--- title: "Dental Case Acceptance: Research, Ethics and Metrics" description: "Dental case acceptance explained: how to measure it, what research says about patient decisions, and where informed consent and the ADA Code set limits." url: https://joncopeland.multisites.ai/guides/dental-case-acceptance-guide publisher: Copeland Consulting Services email: drcopeland@joncopelanddds.com contact: https://joncopeland.multisites.ai/contact --- # Dental case acceptance: what the research, the ADA Code and vendors say Case acceptance is the share of presented treatment plans that patients schedule or complete. Research on patient decisions points to cost, fear and communication. The ADA Code requires dentists to inform patients of proposed treatment and reasonable alternatives. A higher rate is not an ethical goal by itself, and vendor benchmarks use different formulas. GuideUpdated October 26, 20268 min read 1. 1 ## Define the formula Case acceptance can be counted by patients, plans or dollars. Pick one and keep it fixed, or month-to-month comparisons mean nothing. 2. 2 ## Cost and fear lead A recent systematic review of 233 studies in 49 countries found out-of-pocket payment and dental fear the most common factors in treatment decisions. 3. 3 ## Consent is the floor ADA Code 1.A says a dentist should inform the patient of the proposed treatment and any reasonable alternatives so the patient can take part in the decision. 4. 4 ## Vendor numbers are not standards Published averages near 45% come from vendors with their own formulas. Your own baseline is the useful comparison. 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](https://joncopeland.multisites.ai/guides/dental-practice-management). Related reading: [KPIs and benchmarks](https://joncopeland.multisites.ai/guides/dental-practice-kpis-and-benchmarks) and [how to grow a dental practice](https://joncopeland.multisites.ai/guides/grow-a-dental-practice). ## What is case acceptance? [Case acceptance](https://joncopeland.multisites.ai/glossary/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](https://joncopeland.multisites.ai/glossary/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: Version Formula Comment By patients Patients who accepted divided by patients who were presented a plan Easy to count, ignores plan size By plans Plans accepted divided by plans presented Counts a small plan the same as a large one By dollars Accepted fees divided by presented fees Weights large plans more; sensitive to a few cases 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. ADA Code reference What it says What it means for a presentation Section 1, Patient autonomy The dentist’s primary obligations include “involving patients in treatment decisions in a meaningful way” Present choices, not only a recommendation 1.A Patient involvement The dentist should inform the patient of the proposed treatment, and any reasonable alternatives, in a manner that allows the patient to become involved in treatment decisions Explain alternatives, including declining Section 5, Veracity The dentist has a duty to communicate truthfully No false or misleading statements about the need, benefit or cost of care 5.A Representation of care Dentists shall not represent the care being rendered to their patients in a false or misleading manner Describe care accurately 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](https://joncopeland.multisites.ai/glossary/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](https://joncopeland.multisites.ai/glossary/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](https://joncopeland.multisites.ai/guides/grow-a-dental-practice) 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](https://joncopeland.multisites.ai/guides/ppo-participation-decision). ## Next step Continue with the [dental practice management pillar](https://joncopeland.multisites.ai/guides/dental-practice-management) for the other management topics. Dr. Jon Copeland, DDS, is a general dentist in Wildwood, Missouri. [Contact Dr. Copeland about consulting](https://joncopeland.multisites.ai/contact?topic=consulting). ## Frequently asked questions ### What is case acceptance in dentistry? Case acceptance is the percentage of presented treatment plans that result in scheduled or completed care. It can be counted by patients, plans or dollars, and the results differ. Write the formula down before you track it. A rate shows how often patients move forward, not whether the recommendations were right. ### How do you increase dental case acceptance? Research on patient decisions points to cost, dental fear and communication quality. Practices often review how plans are explained, how fees and insurance are discussed before the visit, and how follow-up works. Any change must keep patients informed of alternatives and free to decline, as the ADA Code of Ethics requires. ### What is a good case acceptance rate? No published standard exists. Vendors report averages near 45% and upper-tier figures near 75%, but their formulas differ and some cite their own indexes. A lower rate can be appropriate when patients choose alternatives or defer care. Compare your own rate over time with one formula. ### What does the ADA Code of Ethics say about treatment plans? ADA Code section 1.A says the dentist should inform the patient of the proposed treatment, and any reasonable alternatives, in a manner that allows the patient to become involved in treatment decisions. Section 5.A bars representing care in a false or misleading manner. The Code is binding on ADA members. ### What is a treatment