$6,000 a Month and No ROI: How This Dental Marketing Agency Failed Dr. Hugh Flax

Marketing is supposed to make the phone ring but that hasn’t been the case for Dr. Hugh Flax, who is a cosmetic dentist in Atlanta. Despite paying a marketing agency $6,000 a month, he hasn’t seen a return on investment.

David Meerman Scott, who’s been a friend of mine for years, brought me in to audit performance and advise on next steps. We’ve worked together on dozens of marketing reviews, especially when business owners are frustrated and want clarity.

Two people from the digital agency managing Dr. Hugh’s marketing were on the call, along with Dr. Hugh himself and Edi, the practice administrator at Flax Dental who has been tracking what’s actually coming in the door.

Everyone showed up with reports and data. The goal was to figure out whether this $6,000 a month is producing measurable results — or if it’s just a sunk cost.

The Search and SEO Disconnect

We didn’t have access to the Google Ads account or backend of the site. So we ran a third-party SEO audit — the same way we do for thousands of clients and agencies.

There’s no evidence of link building. No evidence of growth on keywords that matter.

No movement on “Atlanta cosmetic dentist,” “emergency dentist near me,” or other local intent terms that actually drive new patients. What little traffic there is, comes from people already searching for Dr. Hugh by name — reputation-based. It’s his Google Business Profile doing the work, not the website.

The digital agency rep said they’re targeting Sandy Springs while trying to build traction in Atlanta. I get it — SEO takes time. But if the numbers have been flat for a year, something’s not working.

We looked at the backlinks. Mostly low-quality directories. A few spam links. Nothing from real dental organizations or trusted sources. The agency’s head of marketing (who was on the call) said they don’t focus on link building because it’s PR-driven.

Link building is not about PR.

Real link building means EEAT — Expertise, Experience, Authority, Trust or real links from other credible folks in dentistry. Google wants to see real-world signals of credibility.

We coach a lot of agencies that are verticalized — like personal injury attorneys — and they build legit links between each other. It’s also a part of the geo-vertical grid strategy: same niche, different cities, linking across markets in a way that builds authority and trust. That’s what Google rewards.

Take my buddy Caleb Guilliams — he’s a financial advisor who sells life insurance and started from scratch.

He built a podcast interviewing the top names in the industry. Those interviews turned into articles, books, and conferences. Now those same experts link to him. It’s driving him millions of dollars in business.

That’s what moves the needle. That’s what builds authority.

Same with Kim D.H. Butler. She also sells life insurance.

One of her best-performing keywords is “what do rich people do?” Think about it — if you just inherited money or sold your company, you’re probably looking for a wealth advisor to help you pay less in taxes, right? She ranks #1 on that term. It drives a ton of traffic — and it’s all high-intent.

And for Dr. Hugh — except for “Atlanta dentist” — all the other terms are pretty much dead, and very low KD keywords.

For Dr. Hugh, we need the same thing — content and links that show he’s a real dentist doing real work in Sandy Springs and Atlanta.

So if you think of the geo-category grid. You’ve got all the different business types: real estate agent, lawyer, landscaper — like yellow page headings. And then you’ve got all the different cities: LA, Denver, Vegas, Boston.

Dr. Hugh only wants to win in that one cross section. That’s his target. This is exactly what Google looks at when applying EEAT.

My friend is head of search quality at Google — he’s an engineer there. I’m a former search engine engineer myself. I built the analytics at Yahoo almost 30 years ago, so I know how this works.

What Google’s trying to see is whether there’s relevance — in Sandy Springs or in dental.

So how does that work? Anyone in dental — if he’s associated with them — that boosts his authority in dental.

Anyone in Sandy Springs — even if it’s a different kind of business, or a friend who’s a soccer coach — that builds relevance in Sandy Springs.

The combination of those establishes him as a dentist in Sandy Springs.

Not directory spam. Not keyword-stuffed fluff. Real connections. Real patients. Real results.

No Pages, No Power, No ROI

Let’s set the link building aside for a minute. That’s not even the core issue here.

There are two components in the monthly contract — one at around $1,000, and another at $800 for the second location.

Anyone who does websites knows this — for a local dentist, we’re trying to build more power on the location service pages.

But as far as I can tell, we don’t seem to have the location pages that send the right signals for Sandy Springs.

Or for other nearby areas.

When a page like “Emergency Dentistry in Sandy Springs” is built the right way, it shows up in local search. But the page we see has no EEAT — no expertise, no experience, no authority, no trust.

Just so we’re clear — this isn’t me saying it. Google lays it all out in their 180-page Quality Rater Guidelines.

