Review Gating and Fake Reviews: What Dentists Must Avoid

Review gating means screening patients before you ask for a public review, so only the happy ones get the Google link and the unhappy ones get steered to a private form. For dentists, it's the most common review rule that gets broken without anyone realizing it, because plenty of software has offered it as a feature. Google's policies prohibit it, and the FTC has warned that selectively soliciting reviews can be deceptive.

Fake reviews are the blunter cousin: reviews written by staff, family, a marketing vendor or anyone who isn't a real patient describing a real experience. The FTC's rule on fake reviews and testimonials, finalized in 2024, gave the agency a direct way to seek penalties for them.

This guide explains what's off-limits, what's fine, and how to audit your current setup. It's general information, not legal advice. If you have specific questions about your review process or a vendor contract, talk to a healthcare attorney or your compliance advisor.

What review gating looks like in a dental office

Gating rarely looks sinister. It usually looks like a reasonable workflow:

A text goes out after every appointment asking, "How was your visit? Rate us 1 to 5."
Patients who tap 4 or 5 get a "Great! Please share on Google" link.
Patients who tap 1 to 3 get "We're sorry. Tell us what happened" and a private form.

The intent is often good. You want to hear about problems directly. The effect is that your public profile only reflects patients who were already pleased, which misrepresents your practice to people choosing a dentist.

Other forms of gating are even more casual:

The front desk only hands review cards to patients who seemed happy at checkout.
A hygienist asks for reviews only from patients she knows well.
The office manager exports a list of "best patients" and sends them a review email.

None of these require software. All of them are selective solicitation.

The rules that apply

Several sets of rules overlap here. You don't need to memorize them. You need to know where the lines are.

Google's review policies

Google's policies for reviews on Business Profiles prohibit:

Discouraging or prohibiting negative reviews, or selectively soliciting positive reviews from customers
Offering incentives in exchange for reviews
Reviews from people with a conflict of interest, such as owners, employees or competitors
Fake engagement, including reviews that don't reflect a genuine experience

Google can remove reviews that violate these policies, and it has said it may take further action against profiles involved in fake engagement, such as restricting new reviews or showing a warning to people viewing the profile.

The FTC's rule on consumer reviews and testimonials

The FTC's rule, finalized in 2024, targets practices including:

Creating, buying or selling fake reviews, including ones that misrepresent who wrote them or whether they had a real experience
Offering compensation or incentives conditioned on a review expressing a particular sentiment
Reviews from company insiders, such as officers or managers, without clear disclosure, and certain situations where a business asks employees or their relatives for reviews
Using threats or intimidation to suppress negative reviews, or misrepresenting that the reviews you display are all or most of the reviews you've received

Separately, the FTC's Endorsement Guides, updated in 2023, say that procuring reviews in a way that skews them, such as asking only customers you expect to be happy, can be deceptive.

The Consumer Review Fairness Act

This federal law limits contract terms that restrict or penalize customers for honest reviews. A "no negative reviews" clause in your new patient paperwork is a bad idea.

State dental board rules

Some state boards have their own rules on testimonials and advertising. Check yours, especially if you plan to use reviews in ads.

Allowed or not allowed: a quick reference

Practice	Allowed?	Why
Sending the same review request to every patient after their visit	Yes	Not selective, no incentive
Asking patients at checkout, any patient, verbally	Yes	As long as the team asks everyone, not only the happy ones
A private feedback survey sent to everyone, plus the Google link sent to everyone	Yes	Feedback is fine as long as it doesn't decide who gets the review link
Survey first, then Google link only to high scores	No	Classic review gating
Entering reviewers into a raffle or giving a whitening discount	No	Incentive for reviews
Doctor's spouse, staff or staff family leaving reviews	No	Conflict of interest
A marketing vendor "seeding" reviews to get you started	No	Fake reviews
Buying reviews in a package, from anyone	No	Fake reviews
Asking a happy patient to update an old negative review after you resolved it	Use caution	Fine to ask politely; never tie it to a refund or favor
Threatening a reviewer with legal action to get a review removed	No	Review suppression; talk to an attorney before any legal step
Reporting a review that breaks Google's policies	Yes	That's what the flag tool is for

When in doubt, ask yourself one question: would you be comfortable if a prospective patient saw exactly how this review was obtained? If not, don't do it.

