If you have spent any time in Google Ads, you have probably been told to try Performance Max. It is the campaign type Google promotes most, and the pitch is appealing: one campaign, every Google channel, with Google's automation finding the patients for you.
For a dental practice, that pitch is half right. Performance Max can be a genuinely useful campaign. It reaches people across Google's whole network, often months before they are ready to book, at a lower cost per click than search. But it has one requirement that the pitch skips over. It learns from your conversions. Give it an account full of real new-patient calls and bookings, and it has something to go find more of. Give it a brand-new account, and it has nothing to learn from but guesses.
That is why, in the rollout we have followed through this guide, Performance Max comes months after launch, not on day one. This chapter covers when it is ready, how to set it up for a dental practice, and how to keep it honest once it is running.
One Campaign, Every Google Channel
Google describes Performance Max as a campaign that can "access all Google Ads inventory, including YouTube, Display, Search, Discover, Gmail, and Maps, from a single campaign." You give it your goals, your ads and your signals about who your patients are, and it decides where and when to show your ads.
For a dental practice, that reach is the point. Your search campaigns catch people at the moment they are looking for a dentist. Performance Max can also reach people earlier: the person watching a YouTube video about teeth whitening, the family that just moved to town, the patient who has been putting off a crown for a year. Many of them will not book for months. Showing up in the meantime builds familiarity, so that when they are ready, your name is one they already know. Clicks and views higher in the funnel are also far cheaper than a click on "dentist near me."
Google itself positions Performance Max as something that complements your keyword-based search campaigns, not something that replaces them. That is exactly how it fits in a dental account.
Performance Max Never Launches First
Performance Max decides who to reach by learning from your conversions: who called, who booked, who became a patient. An account with months of real conversion history gives it a clear picture of what success looks like for your practice. An account with none gives it nothing but your website and a budget.
That is why we never launch it first. In the rollout from Chapter 6, the Isolation campaign comes first, then the Exploration campaign once Isolation is producing about 30 quality conversions a month. Performance Max comes after both are working, usually around the sixth or seventh month for a new account. By then, Google has seen well over a hundred real new-patient inquiries from your market, and Performance Max has something real to build on.
Launched too early, it tends to do what any automation does without good data: spend the budget learning, and send you leads you would never have paid for on purpose.
It Will Not Take Your Best Searches, If Search Is Set Up Right
A common worry is that Performance Max will start showing ads on the searches your Isolation campaign was built to protect, and take the credit for them. Google's own rules largely prevent that, as long as your search campaigns are set up the way this guide describes.
Google states that when a search matches an exact match keyword in a Search campaign, that keyword "is prioritized over any other broad or phrase keyword or a Performance Max campaign." Performance Max's search themes, covered below, rank alongside phrase and broad match keywords, not above exact match.
In other words, the exact match keywords in your Isolation campaign keep "dentist near me" and your other core searches in the search campaign where you control the bids and the ads. There is one caveat. Google notes that a keyword in a budget-restricted campaign won't always be able to trigger an ad, so if your Isolation campaign regularly runs out of budget, Performance Max may pick up searches it would otherwise have handled. Keep the core search campaign funded before you add Performance Max.
The Settings That Keep Performance Max Honest
Most of the setup follows the same logic as the search campaigns in Chapter 9. A few settings are specific to Performance Max.
Goal and bidding. Choose leads as the goal, and optimize for conversions rather than conversion value. Most practices do not send revenue back into Google Ads, so there is no real value for Google to optimize toward. Start with Maximize Conversions and no target CPA. Give the campaign room to learn first, then add a target CPA once its results settle, set from what a conversion actually costs, just as Chapter 7 describes for Exploration.
New customers only. Leave it unchecked, as with the search campaigns.
Locations. Presence, not "Presence or interest," for the same reason as Chapter 9: patients have to come to the office.
Brand exclusions. Add your practice name and your dentists' names. Your brand campaign already covers those searches cheaply. Without the exclusions, Performance Max can claim those easy conversions and look far better than it really is.
Negative keywords. This used to be a major weakness of Performance Max. It is not anymore. Google now supports campaign-level negative keywords in Performance Max, up to 10,000 of them, and lets you apply negative keyword lists. Apply the dental negative list you built in Chapter 5 and have kept adding to since.
