Google has recently increased enforcement around review policies for local businesses, including dental and orthodontic practices. While many of these rules are not technically new, what has changed is how aggressively Google is now detecting and enforcing violations.

TLDR: 

• If you are using incentivized or pressured review asks, Google will notice trends in how many reviews you’re getting and/or overwhelmingly positive sentiment which can trigger an audit of your Google Business Profile.  
• It is okay and encouraged to continue asking your patients to leave you reviews, but do so in a manner that asks for feedback, not compliments. “We’d love to hear how your experience was, here’s a code to scan to leave us a Google Review.” vs. “If you enjoyed your experience, then please leave us a review.” 
• If you are using an automated system, we recommend taking a moment to review the messaging to ensure you’re in compliance with the verbiage around the ask. 
• Focus on consistent request for feedback instead of time based pushes. Encourage your team to always provide a 5-star experience instead of “this month it’s a priority” campaigns that can mean unnatural spikes in review quantity. 

What’s Actually New vs. What’s Been Around

A lot of the headlines make it sound like Google suddenly banned certain review practices overnight. In reality, many of these behaviors have violated policy for years.

Here’s the breakdown: 

The biggest shift is that Google is now using AI and behavioral analysis to identify suspicious review activity at scale.

What Google Is Paying Closer Attention To

1. Review Gating

This is currently one of the biggest areas of concern.

Review gating happens when practices:

• Ask patients to complete a survey first, before sending the reviews link
• Only send the Google review link to patients who leave positive feedback
• Redirect unhappy patients to private feedback instead of public reviews

Even if this process is automated through a reputation management platform, it can still violate Google’s policies.

Example of a risky workflow:

• “How was your visit today?”
  • 5 stars → Google review link
  • 1–3 stars → Internal feedback form

That type of filtering is specifically what Google is targeting.

Surveying patients is still allowed, and can actually be a valuable way to identify gaps and improve the overall patient experience. The key is making sure the survey is not being used to filter who gets asked to leave a public review. Regardless of how a patient responds, everyone should be given an equal opportunity to also share their feedback on Google.

2. Incentivized Reviews

Offering:

• Discounts
• Gift cards
• Contest entries
• Free products/services

…in exchange for reviews is still prohibited.

Even indirect incentives (“Leave us a review for a chance to win”) can create issues. This has long been a discouraged practice and we strongly advise our clients to not incentivize patients to leave reviews. 

3. In-Office Review Requests

Google has become more cautious about reviews collected:

• On office tablets
• Through office WiFi
• While patients are still in the chair/lobby

Why?

Because these environments can:

• Create pressure on patients
• Produce unnatural review timing patterns
• Result in multiple reviews from the same IP/network

That doesn’t mean you can never mention reviews in-office, but practices should avoid creating a “review station” style setup. 

4. Asking for Specific Language

Practices should avoid coaching patients on:

• What rating to leave
• What keywords to use
• Mentioning providers/staff by name

Simple, open-ended requests are safest. 

How Would Google Actually Know?

One of the most common questions we hear is: “How would Google even know we’re using a gated survey system?”

Google typically cannot see your internal survey logic directly. However, they can identify the patterns that gated systems often create.

Signals Google May Analyze

Review Velocity

Sudden spikes in reviews can raise red flags.

Example:

• Practice normally receives 2–3 reviews/week
• Suddenly receives 25 reviews in 48 hours

This can suggest:

• Bulk campaigns
• Filtered review funnels
• Incentivized outreach

Timing Patterns

Google may look for:

• Reviews appearing in tight clusters
• Reviews consistently posted right after appointments
• Repeated “campaign hour” spikes

Natural reviews tend to happen randomly over time.

Sentiment Distribution

A profile with:

• Extremely high review volume
• Almost no negative feedback
• Nearly all 5-star reviews

…can appear artificially filtered, especially compared to similar businesses.

User Reports

Patients can report businesses if they believe:

• They were pressured into leaving reviews
• Only positive patients received review links
• Incentives were offered

Competitors can also submit reports.

Known Software Workflows

Google may recognize patterns associated with certain review collection tools or routing systems, especially if those workflows are widely used across many businesses.

What Happens If a Practice Violates Policy?

Potential consequences include:

• Reviews being removed
• Reviews being suppressed or never published
• Public warnings on the Google Business Profile
• Reduced local ranking visibility
• Suspension of the Google Business Profile in severe cases

In some situations, practices don’t realize there’s a problem until review performance suddenly drops.

Best Practices Moving Forward

The goal is not to stop asking for reviews, it’s to collect them in a natural and compliant way.

Send Follow-Ups After the Appointment

Automated SMS or email requests sent later that day or the next day are generally safest.

This creates:

• More natural timing
• Less pressure on patients
• Better compliance with current guidelines

Ask Every Patient

Instead of filtering based on satisfaction:

• Give all patients the opportunity to leave feedback

You can still collect internal feedback separately,  just avoid using it to decide who receives a Google review request.

Keep Requests Neutral

Good example:“We’d love your honest feedback about your experience.”

Avoid: “If you had a 5-star experience, please leave us a review.”

This is important to implement in your team’s verbal review ask process as well as on any QR codes or automatic post-appointment follow ups. 

Focus on Consistency, Not Volume

A steady flow of reviews over time is much healthier than occasional large pushes. Natural review growth is what Google wants to see.

Review Your Review Process (no pun intended)

Practices using older reputation management systems should review:

• Survey flows
• Routing logic
• Automation timing
• Incentive language

Some platforms are already updating their workflows to align with newer enforcement standards.

HIPAA Reminder

When responding to reviews:

• Avoid confirming someone is a patient
• Do not reference procedures, appointments, or treatment details
• Keep responses general and professional

A safe response typically:

• Thanks the reviewer
• Avoids specifics
• Invites offline communication if needed

Final Thoughts 

Practices that built review systems years ago may not notice immediate issues, but workflows that rely on filtering, incentivizing, or tightly controlling review behavior are becoming riskier over time.

The safest long-term strategy is simple:

• Ask consistently
• Ask everyone
• Keep it natural
• Keep it honest

That approach not only aligns with Google’s policies, but it also builds a stronger and more trustworthy online reputation over time.