A cleaning reminder and a whitening promotion can go out from the same dental office on the same day, under different TCPA rules. The FCC’s healthcare exemption allows automated texts to patients’ cell phones for appointment reminders and wellness checkups, with strict limits. It excludes marketing and anything about billing. Dental offices, orthodontists, and dental service organizations that send all their texts from one platform often blur the line. A practice facing a claim should start by sorting each message into the rule that governs it.
Which dental texts fit the healthcare exemption?
Appointment confirmations, reminders, and recall messages sent to the number the patient provided, within the frequency limits.
47 C.F.R. § 64.1200(a)(9)(iv) exempts “Calls made by, or on behalf of, healthcare providers,” including “other healthcare professionals,” from the consent requirement for calls to cell phones. The messages must be sent “only to the wireless telephone number provided by the patient,” must name the practice, and are “strictly limited” to purposes such as “appointment and exam confirmations and reminders, wellness checkups,” and “prescription notifications.”
A six-month recall text fits comfortably as a wellness checkup reminder. The exemption also caps volume at “only one message (whether by voice call or text message) per day to each patient, up to a maximum of three voice calls or text messages combined per week.” Each message needs an opt-out, STOP must work, and opt-outs must be honored immediately.
What falls outside the exemption?
Promotions, and anything about money owed.
The exemption’s conditions say the messages “must not include any telemarketing, solicitation, or advertising; may not include accounting, billing, debt-collection, or other financial content; and must comply with HIPAA privacy rules.” Texts promoting whitening, veneers, clear aligners, or a membership plan are marketing. A balance-due reminder or a payment link is billing, so it can’t ride on the exemption either.
That second carve-out surprises many offices. A balance-due text isn’t marketing, so it doesn’t need written consent. It still needs the patient’s prior express consent if it’s autodialed or prerecorded, under 47 U.S.C. § 227(b)(1)(A). A patient who listed a cell number on the intake form for billing contact usually gave that consent.
Do promotional texts need written consent?
If they’re sent with an autodialer or prerecorded voice, yes, unless they fit a separate HIPAA-based exception.
Section 64.1200(a)(2) requires “prior express written consent” for autodialed or prerecorded calls that include “an advertisement or constitutes telemarketing,” except for a call that delivers a “health care” message from a HIPAA “covered entity” or its business associate. Many dental practices are covered entities. A message about a treatment the dentist recommended for that patient may qualify as a health care message. A spring whitening sale sent to every patient almost certainly doesn’t.
The autodialer question often matters more. Equipment counts only if it can store or produce numbers “using a random or sequential number generator,” under § 64.1200(f)(2) and Facebook, Inc. v. Duguid (2021). Most practice-management texting tools send to stored patient lists and don’t qualify. The Do Not Call rules still apply to marketing texts regardless of the equipment.
How do the Do Not Call rules apply to patients?
Current patients are usually covered by the established business relationship for 18 months after their last visit.
A telephone solicitation excludes a message to “any person with whom the caller has an established business relationship,” which rests on a transaction within 18 months or an inquiry within three months. Reactivation campaigns aimed at patients who haven’t visited in two or three years fall outside that window, and Registry-listed numbers in that group need to be scrubbed before any promotional text.
A patient’s request to stop ends the relationship for marketing purposes. Practices that belong to a DSO should confirm that an opt-out at one office reaches the group’s central marketing platform.
What does a violation cost?
$500 per violation, up to $1,500 if willful or knowing.
Robocall claims under § 227(b)(3) and Do Not Call claims under § 227(c)(5) carry that range, and Do Not Call claims require more than one call in 12 months. A practice that sends a few promotional texts to a list of several thousand patients has class-sized exposure on paper, even when the patients were happy to hear from it.
| Dental text | Rule | Exposure | Defense to develop |
|---|---|---|---|
| Appointment and recall reminders | 64.1200(a)(9)(iv) | $500 per violation; up to $1,500 if willful or knowing | Patient-provided number; frequency limits; opt-out |
| Whitening or aligner promotion | 64.1200(a)(2) | Same | Signed consent; not an autodialer |
| Balance-due or payment-link text | 227(b)(1)(A) | Same | Prior express consent on intake form |
| Reactivation text to a Registry number | 64.1200(c)(2) | Same, if more than one in 12 months | Visit within 18 months; scrub records |
| Texts after STOP | 64.1200(a)(9)(iv)(H), (a)(10) | Same | Opt-out logs |
Steps to take when a dental practice gets a TCPA demand
- Preserve texting platform logs, intake forms, and consent records for the numbers in the claim, under a litigation hold.
- Export opt-out replies and the do-not-text list, with dates and the office that received each.
- Export Registry scrub records and each patient’s last-visit date.
- Gather the texting vendor and business associate agreements, message templates, and campaign schedules.
- Have a lawyer review the demand before replying, contacting the patient, or offering a credit.
Sorting messages by template in step 4 usually shows which claims fit the exemption and which don’t. More on defending text message claims is available, and a recent post covers federal caller identification requirements.
Questions dental practices ask about patient texts
Can a recall text mention a discount?
Not under the healthcare exemption. A recall reminder that adds a discount offer contains advertising, which the exemption excludes. Keep recall messages free of offers and send promotions separately, with the consent and Do Not Call steps marketing texts need.
Does the exemption cover texts to a parent about a child’s appointment?
The exemption requires messages sent to the number “provided by the patient.” For a minor, the parent or guardian typically provides the number on the intake form. Documenting who provided the number, and for which patient, strengthens the defense.
How many reminders can a practice send before an appointment?
The exemption allows one message per day and three per week to each patient. A platform that sends a confirmation, a two-day reminder, and a same-day reminder stays within the weekly cap only if nothing else goes to that patient that week.
Do review-request texts fit the exemption?
No. A request to post a review isn’t among the listed purposes. Courts disagree on whether a pure review request is marketing, so practices should get consent for review texts or keep them out of automated campaigns.
Defending claims over patient texts
If your practice or dental group has received a demand over recall reminders or promotional texts, the message templates and the intake-form consent usually decide how much of the claim survives. Rosenberger + Kawabata represents businesses defending TCPA lawsuits and class actions through its business litigation practice, including claims involving patient reminder texts. Contact Rosenberger + Kawabata online for a confidential consultation, or call (310) 894-6921.
Sources
47 U.S.C. § 227; 47 C.F.R. § 64.1200.
This post is general information about the Telephone Consumer Protection Act and related laws as of May 30, 2026. It is not legal advice, and reading it does not create an attorney-client relationship. Courts and the FCC change the rules in this area often, and the outcome of any claim depends on its facts. Past results do not guarantee future outcomes.