Dental case acceptance: what the research, the ADA Code and vendors say

Case acceptance is one of the most searched topics in dental practice management, and one of the most mixed. Some sources treat it as a sales number. The ADA Code of Ethics treats the underlying act, telling a patient about proposed care and alternatives, as a duty. This guide covers both: how to measure case acceptance, what research says about why patients accept or decline, and where informed consent sets the limits. It is general education from Copeland Consulting Services. It is not legal advice. Consent rules and scope-of-practice rules vary by state, so ask your attorney or state dental board.

It belongs to the dental practice management pillar. Related reading: KPIs and benchmarks and how to grow a dental practice.

What is case acceptance?

Case acceptance is the share of presented treatment plans that patients schedule or complete. A Henry Schein One article defines it as “the percentage of presented treatment plans that result in scheduled or completed care.” The word “presented” matters. A case presentation is the point where the dentist or team explains a treatment plan and the patient decides.

A low rate is not always a problem. Patients may defer care for good reasons, choose a reasonable alternative, seek a second opinion or decline. The ADA Code recognizes each of these as part of patient decision-making.

How do you calculate case acceptance?

There is no single formula, which is the main reason vendor averages do not match. Three common versions:

Also decide on four details and write them down:

1. What counts as “presented”: any plan, or only plans above a dollar amount?
2. What counts as “accepted”: a signed plan, a scheduled visit, or a completed visit?
3. How long the window is: same day, 30 days, 90 days.
4. Whether plans that were revised or split into phases count once or twice.

One vendor article puts it this way: “The most important benchmark is your own baseline.” That is the only advice here that holds for every practice.

What do published benchmarks say?

Vendors publish averages and upper-tier figures, and they disagree. A Henry Schein One article for DSOs cites its own 2026 Catalyst Index for an industry average of 45% and a highest-scoring 10% figure of 75%. This guide did not open that index. A Full Arch Masters article reports a patient-based average of about 45% and a lower production-based figure, and warns that an industry number may use a different formula than yours.

These are vendor surveys, not standards. No ADA or government source opened for this guide publishes a case acceptance benchmark. Use vendor numbers as a loose prompt and nothing more. See the KPI guide for how to judge any benchmark.

Why do patients accept or decline treatment?

Research points to cost, fear and communication more than to presentation technique. A recent systematic review in BMC Oral Health searched the literature and included 233 articles from 49 countries. It identified 101 factors affecting patient treatment decisions, grouped into three categories: the dentist and dental institution, the patient, and the treatment. “Out-of-pocket payment” and “dental fear” appeared in the most articles.

Other research adds to this:

• A 2025 narrative review of patient experience found that effective communication, transparent payment and follow-up systems, and easy scheduling were linked to trust and to return visits.
• A questionnaire study of 1,121 patients in 41 practices found that clear treatment explanations and trust in the dentist’s decisions significantly influenced satisfaction and loyalty.
• A literature review on dentist-patient communication describes good communication as clear, correct, concise, complete and cohesive, and says it “empowers patients with the knowledge required to make an informed decision.”

These studies are associations, not trials of a specific script. They do support looking at fees, benefits and fear before looking at wording.

What does the ADA Code of Ethics require?

The ADA Principles of Ethics name five fundamental principles: patient autonomy, nonmaleficence, beneficence, justice and veracity. Two bear directly on treatment presentation.

The Code is binding on ADA members, and violations may result in disciplinary action. The ADA also notes that “ethics and the law are closely related” but not the same, and that ethical obligations may exceed legal duties. For non-members, the Code is still a widely used professional reference. State law sets the legal floor for consent. Ask your attorney what your state requires.

What is informed consent, and how does it connect to acceptance?

Informed consent is the patient’s agreement to a proposed treatment after receiving the information needed to decide. It is not the same as acceptance. Acceptance is a practice metric. Consent is a patient right and a legal and ethical requirement.

The literature gives a practical outline. A review of dentist-patient communication says a consent form should be in plain language, avoid complex terminology and include the procedure, potential risks, benefits, alternatives and expected outcomes. The ADA offers sample informed consent and informed refusal forms on its patients page. Informed refusal matters here: a patient who declines after an honest explanation has made a valid decision, and the record should show it.

A design check for any case acceptance process: if a patient says no, does the process still respect the decision? If the answer is no, the process has a problem that a better rate will not fix.

What does a respectful case presentation process include?

This outline uses only elements named in the sources above. It is not a script.

1. Findings first. Share the diagnosis and its basis in plain words.
2. Options. Present reasonable alternatives, including no treatment or phased care, and their risks and benefits.
3. Cost and coverage, early. Cost is the most frequent factor in the review. Explain fees, insurance benefits and patient financing options before the decision, with accurate numbers.
4. Questions. Invite them and answer without pressure. Address fear directly, since the review names it as a frequent factor.
5. Records. Document the conversation, the consent or the informed refusal.
6. Follow-up. Set a planned check-in for patients who defer, rather than a repeated sales push.

A treatment coordinator may support steps 3 to 6. Which tasks a non-dentist can perform depends on state law. Ask your attorney or state dental board.

How should a practice handle declined treatment and second opinions?

Declined treatment is a normal outcome and should be recorded as one. Record what was recommended, what alternatives were discussed, what the patient chose and the date. The ADA’s sample informed refusal form exists for this reason. A clear record also keeps the acceptance number honest, because declined plans stay in the denominator.

Patients also seek second opinions. The ADA Code includes an advisory opinion, 2.B.1, which says a dentist who has a patient referred by a third party for a second opinion about a diagnosis or treatment plan should render the opinion in accordance with the Code. For the treating dentist, the practical point is that a second opinion is a patient right to be respected, not a lost case to be won back.

A short review each quarter can help. Pick a sample of declined and deferred plans, and ask whether the patient had the information the Code describes: the proposed treatment, the reasonable alternatives and the cost. Where the answer is no, the fix is in the explanation, not in the patient.

What mistakes distort the case acceptance number?

• Mixing formulas between months or between offices.
• Counting only large plans and excluding small ones, or the reverse.
• Treating a scheduled visit as acceptance without checking completion.
• Setting a team target of 90% or similar, which can create pressure to present only easy cases or to under-record declined plans. No source opened for this guide supports such a target.
• Comparing to a vendor average that uses a different formula.

How can a practice review its process each quarter?

A quarterly review keeps the metric and the ethics in the same conversation. Use a fixed sample, such as every plan presented in one month, and look at four questions.

1. Was the formula the same as in prior quarters?
2. For each declined or deferred plan, does the record show the options discussed and the patient’s choice?
3. Did cost or coverage come up before the decision, or only after?
4. Did patients who deferred hear from the practice again in a way that respected their choice?

The first question protects the number. The other three protect the patient. Any team member who presents or records plans can join the review. Keep the focus on the process, not on a person.

The review does not need a target. If the rate falls because more patients chose reasonable alternatives or deferred for stated reasons, that may be a sound outcome. If it falls because explanations became unclear, the record will usually show it.

How does this connect to growth and payer decisions?

Production can rise from more patients, a fuller schedule or more care moving forward. Each has a different cause, so the growth guide tracks them separately. Payer mix also shapes the cost conversation, since patient out-of-pocket cost depends on plan design. See the PPO participation guide.

Next step

Continue with the dental practice management pillar for the other management topics. Dr. Jon Copeland, DDS, is a general dentist in Wildwood, Missouri. Contact Dr. Copeland about consulting.