Two dental practices can run the same keywords, in the same city, with the same budget, and get completely different results. More often than not, the difference is in how they bid.
One practice sets a bid once, when the campaign is built, and never looks at it again. It either overpays for searches that never book, or it underpays and quietly sits below its competitors on the searches that matter most. The other practice treats every bid as a decision: how high on the page it wants to be for each group of searches, what that position is worth, and whether the patients coming in justify the price.
In Chapter 6 we set up the structure: an Isolation campaign (our name for an exact match campaign that protects the dental searches you know will book) and, later, an Exploration campaign (our name for a broad match campaign that finds the ones you could not predict). This chapter is about how to bid each of them so the structure actually makes money.
The two campaigns are bid in completely different ways. In Isolation, you set the bids yourself. In Exploration, Google sets them, inside a target you give it. Both start from the same place: knowing what a click is worth to your practice.
Know Your Ceiling Before You Place a Single Bid
In Chapter 3 we built the chain from a click to a new patient: a $10 click, a 5% conversion rate, a 50% close rate, and $400 for each new patient who actually sits in your chair. Bidding runs that same chain in reverse.
Start with what you can afford to pay for a new patient. If a new patient is worth thousands to your practice over the years, $400 may be comfortable. Half of your leads become patients, so you can afford $200 per lead. One in 20 clicks becomes a lead, so you can afford $10 per click. That is your ceiling for that kind of search.
The numbers will be different for every practice and every service. An implant patient can justify a far higher ceiling than a cleaning. But having the number at all changes how you bid. It is the cushion that lets you bid confidently on the searches that matter, because you know how far you can go and still come out ahead. Most practices never work it out, which means they are guessing every time they change a bid.
Isolation Starts With Bids You Set Yourself
The Isolation campaign uses manual bidding: you set the maximum you are willing to pay for a click, and Google does not change it for you. There are two reasons to start this way.
The first is control. The whole point of the Isolation campaign is to hold a strong position on the dental searches you already know will book. Manual bids let you decide exactly how hard to compete for each one.
The second is that automation has nothing to learn from yet. Google's automated bidding works by learning from your conversions. A brand-new account has none. Handing control to an algorithm with no history mostly means paying for it to guess.
Set bids at the ad group level
You could set a separate bid for every keyword, but in a well-built account you rarely need to. Because each ad group holds only five or six keywords that mean the same thing, like the different ways people ask for a pediatric dentist nearby, one bid for the whole group works well and is far easier to manage. Individual keyword bids are for the rare keyword that behaves differently from the rest of its group.
Read the market before you commit
Before you set real bids, find out what the market expects. Google shows an "Est. top of page bid" column on the Keywords page. Google describes it as "the bid you likely need to set for your ad to be shown among the ads at the top of the first page of search results," based on "each keyword's Quality Score and competition from other advertisers."
Two things are worth knowing about that number. It is calculated for searches that exactly match your keyword, which suits an exact match campaign. And, as Google puts it, "the estimate isn't a guarantee." Treat it as a starting point, not a price.
When we launch a new dental account, we often go live with a very low budget for the first day or so, just to see what Google says the market expects for each group of searches. Then we set the real bids from there, checked against the ceiling you worked out above.
Bid Higher at Launch, Then Ease Off as Quality Builds
A brand-new keyword has no track record. Google has not yet seen how often people click your ad or how they respond to your landing page. That means your early bids have to carry more of the weight, and it is normal to bid more aggressively in the first weeks than you will later.
It does not stay that way. As we covered in Chapter 4, Google weighs the quality of your ads and landing page every time your ad competes, and Google's own help pages say better ads often mean paying less per click. As your ads prove relevant, people click them, and your landing pages hold their attention, the same position on the page usually starts to cost less.
Watch the Quality Score ratings at the keyword level (they do not appear at the ad group level) to see where you stand. As expected click-through rate, ad relevance and landing page experience improve, you can start easing bids down while keeping your position. In our experience, dialing in a new dental account this way takes one to three months.
Four Columns Tell You Where You Stand
The Google Ads interface has hundreds of columns. For an Isolation campaign, four of them do most of the work. Save them as your own column set so they are in front of you every time you log in.
Search top impression share. Google defines it as the impressions you received among the top ads, divided by the impressions you were eligible to receive there. In plain terms: of all the times your ad could have been in the top group of ads, how often was it? This is the column we put first. For the searches that matter most to your practice, we generally aim for somewhere around 70% to 90%.
Search absolute top impression share. The same idea, but only counting the very first ad on the page. Useful for your most valuable searches, but not every search needs to be number one.
