Every chapter so far has handed Google more decisions only after the account earned it. Isolation set bids by hand. Exploration loosened the keywords once there were bookings to learn from. Performance Max and Demand Gen came later still, with real photos and real video.
AI Max is the last step, and it's the one that hands over the words. It can match ads to searches you never chose, write headlines you never wrote, and send people to pages you never picked. For an orthodontic practice, the headline-writing part is the one to worry about, because of where the words come from. Google builds them from the practice's own website. And most orthodontic websites we looked at say things that aren't quite true anymore.
AI Max Comes Last, After Search, Performance Max and Demand Gen Have Months of Booked Exams Behind Them.
Google's documentation describes one switch that brings three behaviors with it: looser matching to searches, headlines Google writes itself, and landing pages Google picks. Flip it on and the headline writing and the page picking come along unless you untick them. All three lean on bidding that optimizes for conversions.
That last point decides where AI Max can go. Isolation, our first campaign, runs exact match with a person setting the bids, so it can't feed AI Max what it needs, and it shouldn't try. Its job is to hold the searches you already know at a price you chose. AI Max belongs on Exploration, the broad match campaign from Chapter 6, and only after the account has months of booked exams for the bidding to learn from.
It also doesn't have to arrive all at once. Google lets you untick final URL expansion when you turn AI Max on, and it notes the dependency the other way: switch off text customization and final URL expansion goes off with it. A cautious orthodontic account can start with the wider search matching alone, watch a month of search terms and booked exams, and only then let Google write headlines. Each step gets judged on the same number as everything else in this guide, the cost per booked exam.
In our rollout that's the last step, after Search, Performance Max and Demand Gen. It isn't a reward for patience. It's the step that does the most guessing, so it should wait until the account has the most to go on.
Text Customization Writes Orthodontic Headlines From Your Domain, Your Landing Pages and Your Existing Ads.
Google calls the headline-writing feature text customization. Its raw material is the practice's own site, the pages the ads point to, the ads already running and the keywords. Google reads all of it and writes new headlines and descriptions to match the search.
That sounds efficient, and sometimes it is. The catch is that the system can't tell a current page from a forgotten one. A promise on the home page, a price in a three-year-old blog post, a sentence left over from a website template: it's all text on the domain, and all of it is fair game. Whatever the site says, true or stale, becomes something Google can put in a headline with your name on it.
So the question before turning AI Max on isn't "is the campaign ready?" It's "is the website telling the truth everywhere?"
10 of 12 Orthodontic Sites We Checked Contradict Themselves Somewhere.
We profiled the websites of 12 orthodontic practices in our example market, Detroit, page by page. Ten of them contradicted themselves somewhere on their own pages. We're not naming them, because the pattern is the point and every practice's site drifts over time. Here's what we found:
- Three promised evening and weekend appointments on one page while the posted hours showed no evenings and closed weekends.
- Two printed a location count that didn't match the offices listed beneath it, including "three convenient locations" above four addresses.
- One showed two different review counts on the same page.
- One called its orthodontist a DDS in one paragraph and a DMD in the next.
- Two carried template copy naming a doctor or a practice that isn't there.
- One had lorem ipsum placeholder text in a pop-up on the home page.
- Three published two to five different phone numbers for new patients.
- Two gave dates about the practice's history or a doctor's experience that disagreed with each other.
The two sites that stayed consistent with themselves weren't spotless either. Their ads and map listings promised things their own pages didn't, which is the same problem pointed the other way.
None of that is unusual. Websites get built once, edited in pieces, and handed between vendors. A new doctor joins, an office closes on Fridays, a promotion ends, and the page that mentioned it never gets touched. A human visitor might not notice. AI Max reads every page.
Picture the result. A parent searches "orthodontist open saturday" and sees a headline Google assembled from your home page: "Evening & Weekend Appointments." They book online for Saturday at 10. The office is closed on Saturdays. That's not a bad click. That's a bad review, written by someone who did exactly what your ad told them to do.
An Orthodontic Website Audit Before AI Max Takes One Afternoon.
The fix is unglamorous and cheap: read your own site before Google does. One person, one afternoon, every page. What to check:
- Hours. Every mention of hours, evenings, weekends or "flexible scheduling" matches the posted hours and the Business Profile from Chapter 12.