Why gating and fake reviews backfire anyway

Set the rules aside for a moment. These tactics also tend to work badly.

Reviews get filtered or removed. Platforms look for suspicious patterns, such as bursts of reviews, reviews from accounts linked to the business or many reviews from one location. When they're removed, your rating can swing hard.
Patients can tell. A profile full of short, generic five-star reviews with no detail reads as fake to many people. A mix of detailed reviews with an occasional complaint and a calm reply often looks more trustworthy.
You lose the signal. Gating hides the complaints that tell you what to fix: the phone that rings out at lunch, the billing surprise, the 45-minute wait.
Staff learn the wrong lesson. If your team sees leadership bending review rules, it's harder to hold the line on HIPAA, billing and everything else.

How to audit your current review setup

Spend an hour on this with your office manager. You may find something you inherited from a past vendor.

Map the patient journey after checkout. What messages go out, when, and to whom? Get screenshots of each one.
Look for a rating step before the review link. If a satisfaction question determines who sees the Google link, that's gating. Change it so everyone gets the link.
Check vendor settings. Some review tools have a "filter" or "routing" setting. Turn it off, and get your vendor to confirm in writing how requests are sent.
Ask the team how they ask. Find out whether anyone is picking who gets review cards or verbal asks.
Search your own profile for insider reviews. Look for reviews from current or former staff, family members or business partners. You can ask those people to remove them.
Read your patient paperwork. Remove any language that restricts reviews.
Check for incentives. Look at old promotions, social posts and front desk signs for anything that rewards reviews.
Write it down. Add a short review policy to your office manual: everyone gets asked, nobody gets rewarded, insiders don't review.

Once you're clean, use compliant review request templates and the steady habits in our guide on how to get more Google reviews.

What to do about fake reviews targeting you

Sometimes the problem runs the other way: a review from someone who was never a patient, a competitor, or a cluster of one-star reviews in a single day.

Don't accuse anyone publicly. Your reply should be calm and neutral. Avoid saying "this person was never a patient," which can create privacy issues of its own if you're wrong. Our article on responding to reviews without violating HIPAA has wording that works.
Flag the review through your Google Business Profile and choose the policy reason that fits.
Document it with screenshots and dates.
Follow up through Google's review management tools if the review isn't removed and you believe it clearly violates policy.
Keep asking real patients for reviews. A healthy flow of genuine reviews is the best long-term buffer against one bad actor.

If you face something that looks like extortion, for example someone demanding payment to remove reviews, document it and talk to your attorney.

Red flags when hiring a review or marketing vendor

Ask these questions directly, and get answers in writing:

Does your system send review requests to every patient, or only some?
Is there any rating, survey or score that decides who gets the review link?
Do you or anyone you work with ever write, post or purchase reviews?
Will you offer patients anything in exchange for reviews?
Who owns the review request account and data if we leave?

A vendor who hesitates on any of the first four is a vendor you don't want. For broader vetting, see how to choose a dental marketing agency.

Frequently asked questions

What is review gating?

Review gating is screening customers before inviting them to leave a public review, so that people likely to be happy are sent to Google while unhappy people are steered elsewhere. Google's policies prohibit selectively soliciting positive reviews, and the FTC has warned the practice can be deceptive.

Is it legal to send a patient satisfaction survey before asking for a review?

A survey on its own is fine. The problem is when the survey result decides who receives the public review link. If you send the survey and the review request to every patient regardless of their answer, you avoid gating. Confirm your specific process with your compliance advisor.

Can my dental staff leave Google reviews for our practice?

No. Google's policies prohibit reviews from people with a conflict of interest, including employees and owners. The FTC's rule also addresses reviews from company insiders. Ask staff and family members not to review the practice.

What happens if Google finds fake reviews on my profile?

Google can remove the reviews, and it has said it may restrict new reviews or display a warning on profiles involved in fake engagement. Removed reviews can drop your count and change your rating quickly. Serious cases may also draw regulatory attention under the FTC's rule.

Can I offer a discount to patients who leave a review?

No. Google doesn't allow incentives for reviews, and the FTC's rule restricts incentives tied to a review's sentiment. Even small perks like raffle entries create risk. Ask every patient for an honest review and offer nothing in return.