Dentrix vs Open Dental
From an IT Perspective
Not a sales pitch for either. A practical look at what each system means for your infrastructure, your support costs, and your IT team's daily life.
Dentrix and Open Dental are two of the most widely used dental practice management systems in the United States. Clinical staff have strong opinions about each. This guide ignores all of that. We are not going to evaluate treatment planning workflows, charting interfaces, or which system dentists prefer to use. Those questions belong to your clinical team.
What we will cover is the IT reality of each system: what it costs to run, how licensing works, what hardware it needs, how updates are managed, how good the vendor support is when something breaks, what integrations look like, and how painful it is to migrate to or from each platform. If you are a practice owner trying to understand the infrastructure implications of a software decision, this is the guide for that.
Siotek supports both systems in active production environments. We have no financial relationship with Henry Schein Dental (Dentrix) or Open Dental Software. Our assessment is based on what we see in the field.
The IT Comparison
| Area | Dentrix | Open Dental |
|---|---|---|
| Licensing model | Proprietary, per-seat or per-location. Annual support contract required for updates and tech support. | Open-source base; paid monthly support plan for phone support and updates. Self-support possible for technically capable offices. |
| Typical annual software cost | $2,000–$6,000+/year depending on module selection and seat count. Higher for full feature set. | $150–$300/month for the support plan, or ~$2,000–$3,600/year. Free if self-supported (most practices pay for support). |
| Server requirements | Windows Server required for the database tier. Specific SQL Server version requirements. Well-documented hardware minimum specs. | Uses MySQL. Can run on Windows Server or even a workstation for small practices. More flexible hardware requirements. |
| Update / upgrade experience | Structured annual releases with service packs. IT should test updates in a staging environment before production. Major version upgrades can require database migration steps. | Frequent releases (sometimes monthly). Open-source means updates are transparent. IT can review change logs. Update path is generally clean but more frequent than Dentrix. |
| Vendor tech support quality | Henry Schein Dental support is large and well-staffed. Response times vary. Complex issues escalate well. Integration with imaging vendors (Schick, Dexis) is deep. | Open Dental support team is smaller but highly responsive on paid plans. Community forums are surprisingly active and technically detailed. |
| Imaging integrations | Deep native integrations with Schick CDR, Dexis, DEXIS, Carestream. Bridge configuration is well-documented and widely deployed. | Supports all major imaging systems via bridge. Configuration occasionally requires more manual setup. Community has extensive documentation for most bridges. |
| Third-party ecosystem | Large vendor ecosystem built around Dentrix. Clearinghouses, patient communication tools, and billing software often list Dentrix integration first. | Growing ecosystem. Most major clearinghouses and patient communication platforms support Open Dental. Smaller selection of specialty integrations. |
| Backup complexity | SQL Server database requires application-consistent backup (VSS-aware or SQL Agent jobs). File-level backup alone is insufficient. | MySQL database. mysqldump or VSS-aware backup tools work well. Open Dental's built-in backup tool is functional for small practices. |
| Migration complexity | Henry Schein handles data conversion for practices migrating to Dentrix. Migrating away from Dentrix requires third-party conversion tools or vendor assistance. | Open Dental can import from most competing systems. Open-source database means data is accessible — migrating away is less restricted than proprietary systems. |
The Details That Matter
Cost
The sticker price difference between Dentrix and Open Dental is real but smaller than most people expect. Dentrix's licensing structure means you pay more upfront and annually, but you also get a more structured vendor relationship and a larger integration ecosystem. Open Dental's lower software cost is sometimes offset by the need for more IT-side configuration — particularly for imaging bridges and custom reports.
For practices where budget is the primary constraint, Open Dental's cost structure is genuinely lower. For practices where integration ecosystem breadth is the priority — particularly if you are running Schick or Dexis with plans to add more imaging devices — Dentrix's native integrations may be worth the premium.
Infrastructure requirements
Dentrix's SQL Server dependency means your server needs a valid SQL Server license, which adds cost. SQL Server Express (free tier) has a 10GB database size limit — adequate for smaller practices, problematic for larger ones. Full SQL Server licensing is not cheap. Open Dental's MySQL backend is free and open-source, with no database size restriction at the software level.
In practice, both systems need a dedicated server for anything beyond a two-operatory practice. The difference is that Open Dental can run acceptably on slightly lower-spec hardware. Neither system is forgiving if you undersize storage IOPS — both are database-heavy applications with imaging data flowing through them.
Updates
Dentrix's structured annual release cadence is predictable, which is an IT advantage. You can schedule updates, test them, and communicate them to staff in advance. The tradeoff is that you may wait for bug fixes until the next service pack. Open Dental's frequent release cycle means bug fixes arrive faster, but it also means your update cadence requires more active management. We typically recommend Open Dental practices update quarterly rather than chasing every release.
Data portability
This is the area where Open Dental has a meaningful structural advantage. Because the database schema is open and documented, your data is yours in a way that proprietary systems do not guarantee. Migrating away from Open Dental is primarily a data conversion project. Migrating away from Dentrix requires either vendor cooperation or a third-party conversion tool — and those tools vary in fidelity. If long-term data portability matters to you, Open Dental's open-source architecture is a genuine differentiator.
Vendor support comparison
Dentrix benefits from Henry Schein's scale. Their support team is large, widely distributed, and handles high call volume reasonably well. For practices using Schick sensors, the integrated Henry Schein ecosystem means one vendor handles both the PM software and the imaging hardware — which simplifies escalation significantly.
Open Dental's support is smaller but, in our experience, technically stronger at the individual level. When you get an Open Dental support engineer on the phone for a complex issue, they usually know the code. The community forum is unusually detailed and is often the fastest path to a solution for non-urgent issues.
Who Each System Is Best For
- Practices using Schick CDR or Dexis where the native Henry Schein integration matters
- DSOs that want the largest third-party vendor ecosystem
- Practices where the IT team prefers a structured, predictable update cadence
- Groups planning to use Dentrix Ascend as a cloud migration path
- Practices where cost is a primary constraint
- Practices that value data portability and want to avoid vendor lock-in
- Technically sophisticated practices or those with an MSP comfortable with MySQL
- Groups interested in custom reporting or database-level integrations that require open access
Neither system is inherently superior from an IT perspective. Both are mature, widely deployed, and well-understood by dental IT specialists. The choice between them should be driven primarily by your clinical team's workflow preferences and your integration requirements — not by IT considerations alone. From an IT standpoint, we can run either one well.
What we do recommend strongly is that whichever system you choose, you work with an IT provider who has deployed it before — not one who will figure out the SQL Server configuration or the MySQL backup schedule after you have already gone live.