Six Steps to a Paperless Dental Practice

Lorne Lavine, DMD


There is no doubt that the modern dental practice has changed rapidly over the past 20 years. Dentists have come to realize that with new technology, they can create a practice that is more efficient, costs less to run, and allows for decentralization of the front office.

Most offices realize that there will always be paper in a dental practice. Whether it’s walkout statements, insurance forms, or printed copies of images, paper will forever be part of the dental practice.

That being said, there are a number of practices that have truly eliminated their paper charts. While the process is easier for a startup practice, with proper planning, existing practices can achieve this goal as well. 

The challenge for most offices is to develop the best plan on how to evaluate their current and future purchases to ensure that all the systems will integrate properly together. I have therefore developed a 6-point checklist for dentists who are adding new technologies to their office, and each step should be completed in order.

Practice Management Software 

It all starts with the administrative software that is running the practice. To develop a chartless practice, this software must be capable of some very basic functions. Offices that want to eliminate paper will need to consider every paper component of the dental chart and try to find a digital alternative. 

It’s also important to understand that as much as we would all prefer that our practice management software programs can handle all of these functions, most fall short. Fortunately, there are third-party programs that can provide functionality where practice management programs cannot.

Image Management Software

This is probably the most challenging decision for any office. Most practice management programs will offer an image management module: Eaglesoft has Advanced Imaging, Dentrix has Dexis, Carestream Dental has CS Imaging Version 7, and so on. These modules are tightly integrated with the practice management software and will tend to work best with digital systems sold by the company. 

However, there are also many third-party image programs that will bridge very easily to the practice management software and offer more flexibility and choices, although with slightly less integration. Some of the better known third-party image programs include Apteryx’s XRayVision and XDR’s Dental Imaging Software.

Operatory Design

The days of a single intraoral camera and a TV in the upper corner are being replaced by more modern systems. Most offices are placing 2 monitors in the operatories: one for the patient to view images, patient education, or entertainment, and one for the dentist and staff to use for charting, treatment planning, and sensitive information, such as the daily schedule or other data that you would prefer that the patient not see. 

There are numerous ergonomic issues that must be addressed when placing the monitors, keyboards, and mice. For example, a keyboard that is placed in a position that requires dentists to twist their back around will cause problems, as will an improperly positioned monitor. 

Computer Hardware

After the software has been chosen and the operatories designed, it’s time to add the computers. Most offices will require a dedicated server to protect their data and provide the necessary horsepower to run the network. The server is the lifeblood of any network, and it’s important to design a server that is bulletproof, has redundancy built-in for the rare times that a hard drive might crash, and can easily be restored. 

The workstations must be configured to handle the higher graphical needs of the office, especially if the office is considering digital imaging. Most dental software programs will work on the Windows 10 operating system. I recommend Windows 10 Professional in the office. 

Digital Systems

The choice of image software will dictate which systems are compatible. Digital radiography is pretty much the standard in dental offices. For those that can afford it, cone-beam 3-D systems are all the rage. All systems have pros and cons, and dentists will have to evaluate each system based on a set of standards that are important to that practice.

For some dentists, it might be image quality. For others, it may be the cost of the systems, the warranty of the sensor, the company’s reputation, or the compatibility of the sensors with their existing image management software. Keep in mind that intraoral cameras are still an excellent addition to any office since they allow patients to see the things that typically only a practitioner could see. 

Data Protection

With a chartless practice, data protection is absolutely crucial to prevent data loss due to malware or user errors. Every office, at a minimum, should be using antivirus software to protect against the multitude of known viruses and worms and a firewall to protect against hackers who try to infiltrate the network. 

Also, every office should have an easy-to-verify backup protocol in place to be able to recover from any disaster. Online backup is now a reality and a very viable option for many practices that want a true set-it-and-forget-it system for their daily backup. 

Your Turn

For offices that wish to be chartless or paperless, it’s crucial to evaluate all the systems that need to be replaced with a digital counterpart and to take a systematic approach to adding these new systems to the practice. Most offices would be well advised to replace one system at a time and get comfortable with each one before adding new technologies to the practice. The typical practice will take 6 to 18 months to transition from a paper-based office to a chartless one, but the journey will be well worth the reward at the end.

Dr. Lavine, founder and president of The Digital Dentist, has more than 30 years invested in the dental and dental technology fields. A graduate of the University of Southern California, he earned his DMD from Boston University and completed his residency at the Eastman Dental Center in Rochester, NY. He received his specialty training at the University of Washington and went into private practice in Vermont until moving to California in 2002 to establish The Digital Dentist, a company that focuses on the specialized technological needs and HIPAA compliance for the dental community. He can be reached at

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