Google added an extra E for “Experience.” They want proof that the content was created by someone who’s actually done the work. Real dentists. Real cases. Real photos. Real videos. Not keyword-stuffed FAQs.

I ran a service page through our Article Grader tool to audit if there was any evidence of EEAT at all.

You could use Google’s guidelines, too. You don’t have to use our tool.

The content on the page got a “D” grade.

We then looked at the on-page SEO metrics in Ahrefs — nothing coming in. No backlinks. So the URL power is basically a one.

And the site itself doesn’t have much authority either, so there’s not much to push with internal linking anyway. Right?

So if we want to rank for emergency dentistry in Sandy Springs, this page isn’t going to do it. It’s missing the basics. It violates a lot of Google’s standards.

You’re not linking to the GMB. You’re not including real examples, pictures, or videos. What you’ve got is basically PAA content — just keyword-stuffed FAQs.

The digital agency rep said they’d been working on blog posts and service page content as part of the monthly hours. I asked two questions:

• Are those pages following Google’s standards?
• Are they driving traffic or new patients?

The reps of the digital agency said that this was a dental marketing program, not a full SEO program. They benchmarked search terms and started with no rankings in Atlanta or Sandy Springs, and that there’s been progress.

However, our concern was that the numbers had been flat over the past year.

They argued saying they’re now in the top 10 for terms like “emergency dentistry.”

But small keyword movements don’t equal growth. The overall traffic trend is flat. When we look at the data in Google Analytics or Search Console, any ranked content isn’t producing traffic.

You can rank 40th on a no-volume keyword. That doesn’t make the phone ring.

This isn’t about dashboards and reports. It’s about ROI. Is the money turning into patients? Because right now, it’s not.

Flatlined Performance, But They Still Sent the Bill

The digital agency rep said they paused most of the campaigns because Dr. Hugh stopped paying invoices. They’re two months behind.

But Dr. Hugh had stopped paying because the results never came. “I feel like I have handcuffs. I have no control over my marketing right now. That’s the bottom line,” he said.

The agency brought up weekly calls, responsive emails, and a formal cancellation process. They claimed they did everything they could and even offered to keep going at cost.

But when we asked them to show revenue tied to marketing, they had nothing. “If that were the case,” Dr. Hugh said, “I’d be busting at the seams. I don’t see it in my bank account. I don’t see it in my chairs. Thank God I get referrals and have a reputation — otherwise I’d be completely broke right now.”

The agency pointed to $30,000 and $60,000 cases in the ROI report. Dr. Hugh said those came from referrals.

David Meerman Scott stepped in: “Somebody like Dr. Hugh would be really silly to cancel an agreement with someone who’s bringing in substantial ROI. From his perspective, that’s not happening.”

The agency claimed leads were coming in, phones were ringing, and forms were getting filled.

They mentioned that the account had generated 520 calls and form submissions over the past 12 months, and referenced internal reports showing plan revenue figures by month, including: $67,000 in April, $18,000 in March, $54,000 in February, and $36,000 before that.

David ran the math — those numbers didn’t justify spending $6,000 a month.

The agency said they generated close to a $100,000 in total production revenue. Dr. Hugh disagreed. “We remember the big cases,” Dr. Hugh said. “It takes a lot to hit $100K, and we’re not seeing it.”

“We wouldn’t even be having this conversation if that were true. We’d be talking about how to recreate it and double it.”

What We Found in the Lead Export Was Alarming

After reviewing the lead export from the agency, we found serious problems.

The tracking was completely off. We couldn’t find a single valid entry that tied to actual production. The names and dollar values looked impressive on the agency’s dashboard — but when we checked Flax Dental’s systems, most of those patients didn’t exist.

Over half of the leads were unreachable. They didn’t answer calls, respond to emails, or follow up. Many of them were just not viable prospects: people looking for Medicaid providers, in-network dentists, or budget services well outside of the premium offerings Dr. Hugh provides. Others were outside the geographic area.

One lead was supposedly worth thousands of dollars — but the patient name wasn’t even in the system. A closer look revealed multiple leads that were either nonsensical or placeholders, with no phone activity or appointment logs.

Google Ads Misfire: Low Quality Scores, Broken Structure, No Lift

We logged into the Google Ads account to review performance. We asked the agency to pull the last six months of keyword data and sort by clicks. The top-spending terms were Exact Match keywords like “dentist near me,” “Atlanta dentist,” and “cosmetic dentist.”

These keywords showed quality scores as low as 1 and 2. According to Google’s ad rank formula—bid x quality score.