- Phone numbers. One number for new patients, used everywhere a new patient might look. Separate numbers for current patients or billing, clearly labeled.
- Offices and doctors. The count of locations and doctors matches the list. Retired or departed doctors are gone from booking pages.
- Credentials. Degrees, board certification and memberships stated the same way on every page.
- Reviews. One review figure, or none. Never two different numbers on the same page.
- Offers. Every promotion on the site is current and matches the ads. Chapter 4 found five practices whose ads offered discounts their own sites never mentioned; AI Max can create the same mismatch in reverse.
- Leftovers. Template text, placeholder copy, old promotion flyers, pages for services the practice no longer offers.
Fix what's wrong, delete what's dead, and only then give AI Max the keys. Then keep a standing reminder: every time the practice changes hours, adds an office or ends an offer, the website changes the same week.
Text Guidelines Allow 25 Excluded Terms and 40 Restrictions, and Excluding "$" Doesn't Stop a Price.
Even with a clean site, Google gives you a fence for the words it writes. It calls the feature text guidelines, and it comes in two parts.
Term exclusions are exact words or phrases Google won't use in generated text. Google allows up to 25 per campaign. They aren't case-sensitive, and they only apply to the language you write them in. Messaging restrictions are plain-language instructions about what to avoid, like a tone, a claim or a kind of promise. Google allows up to 40.
One detail matters for orthodontists in particular. Google's help page says that excluding the "$" symbol won't stop a headline with a price in it from being generated. To keep prices out, you need a messaging restriction that says so directly. Given how many orthodontic pages carry a monthly figure, a down payment or a discount somewhere, that restriction belongs in every orthodontic campaign that uses AI Max. Chapter 14 covers why prices in orthodontic ads come with federal disclosure rules attached.
A starting list for an orthodontic practice:
- Term exclusions: superlatives the practice can't prove ("best," "#1," "top-rated"), "guarantee," the names of mail-order aligner brands, and "specialist" if any doctor in the practice isn't one (Chapter 15).
- Messaging restrictions: don't generate prices, discounts or monthly payments; don't promise a treatment length; don't promise evening or weekend appointments; don't compare the practice to other orthodontists.
URL Exclusions Keep Final URL Expansion Off the Blog, the Patient Portal and the Before-and-After Gallery.
The third AI Max behavior is the landing page. With AI Max on, final URL expansion is on too, and the Invisalign ad you pointed at the Invisalign page can open on whatever page of the site Google prefers for that search. It's the same behavior Chapter 10 fenced in for Performance Max, and it needs the same fence here.
The fence is a list of excluded addresses, which only works while both of those AI Max features stay switched on. Use the list you already built: the before-and-after gallery, the blog, the patient portal, bill pay, careers and any old promotion pages. Every treatment page from Chapter 4 stays in. Everything a new patient shouldn't land on from an ad stays out.
There's one more reason to keep that fence tight. Here's a detail buried in Google's help center: whenever the system swaps in a different landing page, any headline you pinned in place gets left out of that ad. Chapter 8 kept pinning for one job only: a line some state board requires in every orthodontic ad. With final URL expansion on, a pinned line can be dropped whenever Google swaps the page. If a campaign depends on pinned text, either keep final URL expansion off for it or put that required wording on every page Google is allowed to use.
Then watch it. Once a week for the first couple of months, open the generated assets and the landing pages Google chose, and read them the way a parent would. Remove any headline that isn't true today. Add a term exclusion or a restriction every time you catch one. AI Max learns from bookings. It won't learn your practice's rules unless you write them down.
An orthodontic practice that would rather have someone audit the site, write the guidelines and review AI Max's output every week can see what our Google Ads management includes.
Next, a Bonus Chapter: "$99 a Month" in a Braces Ad Brings Federal Disclosure Rules With It.
Chapter 12 covered the map and Local Services Ads. That completes the rollout. The bonus chapters start with the money question every orthodontic ad flirts with: what happens, legally, when an ad puts a monthly price on braces.
This chapter is part of Google Ads for Orthodontists, our sixteen-chapter guide for orthodontic practices anywhere in the US.
