your inbox.
We wrote a separate guide on this: what orthodontic marketing reports should measure.
4. Who owns everything if you leave?
Get this in writing before you sign. You should own your website, your domain, your Google Ads and Meta ad accounts, your Google Business Profile, your social accounts, and your data. If an agency owns your ad account, you lose years of history when you leave. If they own your domain, you are not really free to leave at all.
5. How do they charge, and where does ad spend go?
Ask three things. Is the fee flat, or a percentage of ad spend? Is there a setup fee? Does ad spend go straight to Google and Meta on your card, or does it pass through the agency first? A percentage-of-spend fee gives the agency a reason to spend more of your money. Spend that passes through them makes it harder to see what you actually paid for media.
6. What are the contract terms?
A long contract is not automatically bad, especially if it buys a lower rate. What matters is that you can choose. Ask whether month to month is available, what the longer terms save you, and what happens to your accounts if you cancel.
7. Will they also work for the orthodontist down the street?
Some agencies sell the same playbook to several practices in one market. Ask whether they offer exclusivity, how far it reaches, and whether it applies to every one of your locations or only your main office.
8. Who will actually do the work?
Ask who your day-to-day contact is, and who writes, designs, shoots, and manages the ads. Many agencies subcontract video and content. That is not always a problem, but you should know it, because it affects quality and turnaround.
9. How long should you wait before judging them?
It depends on the service. Paid ads can be running within a day. A new website takes weeks to build. Organic search moves on its own schedule, and anyone who promises a specific date for page one is guessing. What you should not have to wait for is visibility: by the second month, the reporting should already show which channels produce consultations and which produce nothing.
10. Red flags
- They cannot tell you what it costs you to start a case.
- They own your ad accounts or your domain.
- Every result they show is traffic, reach, or rankings.
- The fee is a percentage of ad spend.
- They cannot name the person who will run your account.
- They will not let you talk to a current client.
How Orthodontic Revolution answers these questions
I promised I would put us through the same test. Here is how we answer each question, in the same order.
- Specialization. We work with orthodontic practices, and we have for a long time. Jeff Behan and I have supported more than 2,000 practices across the US, Canada, and Australia, and I have been marketing orthodontics since 1995.
- Results. Dr. Haeger of Haeger Orthodontics in Kent and Maple Valley, Washington, told us on camera: "We've gone from flat three years in a row to about a 9% net production growth this year." You can watch the doctors on our results page.
- Reporting. Every engagement runs on PracticeROI, our own tracking system, which follows each inquiry to Patient Won or Patient Lost. We review it with you monthly, on a call, with a person who knows your practice.
- Ownership. If you leave, you keep your website, domain, ad accounts, Google Business Profile, social accounts, data, and finished video edits.
- Pricing. A flat monthly retainer with no setup fee. Ad spend goes straight to Google and Meta, never through us.
- Terms. Month to month is the minimum. We also offer 6, 12, and 24 month terms, and the 12 and 24 month terms cost less.
- Exclusivity. We work with one orthodontic practice within 10 miles of each of your locations.
- Who does the work. Our video is produced in house by the same crew that shoots for Align, Ormco, and Angel Aligners. It is not subcontracted.
- Timelines. Ads usually go live within 24 hours of your approval. A new website takes six weeks. SEO results vary by market, and the monthly report shows you whether it is moving.
We also measure something most agencies do not: whether ChatGPT, Gemini, Perplexity, and Claude actually name your practice when a parent asks for an orthodontist. That is our AI Smile Score.
The easiest next step
Ask your current agency, or any agency you are considering, the questions above. If you want to see how your marketing holds up first, request a free practice audit. We review your website, ads, referrals, and AI visibility and send you a written plan. If you do not need us, we will tell you.