Google penalizes keywords with scores under 4 by making them more expensive to run, often requiring 3–4x the budget to achieve the same ranking. The campaign structure was too shallow—grouping head terms into limited ad groups with no clear alignment between search intent, ad copy, and landing pages.

Here’s what was missing:

• Ad groups weren’t tightly themed around specific services like “veneers,” “emergency dentistry,” or “cosmetic implants”
• Landing pages lacked keyword alignment and did not reflect strong relevance or EEAT signals
• Quality score optimization focused only on bid adjustments, not creative or structure

The agency said they used a bid management system called Acquisio. Most recent changes in the account were automated bid adjustments. There were no visible changes to ads, ad groups, or landing pages in the Google Ads change history.

The account contained 129 keywords, though many were paused. Only two campaigns were active: cosmetic and general dentist. They explained that they used “Exact Match” settings for the ads “Match type” to avoid irrelevant traffic.

Exact Match is not the issue. Low scores typically stem from poor alignment between keyword, ad copy, and landing page.

We discussed the need for more granular ad group structures. Google rewards specificity with higher scores, lower cost-per-clicks, and better visibility. The agency reps said they optimized landing pages outside the ad platform. I explained that those updates would still influence quality scores if Google re-scores the page.

The agency confirmed the team had focused on Atlanta as requested, despite initially recommending Sandy Springs for faster traction. That shift likely delayed traction, given the competitive nature of the Atlanta market.

Misalignment Between Calls and Target Market

520 calls and form submissions came in over the course of a year. The problem? They didn’t convert into meaningful business. Most of them didn’t match Dr. Hugh’s ideal patient profile.

Edi reviewed the calls. Many came from outside the geographic target. Others were low-intent inquiries—wrong income bracket, wrong needs, wrong services. She had folders of leads that never turned into cases. The frustration wasn’t just that the calls didn’t convert—it was that they weren’t the right calls to begin with.

Early on, they’d defined the ideal patient: high-value cosmetic cases from the Atlanta and Sandy Springs area.

The agency had run an email campaign that failed to generate any leads or calls. During the same time, Dr Hugh used a third-party to run a Facebook campaign, which attracted traffic from Alabama and other unrelated regions. Some calls were for dentures and budget dentistry—far from the premium service Dr. Hugh offers.

Key points:

• The 520 leads were tracked and reviewed manually
• Very few aligned with the agreed-upon target patient profile
• The team had communicated expectations early on but still received off-target traffic
• Some leads were clearly misrouted from outside the intended area

When results aren’t showing up in the chair, we automatically question the source of the leads. A high lead count doesn’t matter if the leads aren’t qualified.

Dr. Hugh said he wanted out, and the agency confirmed they would proceed with cancellation. They offered to send over all remaining data, transfer website ownership, and export lead information into a spreadsheet—but only after Dr. Hugh paid what they claimed were outstanding invoices. This demand was questionable, given the agency had largely stopped optimizing campaigns and had paused nearly all activity over the past two months.

Dr. Hugh also wanted clarity on the claim that the program generated $100,000 in production. He requested the names tied to those cases, and the agency agreed to send them the next day.

As part of the offboarding, Dr. Hugh would receive all assets and data, including site files, PPC call records, and the case details linked to the reported revenue.

Both sides agreed the relationship had run its course. Nobody wins when marketing becomes a source of stress. It was time to reset and build a system that actually aligned with the business goals.

Time to Cut Ties: Rebuilding from a Failed Collaboration

Even if you’re not an SEO or PPC expert, you could tell from the Google ads account history that it hadn’t been actively managed. Anyone could see it.

Here’s what we decided next:

• Copy the website before any access gets shut down.
• Change the GoDaddy password to lock down domain control.
• Send a demand letter asking for a refund or reduction based on poor performance.

So we’re going to send a demand letter that states all the main facts. 

If the agency plays hardball, we have the data to publish an audit showing what was done (or not done) and why it didn’t meet Google’s standards.

We also plan to:

• Spin up a new Google Ads account from scratch, ignoring the one with a broken structure.
• Prioritize Local Service Ads (LSAs), since they’re lower cost and higher intent.
• Rebuild the website properly, without recycled content or weak service pages.
• Keep moving forward with thought leadership content to build real EEAT authority.

If You’re Feeling Trapped, Take Back Control

If you’re a local business owner stuck in a marketing contract that isn’t delivering, you’re not alone. You don’t need to wait until your bank account tells the story. You can audit your ad account, grade your content against Google’s standards, and see for yourself if your marketing is working.

If it’s not, walk away. You own your brand. You deserve transparency. You don’t have to keep paying for excuses.

Reach out to us and we’ll show you how to take control of your assets, rebuild your system, and make the phone ring again.