Broken Dental Appointments & the 80/20 Rule: How 20% of Patients Cause 80% of Lost Revenue
- Russ Ledbetter
- Jan 20
- 4 min read
Updated: 5 days ago
What Is a Broken Appointment in a Dental Practice?
My definition of a broken appointment is one of two things:
A no-show
A cancellation with less than 24 hours’ notice
Broken appointments are a pernicious drain on a dental practice’s productivity. They quietly erode revenue, increase stress, and destabilize schedules—especially in the hygiene department.
Let’s look at the math.
The Real Cost of Broken Hygiene Appointments
If you have:
2 hygienists
3 broken appointments per day total
16 workdays per month
$175 average for a hygiene visit
Here’s what that actually costs:
Monthly loss: 3 × 16 × $175 = $8,400
Annual loss: $100,800
10-year loss: $1,080,000
Over the course of an average dental career, that can easily exceed $4 million in lost revenue.
Whether you are a fee-for-service urban practice or an insurance-based rural practice, the numbers change—but the problem does not.
Why Broken Appointments Create Stress (Not Just Lost Revenue)
It doesn’t matter what the schedule looks like at the beginning of the day. What matters is what it looks like at the end of the day.
Broken appointments:
Create last-minute chaos
Force teams into reactive mode
Frustrate practice owners
Lower morale
Waste overhead that is already paid for
Trying to fill same-day cancellations is stressful, inefficient, and often unsuccessful.
What Is the 80/20 Rule?
The 80/20 Rule, also known as the Pareto Principle, was identified by Vilfredo Pareto. He observed that 80% of outcomes tend to come from 20% of causes.
This pattern appears everywhere:
80% of wealth held by 20% of the population
80% of crime committed by 20% of offenders
80% of referrals coming from 20% of patients
And yes—this rule applies directly to dentistry.
How the 80/20 Rule Applies to Broken Dental Appointments
Here’s the critical insight: 80% of your broken appointments are caused by about 20% of your patients.
If your practice had 400 broken appointments last year:
That does not mean 400 patients missed one appointment
It means about 80 patients missed 320 appointments
These repeat offenders are what destroy schedules and profitability.
Every dental team knows exactly who they are. During the morning huddle, someone might say:
“They won’t be here.”
“She’s definitely not coming.”
“He’s 50/50.”
If that sounds familiar, the real question is: Why are those patients still being scheduled the same way?
Personal Perspective—It’s Not About “Good” or “Bad” Patients
I am over 60 years old and have never missed a dental appointment. My sister is also over 60—and she has missed dozens.
She isn’t irresponsible. I’m not superior. We simply have different personalities and priorities.
The solution is not judgment. The solution is policy and systems.
What Should a Practice Do With Repeat Offenders?
Here are your options, from most strict to most flexible:
Dismiss them from the practice
Require prepayment or a substantial deposit
Warn them that one more missed appointment means no rescheduling
Do not reschedule—place them on a quick-call list only
If hygiene is booked four months out, this approach might reduce it to three months. That does not hurt cash flow. But having patients actually show up absolutely increases profitability.
Why This Improves Profitability Immediately
Your hygienist is paid whether the patient shows up or not. Your overhead exists whether the chair is filled or empty.
The cost of hygiene supplies is minimal—which means: Recovered hygiene production is almost pure profit.
Make your schedule at the end of the day look like it did at the start of the day, and the financial impact is immediate.
How Many Broken Appointments Are Acceptable?
Eliminating broken appointments entirely is unrealistic. People will always prioritize:
Family emergencies
Severe illness
Work-related crises
Based on 36 years of consulting experience:
Target: 0.5 broken appointments per hygiene day
Never more than 0.75 per hygiene day
What Is a “Hygiene Day”?
A hygiene day is defined as:
One hygienist
One chair
Eight hours
Two hygienists working the same day = two hygiene days.
Step-by-Step Example for a practice with:
2 hygienists
16 workdays per month
Step 1: Calculate hygiene days
2 hygienists × 16 days = 32 hygiene days per month
Step 2: Apply the benchmark
32 hygiene days × 0.5 = 16 acceptable broken appointments per month
Rule of Thumb
For the above example:
Acceptable: Up to 16 per month
Warning zone: 17–20 per month
System problem: 20+ per month*
*At this point, broken appointments are not accidental—they are predictable and policy-driven.
Final Takeaway for Practice Owners
Broken appointments are not random. They are predictable, trackable, and manageable.
When you stop treating all patients the same—and start managing patterns of behavior—you can dramatically reduce lost revenue, stress, and chaos in your practice.
I hope this gives you insight into your business and helps you grow and prosper.
About the Author
Russ Ledbetter is a dental practice management consultant with Dental Consulting Experts, The Ledbetter Group, helping dentists increase production, reduce stress, and improve team accountability—without changing diagnosis or fees. Learn more about Russ and our Dental Practice Consulting.
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