A paper chart works until the patient sees a second dentist. Then the handwriting, the abbreviations and the missing dates turn a five-minute review into a phone call. A digital chart fixes the legibility, but a good one does more than that: it connects what the dentist sees to what the patient is offered, what they agree to and what they’re billed.
This guide looks at what a digital dental chart should record and how it fits with treatment plans, orthodontic records and prescriptions.
Record on the tooth, with history
The core of a dental chart is simple: for each tooth, what’s wrong, what was planned and what was done, with dates and who did it. A digital chart should let you:
- Record diagnoses on a tooth (caries, fracture, periapical lesion).
- Record procedures done (filling, root canal, crown), with the dentist and date.
- See the history of each tooth, so the next dentist knows what was done and when.
- Keep the patient’s medical history (diseases, allergies, medications) visible on the file, not on a separate sheet.
The best test is to open a returning patient’s file and answer “what happened to the lower left first molar?” in under ten seconds.
In BeClarified, diagnoses, diseases and procedures are recorded per tooth with full history in the patient file. See clinical records.
From findings to a treatment plan
A list of problems isn’t a plan. A good treatment plan groups the work into phases, puts a price on each item and is something the patient can agree to.
Phases. Urgent work first (pain, infection), then disease control (fillings, scaling), then restorative and cosmetic work. Phasing helps the patient understand the order, and helps them budget.
Prices. Each item comes from your price list, so the plan shows the total and the cost of each phase. If the patient has insurance, the plan is also where a pre-approval request starts. See dental insurance claims.
Approval. The patient agrees to the plan, or to part of it. With BeClarified, patients can review and approve their plan in the patient app, so the agreement is recorded rather than remembered.
Plans that become invoices
Here’s where digital charting pays for itself. When a step in an approved plan is completed, it should flow into the patient’s account: no retyping, no forgotten items.
BeClarified’s treatment plans are priced and phased, and completed steps flow straight into billing. Lab orders can be attached to the plan, so you see what a case really cost. That’s covered in managing dental lab accounts.
It also helps with follow-up. A patient with an approved plan and an unfinished next step is easy to find and call back.
The orthodontic record
Orthodontic cases need more than a tooth chart. They need a structured record that every dentist on the case reads the same way:
- A short case summary, for example “Class II div 1 with crowding; non-extraction plan with expansion”.
- History and motivation: past extractions, what the patient wants and why.
- Examination: midline, teeth present, findings on the panoramic X-ray.
- Analysis, such as space analysis from the casts.
- Problems list and the treatment plan, including what happens before bonding.
- Retention plan.
- Steps in the order you plan them, ticked off as each is done.
In BeClarified, the orthodontic record has its own tab in the patient file, and the case summary feeds the patient list’s filters, so you can find every Class II case in a click. Editing it needs the orthodontics permission, while others on the team can read it.
Prescriptions without handwriting
Prescriptions are part of the chart too. A printed prescription with your clinic’s name, address and logo is easier to read at the pharmacy and easier to find in the file later.
BeClarified also lets you share a prescription with the patient by link or QR code. The patient opens it on their phone and downloads it, without signing in.
Images in the same file
X-rays and intraoral photos belong next to the chart, not in a separate program. When you’re looking at tooth 36’s history, you want its X-rays one click away. We cover this in detail in dental X-ray and imaging software.
Making the switch from paper
You don’t have to digitise old charts all at once. Start with every new visit from day one. When a returning patient comes in, summarise their relevant history into the digital chart (existing restorations, missing teeth, medical alerts) and scan anything you need to keep. Within a few months, your active patients are fully digital.
Frequently asked questions
Do dentists find digital charting slower? For the first week, sometimes. After that, most find it faster, because they’re not rewriting history and the plan becomes the invoice without extra steps.
Can assistants record on the chart? That’s a role decision. In BeClarified, permissions decide who can view, record and edit clinical data.
Can patients see their chart? Patients see their appointments, invoices, balance and treatment plans in the app. The detailed clinical chart stays with the clinic.
What about perio charting? BeClarified records diagnoses and procedures per tooth. Full periodontal pocket charting isn’t part of it today. If you need it, record findings as diagnoses and keep the dedicated chart as an attachment.