What should a practice text a patient who is overdue for a cleaning, and when?

Send three short texts around each patient's own recall date: one 30 days before, one on the date, and one 30 days after, each with a booking link, and add a benefits reminder in the fall. GoHighLevel's Custom Date Reminder trigger runs it from a due date field. The bottom line: the date should come from the interval the dentist assigned, not a fixed six months, because the evidence does not support one interval for everyone.

Why the interval should be per patient

A Cochrane review of recall intervals found that for adults attending check ups in primary care, there is little to no difference between risk based and 6 month recall in tooth decay, gum bleeding, and quality of life over four years, with high certainty evidence. The NICE guideline recommends individual intervals of 3 to 24 months for adults based on risk, with 12 months the longest for patients under 18, and a UK trial of 6 month, 24 month, and risk based recall found no difference in oral health outcomes. A qualitative study of NHS dentists notes that most patients still attend at six month intervals. So a practice should store the interval its dentist assigned and text from that date.

The fall benefits reminder

The ADA's MouthHealthy site says many dental plans have a December 31 benefit deadline and that unused benefits do not roll over for most plans, though some plans end at other times of the year. It also cites the National Association of Dental Plans finding that only 2.8 percent of PPO plan participants reached their annual maximum. A reminder in October or November that says many plans reset on December 31 is useful and accurate, as long as it tells the patient to check their own plan.

The rules

HHS says communications about a covered entity's own health related services are not marketing under HIPAA, and its FAQ says preventive care and wellness communications are generally not marketing, unless a third party pays. The FCC's healthcare exemption lists wellness checkups among exempt treatment messages, subject to conditions: no marketing, billing, or debt collection content, 160 characters or less, one message a day and three a week, an easy opt out, and immediate honoring of opt outs. A reminder with a booking link fits. A message offering a whitening discount does not.

Build it in GoHighLevel

GoHighLevel's Custom Date Reminder page says the trigger fires before, on, or after a date, that in contact based workflows you can choose supported contact date fields and supported opportunity date fields, that it does not fire for a contact whose date field is empty, and that a workflow can hold two triggers, one before and one after the date. It also describes a Match on the year option for reminders that repeat every year, so read that setting's description in your account and test it with a real date field.

1. Create two fields: Recall interval in months, set by the dentist, and Next recall due, a date.
2. Set Next recall due when a visit is completed. GoHighLevel's Math Operation action can add months to a date, or import it from the practice system.
3. Build a workflow with the Custom Date Reminder trigger set to 30 days before the date, and duplicate for the date and 30 days after.
4. Add an If/Else so a patient who booked leaves the sequence.
5. In October, build a one time campaign for patients with a visit due before the end of the year.
6. Add a call task for the front desk on the day of the third text, and stop after it.

Worked example

For example, a practice with 2,500 active patients at an average 8 month interval has about 3,750 recall dates a year (2,500 times 12 divided by 8). Three texts per date is 11,250 messages, which a trigger sends without a staff member keeping a list.

Mistakes to avoid

• Texting everyone at six months. Use the assigned interval.
• Adding a discount. That leaves the exemption.
• Promising what a plan covers. Tell the patient to check.
• Not clearing the date after a visit. The reminder follows the field.

How this was handled before

Practices mailed recall postcards at six months for everyone. Evidence from the NICE guidance and a Cochrane review has since moved the field toward risk based intervals, which means a reminder should follow each patient's own date.

What to measure after launch

Track patients due, texts sent, visits booked within 60 days, and opt outs. Check that the interval field matches each patient's chart.

Check before you switch it on

US text messages sent from a standard 10 digit number need A2P 10DLC registration. The HighLevel support portal says registration is required for texts to US recipients from 10 digit long code numbers and that toll free numbers do not require it. HighLevel's opt in guidelines also say a person cannot be forced to agree to text messages in order to submit a form, so keep the consent box optional. One compliance guide separates informational texts, which need documented consent, from marketing texts, which need prior express written consent. Ask your attorney which category your reminders fall into. Have the dentist approve the interval rules and the privacy officer approve the texts. This is general information, not legal advice.

Questions people ask

Do all patients need a cleaning every six months?

A Cochrane review found little to no difference between risk based and six month recall in adults over four years. NICE recommends 3 to 24 months based on risk.

Do dental benefits roll over?

For most plans no. The ADA's MouthHealthy site says many plans have a December 31 deadline, and some end at other times.

Is a recall reminder marketing under HIPAA?

HHS says communications about the practice's own services are not marketing, unless a third party pays.

Ready to try it yourself? Start a GoHighLevel account here.

You can also see this in action in our GoHighLevel capabilities demo.