Open Dental vs. Dentrix: An IT Perspective

Dental practice with modern computer setup

We get this question at least once a month: "Should I use Open Dental or Dentrix?" Usually it's asked in terms of features, cost, or what their dental school taught them to use. Valid considerations, all of them.

But as the IT company that has to install, maintain, secure, and troubleshoot these systems, we see things from a different angle. Here's what both platforms look like from the server room.

Dentrix: The Incumbent

Dentrix by Henry Schein is the most widely used dental PMS in the United States. It's been around since the early 90s. Most dental IT companies know it well, and most dental supply companies support it.

From an IT perspective:

Database: Dentrix uses a proprietary database engine. Backups require Dentrix-specific tools. You can't just back up the database files like you would with a standard SQL database.
Updates: Dentrix updates can be complex, sometimes requiring specific versions of other software (like Crystal Reports). They occasionally break integrations with imaging software or other tools.
Server requirements: Dentrix has specific hardware requirements that increase with each version. Server sizing needs to account for the number of workstations and the size of your database.
Security: Recent versions have improved, but historically Dentrix has had limited built-in security controls. User permissions are available but not granular enough for some HIPAA requirements.
Support: Henry Schein has a large support organization, but response times can vary. Tier 1 support handles basic issues; complex problems sometimes take multiple calls to resolve.
Cost: Higher upfront licensing costs. Annual support agreements are essentially mandatory.

Open Dental: The Challenger

Open Dental is, as the name suggests, open-source dental practice management software. It's been growing steadily and has a loyal user base, particularly among practices that value flexibility and cost control.

From an IT perspective:

Database: Open Dental uses MySQL, a widely-supported, open-source database. Backups are straightforward using standard MySQL tools. This makes disaster recovery simpler and more reliable.
Updates: Updates are generally smoother than Dentrix. The open-source nature means the development cycle is more transparent, and breaking changes are better communicated.
Server requirements: More flexible hardware requirements. Runs well on modest hardware. Can be hosted on Linux servers (though Windows is more common in dental environments).
Security: Good user permission controls. The MySQL database supports encryption at rest. The open-source codebase means security vulnerabilities, when found, are typically addressed quickly.
Support: Open Dental's support team is smaller but responsive. The community forums are active and helpful. Documentation is comprehensive.
Cost: Significantly lower licensing costs. The software itself is free; you pay for support and eServices.

What Matters for Security and Compliance

From a HIPAA compliance standpoint, both platforms can be configured to meet requirements. But there are differences:

Audit trails: Both offer them, but Open Dental's are more detailed out of the box.
Encryption: Both support encrypted connections. Open Dental's MySQL backend makes server-side encryption more straightforward.
Access controls: Open Dental has more granular permission settings, which makes it easier to implement least-privilege access.
Backup reliability: Open Dental wins here. Standard MySQL backups are well-understood and easy to verify. Dentrix's proprietary backup process introduces an additional point of failure.

Our Take

Both are capable systems. Both can serve your practice well. The decision should be based on your specific needs, your budget, and your team's comfort level.

From a pure IT management perspective, Open Dental is generally easier to maintain, backup, and secure. Dentrix has the advantage of ubiquity and a larger ecosystem of integrations.

What matters most is that whichever system you choose, it's properly configured, regularly updated, and securely backed up. A well-maintained Dentrix installation is more secure than a neglected Open Dental installation, and vice versa.

If you're considering switching, or if you want to make sure your current system is optimized, we're happy to walk through the specifics for your practice.