Trusting Your Periodontal Evaluation
As a former Deputy Chief Investigator for the Arizona Board of Dental Examiners (AZBODEX), I frequently reviewed patient complaints alleging overdiagnosis of periodontal conditions and treatment plans that were far more costly than expected by the Complainants.
Diagnoses and treatment plans can vary among providers, but they should not come as a complete surprise during a routine recare interval, whether at the same practice or a new one. Periodontal treatment recommendations should be based on standard clinical information, such as radiographs, periodontal probing, changes in health history, medications, smoking status, home care, and photographs.
When these factors support the diagnosis, advanced periodontal treatment may be appropriate. If an unexpected treatment plan raises concerns, seeking a second opinion from another practice is always reasonable.
The dentist is ultimately responsible for confirming the periodontal diagnosis and treatment plan, even when recommendations are first presented by a hygienist or administrative assistant. A referral to a periodontal specialist may also be appropriate. If a patient declines recommended treatment, the practice may ask the patient to sign a release acknowledging that the treatment was offered and refused. When appropriate, the practice may also consider dismissing the patient for non-compliance.
In March 2026, the Iowa Dental Board issued a warning to a hygienist for over diagnosing periodontal disease in two patients and recommending associated treatment. The decision did not mention the examining dentist, although responsibility for the treatment plan would appear to rest with the dentist as well. From my experience as a former Deputy Chief Investigator for AZBODEX, disciplinary action can be difficult to substantiate when providers offer reasonable but differing explanations.
All parties should be truthful, rely on clear evidence, and pursue fair, reasonable treatment for patients. As a patient, consider seeking a second opinion whenever you have not received enough information to make an informed decision about your dental health.
