Second opinion on a periodontal plan Patient guide

A second opinion is a separate evaluation of the diagnosis and plan by another periodontist, built on copies of the first office's x-rays, chart and coded plan. Under HIPAA, a provider must act on a request for records no later than 30 days after receiving it.

Smiling woman relaxing on a beige couch, photo for Second opinion on a periodontal plan

When should I get a second opinion?

Consider a second opinion when a plan proposes surgery, extractions or implants, when the chart gives no stage and grade, or when the estimate is large.

Surgery before a re-evaluation: the EFP guideline considers surgery for sites that stay deep after cleaning below the gumline, at a re-evaluation after healing.
Extractions in a patient on bone drugs: the ADA links MRONJ mostly to extractions and other bone surgery.
No stage and grade: the 2017 classification defines periodontitis in each patient by a stage and a grade.
A request from the dental plan: the ADA Code says the dentist giving a second opinion at a plan's request should have no vested interest in the recommendation.
Conflicting advice from two offices.

The ADA Code also calls recommending or performing unnecessary services unethical. Seeking consultation is part of the ADA Code: dentists are obliged to seek consultation when it will safeguard or advance the patient's welfare. Questions to ask.

What should I bring to a second opinion?

Bring copies of the x-rays, the periodontal chart and the written plan with its codes and fees.

X-rays and any CBCT scan, as digital files when possible, with the dates taken.
The periodontal chart: pocket depths, bleeding, recession, mobility and furcation.
The treatment plan with CDT codes, fees and any insurance predetermination.
A list of medications and supplements, and the medical history.
The referral note, if there is one.

A Florida dental record must contain patient histories, x-rays if taken, examination and test results, drugs prescribed or given, reports of consultations or referrals, and each treatment with its date. Dated x-rays help the second office decide whether new images are needed, since the ADA calls for imaging only when there is a clear clinical benefit. Ohio State's periodontics clinic, for example, takes new x-rays unless acceptable ones arrive with the patient. Treatment codes.

What does HIPAA say about getting my dental records?

HIPAA gives patients a right to inspect and obtain a copy of their health information in a provider's designated record set, under 45 CFR 164.524 of the HIPAA Privacy Rule.

Deadline: the provider must act on the request no later than 30 days after receiving it.
Extension: the provider may extend once by no more than 30 days, with a written statement of the reason and the completion date.
Fee: a reasonable, cost-based fee covering only labor for copying, supplies, postage and any summary the patient agrees to.
Format: the provider must supply the form and format requested when it is readily producible.
Third party: a signed written request can direct the copy to another person, such as a second periodontist.
Writing: a provider may require the request in writing if it tells patients so.

The regulation text is published in the Electronic Code of Federal Regulations at ecfr.gov. Referrals and records.

What does Florida law add for dental records?

Florida rule requires a dentist to furnish copies of all reports and records of an exam or treatment, including x-rays, when the patient asks. Florida Administrative Code Rule 64B5-17.009 sets the terms.

Timing: timely means less than 30 days, unless circumstances beyond the dentist's control intervene.
Unpaid bills: copies may not be held back because a fee is unpaid or disputed.
Fees: per-page copy charges may not exceed what the Clerk of the County Court charges where the dentist practices.
X-ray copies: the fee may not exceed the actual cost of duplication.

A Florida dentist keeps each patient's record for at least 4 years from the last exam or treatment. Florida Statute 456.057 requires copies, including X rays, to be furnished in a timely manner without delays for legal review. The ADA Code applies the same duty whether or not the account is paid in full. Paying for treatment.

How does a second opinion visit work?

A second-opinion visit is a new evaluation: the second periodontist reviews the records, examines and charts the mouth, and gives a diagnosis and plan.

Codes: D0180 is a comprehensive periodontal evaluation, and D9310 is a consultation by a dentist other than the one who requested it.
Coverage: ask the dental plan whether it pays for a second evaluation before booking.
Comparison: ask both offices for the stage, grade and pocket depths at the same teeth.
Choice: Delta Dental states that which specialist a patient visits is up to the patient.

SDCEP guidance calls clinical attachment level, which combines pocket depth and recession, the best measure of change in periodontal support over time. Probing depth gives a good short-term read of the response to treatment. Comparing those readings tooth by tooth shows whether the charts agree. How to check credentials.

Questions

Do I own my dental x-rays?

In Florida, the dental records belong to the owner dentist of the practice where the patient was seen, under Florida Administrative Code Rule 64B5-17.002. The patient has the right to copies. Florida rule requires a dentist to furnish copies of records, including x-rays, on request, and the x-ray copy fee cannot exceed the actual cost of duplication.

Is it rude to ask for a second opinion?

Consultation is built into dental ethics. The ADA Code of Ethics obliges dentists to seek consultation, where possible, whenever it will safeguard or advance the patient's welfare. Florida rule and HIPAA both give patients the right to copies of their records, including x-rays, to take to another dentist.

Will the second office take new x-rays?

Some offices accept recent outside x-rays. Ohio State's periodontics clinic takes x-rays at the first visit unless the dentist has sent acceptable ones or the patient brings them. ADA guidance calls for imaging only when there is a clear clinical benefit that outweighs the radiation risk. Bring dated copies, and ask whether they are recent enough.

What if two periodontists disagree?

Ask each office to explain the stage, grade and pocket readings behind its plan, tooth by tooth. The 2017 classification sets the stage from clinical attachment loss first, and from bone loss on x-rays when attachment loss is not available. The EFP guideline treats periodontitis in steps, so ask whether cleaning and a re-evaluation could come before any surgery.

Can I get my dental records electronically?

Yes, when the office can produce them that way. Under HIPAA, a provider must give access in the form and format the patient requests if it is readily producible. Florida rule allows dentists to keep records electronically if the office keeps a backup copy updated at least every 72 hours.

Sources

Reviewed by Steve Schadt, Director of IT and Medical Compliance: 25 years in dentistry, medicine and HIPAA compliance. Updated 2026-10-02. Checked against the sources listed. General information, not medical advice.

Patient guide Read next

First periodontist visit step by stepA first periodontist visit moves through a medical and medication review, an exam, a full periodontal chart, x-rays, a diagnosis by stage and grade, and a written treatment plan with a cost estimate.

How long periodontal treatment takesPeriodontal treatment time runs from a single deep-cleaning visit to many months when extraction, bone grafting and an implant are staged.

Sedation for gum and implant surgeryGum and implant surgery is done under local anesthesia, alone or with nitrous oxide, oral sedation, IV moderate sedation or general anesthesia.

Preparing for gum or implant surgeryPreparing for gum or implant surgery means a medication review with the prescribing physician, antibiotics only for patients who meet heart or joint criteria, fasting when sedation is planned, a ride home and soft food at home.

Questions to ask a periodontistPatients can ask a periodontist about training, the diagnosis, treatment options, time and visits, cost and insurance, sedation and aftercare before agreeing to a plan.

Treatment codes on a periodontal planThe codes on a periodontal treatment plan are CDT codes, the HIPAA standard code set for dental records and claims, published by the American Dental Association.