Final URL expansion. This lets Google send people to pages on your site other than the one you chose. Check how it is set, and make sure traffic lands on pages built for the service being advertised, not your blog or your careers page.
Search Themes Tell Google What Patients Look For
Performance Max has no keywords, but it does have search themes. Google describes them as words and phrases that describe what your customers are likely to search for, and it is clear that they are a broader signal to Google's AI, not keywords. You can add up to 50 per asset group.
Use the services you offer and the keyword families from Chapter 5: implants, cleanings, emergency visits, pediatric care, cosmetic work, and the ways patients phrase them. Google will expand well beyond your list, but the themes steer it toward the right kind of search from the start.
In our experience, some health-related themes, particularly personal ones with "near me," can be flagged during review. If that happens, remove them and keep the service-level themes.
Audience Signals Work Differently in Healthcare
Performance Max also asks for audience signals: hints about who your patients are. For most businesses, the strongest signal is their own data, such as website visitors and customer lists. For a dental practice, that data is close to zero, because health-related remarketing is off-limits on service pages.
Google's health policy for personalized advertising also matters here. It treats "invasive medical procedures, including cosmetic surgery, surgical procedures, or injections" as sensitive health content. For ads in that territory, which can include implants and oral surgery, Google does not allow advertiser-curated audiences or customer lists, and it limits custom segments to Display, shown to non-sensitive audiences or contextually.
That does not make signals useless. It changes which ones do the work:
- Custom segments. We still build them before launching, in Google's audience manager: one for purchase intentions (the services people are shopping for), one for the searches they make, and one based on competitor websites, with up to about 20 practices in your area. The competitor list is profiling, not remarketing: Google looks at the kinds of people who visit sites like those and finds more like them. Expect these to carry more weight for general dental services than for implants and surgery, where Google's health rules limit them.
- Life events and demographics. These remain available. A household that has just moved to your area needs a new dentist, and that is exactly the kind of signal Google allows.
- Search themes. For the services where audience signals are limited, the search themes above do more of the steering.
Remember that signals are hints, not targeting. Performance Max will look beyond them either way. Good signals just help it find the right people faster.
Bring Your Proven Search Copy With You
A Performance Max asset group holds the creative Google mixes and matches across channels: up to 15 headlines, 5 descriptions, 20 images and 5 videos, along with your logo and sitelinks.
By the time you launch Performance Max, your search campaigns have months of data on which headlines and descriptions patients respond to. Start there. Move your best-performing lines from the search ads in Chapter 8 into the asset group, then add the longer headlines and descriptions Performance Max allows.
Three things matter more here than in search:
- Real photos. Your office, your team, your dentists, your patients' smiles with permission. Stock photos make a practice look like every other practice, and Performance Max shows images far more than search does.
- Your own video. Google says that if you do not add a video, one or more may be generated automatically from your other assets. Those rarely represent a practice well. Even a simple, well-shot video tour or a short introduction from the dentist is better.
- Skip the automatic asset generation at launch. Google offers to create assets for you with AI. As with search ads, it works better as a way to get ideas than as the source of your creative.
Performance Max Is No Longer a Black Box. Read It.
For years, the biggest complaint about Performance Max was that you could not see what it was doing. That has changed. Google now offers search terms reporting for Performance Max campaigns, a channel performance report showing where your ads ran, and full statistics on your assets.
Use them the way you use the search terms report for Exploration. In the first weeks, look at which searches Performance Max is showing up on and add negatives for anything that is not a patient. Check the channel report to see how much of the spend went to search, video and display, and whether conversions followed. Check which assets are driving results and replace the weak ones.
Once the campaign has run long enough to show a steady cost per conversion, add a target CPA, just as you did for Exploration. From there, Performance Max becomes one more campaign in a system that balances itself: Isolation protecting the searches you know, Exploration finding the ones you don't, and Performance Max reaching patients before they ever search at all.
Next, Reach Patients Before They Search
Performance Max is one way to reach people higher in the funnel. The next chapter covers the campaign type Google built specifically for it, and the one that now carries Google's display ads: Demand Gen.
That is Chapter 11, Demand Gen.
If you would rather have Performance Max set up with the right signals and guardrails, we build it on every dental account that is ready for it, and not a day before. Our Google Ads management follows the same rollout you have read in this guide.