coordinator? A treatment coordinator is a team member who helps patients understand treatment plans, costs, insurance benefits and scheduling. Duties vary by practice. Which tasks a non-dentist may perform depends on state law, so ask your attorney or state dental board. ## Terms on this page - [Dental practice management](https://joncopeland.multisites.ai/glossary/dental-practice-management) - [Patient communication](https://joncopeland.multisites.ai/glossary/patient-communication) - [Treatment coordinator](https://joncopeland.multisites.ai/glossary/treatment-coordinator) - [Patient experience](https://joncopeland.multisites.ai/glossary/patient-experience) - [Case presentation](https://joncopeland.multisites.ai/glossary/case-presentation) - [Patient financing](https://joncopeland.multisites.ai/glossary/patient-financing) - [PPO participation](https://joncopeland.multisites.ai/glossary/ppo-participation) - [Informed consent](https://joncopeland.multisites.ai/glossary/informed-consent) - [Case acceptance](https://joncopeland.multisites.ai/glossary/case-acceptance) - [Code of ethics](https://joncopeland.multisites.ai/glossary/code-of-ethics) ## Sources 1. [American Dental Association: 2026 ADA Principles of Ethics and Code of Professional Conduct](https://www.ada.org/-/media/project/ada-organization/ada/ada-org/files/about/principles/2026_code_of_ethics_complete.pdf) 2. [American Dental Association: Code of Ethics](https://www.ada.org/about/principles/code-of-ethics) 3. [American Dental Association: Patients (practice management)](https://www.ada.org/resources/practice/practice-management/patients) 4. [BMC Oral Health via PMC: Decision-making regarding dental treatments, what factors matter from patients' perspective? A systematic review](https://pmc.ncbi.nlm.nih.gov/articles/PMC12903421/) 5. [PMC: Strategies for Effective Dentist-Patient Communication, a literature review](https://pmc.ncbi.nlm.nih.gov/articles/PMC11225999/) 6. [PMC: Factors Influencing Patient Satisfaction and Loyalty as Perceived by Dentists and Their Patients](https://pmc.ncbi.nlm.nih.gov/articles/PMC10529870/) 7. [Henry Schein One: Dental Case Acceptance Rate for DSOs (vendor blog, 2026)](https://www.henryscheinone.com/insights/blogs/dso-dental-practice-case-acceptance-rate/) 8. [Full Arch Masters: Dental Case Acceptance Rate, Benchmarks and How to Improve (vendor blog)](https://www.fullarchmasters.com/articles/dental-case-acceptance-metrics) Written by Copeland Consulting Services and checked against the sources above on October 26, 2026. Rules, data and guidance change, so check the linked page before you act on it. ## Keep reading - [Dental practice management: people, money, schedule, patients and complianceDental practice management is the business side of running a dental office: finances, scheduling, patient communication, insurance decisions, team systems and legal compliance. Track a few core numbers, build written systems, review them on a set schedule, and use federal and ADA sources for compliance basics.](https://joncopeland.multisites.ai/guides/dental-practice-management) - [How to grow a dental practice: a systems guide with sourcesPractice growth comes from a small set of measurable systems: new patient flow, patient retention, schedule use, payer mix and overhead. Published data shows national demand is limited, so most practices grow by keeping patients, filling the schedule and reading their own numbers monthly. This guide lists each lever, how to measure it and what sources say.](https://joncopeland.multisites.ai/guides/grow-a-dental-practice) - [Dental practice KPIs and benchmarks: formulas, sources and limitsA dental practice KPI is a number the team tracks on a schedule, such as collections, overhead percentage, no-show rate or case acceptance. Few KPIs have an official benchmark. The ADA publishes survey averages for income and billings. Most other benchmarks online come from vendors, and formulas differ, so compare your own trend first.](https://joncopeland.multisites.ai/guides/dental-practice-kpis-and-benchmarks) - [The PPO participation decision: data to pull, contract terms and questions to askA dental PPO contract trades a lower fee schedule for network status with a plan. The choice belongs to the practice owner, with an attorney and CPA. This guide gives no advice on joining or leaving. It lists how PPOs work, the data to pull by payer, the contract terms to read and the questions to ask.](https://joncopeland.multisites.ai/guides/ppo-participation-decision) - [AI in the dental practice: what it does, what studies show and what to checkAI in dentistry mostly means software that reads images or handles office tasks. Studies of radiograph tools show promising accuracy but often rest on weak designs. Some image tools are regulated by the FDA as prescription devices. Any tool that touches patient data raises HIPAA questions you should settle before use.](https://joncopeland.multisites.ai/guides/ai-in-the-dental-practice) - [Dental leadership: team skills, training programs and where to learn themDental leadership is the work of guiding a dental team, a practice or a part of the profession. Core skills include clear communication, delegation, feedback and hiring. Learn them through team routines, mentors, organized dentistry such as the ADA and state societies, and formal programs like the ADEA Leadership Institute.](https://joncopeland.multisites.ai/guides/dental-leadership) ## Talk with Dr. Copeland [Contact Dr. Copeland](https://joncopeland.multisites.ai/contact)[Email](mailto:drcopeland@joncopelanddds.com)