Search lost top impression share (rank). Google describes this as how often your ad "didn't show anywhere among top ads due to poor Ad Rank." If this number is high, you are being outbid, outperformed on quality, or both. Early on, that is expected. Over time, the answer is a higher bid, a better ad, a better landing page, or a decision that this search is not worth fighting for.
Search lost top impression share (budget). How often you missed the top because your budget ran out. If this is high, raising bids will not help. Either the budget needs to grow, or the campaign needs to cover fewer searches.
The difference between those last two matters more than it looks. Practices often raise bids when the real problem is budget, or raise budget when the real problem is quality, and spend more without moving at all.
Give Every Ad Group a Fair Test Before You Judge It
You will not know which groups of searches matter most until they have had a fair chance. Our rule of thumb is around 100 clicks: if a group of searches can produce phone calls and booking requests within about 100 clicks, it is earning its place, and it is worth bidding for a strong position.
If your budget is smaller, you do not have to launch everything at once. Start with a subset of your most important ad groups, such as general dentist searches and the one or two services you most want to grow. Prove them, then add more. A small budget spread across every ad group gives none of them a fair test.
Judge Your Bids by Patients, Not by Conversions
A conversion in Google Ads is a call or a booking request. It is not yet a patient. Bidding decisions should be based on the patients.
That starts with counting the right calls. In Chapter 1 we set dental accounts to count calls of 30 seconds or longer. Beyond that, call tracking software that records calls lets you actually listen: were these real new patients, and did the front desk turn them into appointments? When calls are missed, sent to voicemail or never returned, the problem is not the bid, and no amount of bidding will fix it.
Then compare each ad group's cost per new patient to the ceiling you worked out at the start. Where an ad group brings in patients comfortably below the ceiling, raise the bid and take a stronger position, as long as it stays profitable. Where it runs above the ceiling, pull the bid back, improve the ad or landing page, or pause it. This is the whole job of bidding an Isolation campaign, repeated week after week.
Auction Insights Shows Who You Are Bidding Against
Once your campaign has been running for a while, the Auction insights report shows which other advertisers are competing in the same auctions and how you compare. For Search campaigns, Google's statistics include:
- Overlap rate: "how often another advertiser's ad received an impression when your ad also received an impression."
- Position above rate: "how often the other advertiser's ad was shown in a higher position than yours was, when both of your ads were shown at the same time."
- Top of page rate: how often each advertiser's ad was shown at the top of the page.
- Outranking share: "how often your ad ranked higher in the auction than another advertiser's ad, or if your ad showed when theirs didn't."
For a dental practice, this is often where you discover that a national chain, an implant center or a practice across town is bidding hard on exactly the searches you care about. That is useful to know, but it is not an instruction to outbid them at any cost. If an auction becomes too expensive for the patients it brings in, step out of it and put that money into searches where you can win profitably.
Exploration Bids From a Target You Set
When the Isolation campaign reaches about 30 quality conversions a month and the Exploration campaign launches, bidding changes completely. Exploration runs on broad match, and we never run broad match on manual bids. It uses Maximize Conversions with a target CPA: you tell Google the average cost per conversion you are aiming for, and it sets the bid for every auction to hit that average.
Set the target from real numbers
This is where the Isolation campaign pays off a second time. By now you know what a conversion actually costs in your market, because Isolation has been producing them for a month or two. That real cost per conversion is the natural starting point for Exploration's target, checked against your ceiling. A target pulled from thin air is a guess. A target pulled from your own account is a standard.
Give it time to learn
Google says a new bid strategy can take up to about 50 conversions, or three conversion cycles, to calibrate. A conversion cycle is how long it usually takes from the click to the call or booking. Google also notes that changing a target does not restart that learning, and suggests waiting one to two conversion cycles after a change before judging the results. In practice, that means patience in the first few weeks, and small, deliberate changes rather than a new target every few days.
Expect the long tail to be cheaper
In our experience, the Exploration campaign often ends up with a lower cost per click and a lower cost per conversion than the Isolation campaign. That makes sense: the long-tail searches it finds are less contested than "dentist near me," but they still come from people who want a dentist. It is one more reason Exploration is where a dental account grows.
The one thing that does not change is the search terms report. As we covered in Chapter 6, broad match needs daily checking and new negative keywords in its first 30 days, and steady attention after that. Target CPA keeps the average cost in line. Only negatives keep the searches themselves in line.
Next, Write Ads Worth Bidding For
You now know how to bid both campaigns: a ceiling worked out from your own patient value, manual bids in Isolation guided by the columns that matter, and a target CPA in Exploration set from real results. Every one of those numbers depends on something bidding cannot fix on its own: whether people choose your ad once it is on the page.
That is Chapter 8, Creating Ad Copy.
If you would rather have your bids managed week by week, this is the work we do on every dental account we run. Our Google Ads management sets bids from your patient value, not from Google's suggestions.
