Module 4: Clinical Charting and Treatment Plans

Everything the clinical team enters in Open Dental does double duty. A procedure charted in the Chart module is part of the patient's clinical record, but it is also the raw material for the treatment plan, the appointment, the insurance claim, the ledger, and the production report. When charting is precise, all of those downstream steps work almost automatically. When it is sloppy (wrong status, wrong surface, wrong provider), the front office spends its week cleaning up after it.

This module covers the Chart module and the Treatment Plan module: the tooth chart, procedure statuses, entering existing and planned treatment, completing work and writing progress notes, building and presenting multiple treatment plans, planned appointments, perio charting, and imaging. It is about using the software, not clinical decision-making. Nothing here is clinical advice, and charting conventions should follow your dentists' judgment, your state's record-keeping rules, and your office's written protocols. As with every module in this independent course, practice in the trial demo database or a test copy (see Module 1).

Key takeaways

Procedure status is the most important choice in the chart. Treatment Planned feeds the treatment plan, Complete posts to the patient's account, and existing statuses record history without billing it.
Configure procedure buttons, auto codes, procedure code defaults, and auto notes before go-live. They are what make charting fast and consistent.
A patient has one active treatment plan, any number of inactive plans for alternatives, and saved plans that serve as a permanent, signable record of what was presented.
Planned appointments are the bridge between a treatment plan and the schedule. If a plan has no planned appointment, the front desk has nothing to track.
Decide early whether you will capture images in Open Dental's own Imaging module or bridge to third-party imaging software, and set up image categories either way.

The Chart module layout

Select a patient and click Chart in the module bar. The main areas are:

The Graphical Tooth Chart. Click a tooth or tooth number to select it, click again to deselect, or click and drag to select several. Colors reflect procedure status (treatment planned, complete, existing by the current provider, existing by another provider, referred, and conditions), and those colors are set in Setup > Definitions under Chart Graphic Colors. A larger version, the Big Graphical Tooth Chart, is available from a dropdown.
Tabs beside the chart, including Enter Treatment (charting procedures), Missing/Primary Teeth, Movements, Planned Appts, Show (chart view filters), and Draw.
The progress notes grid, listing procedures and, depending on your view settings, appointments, commlogs, tasks, emails, lab cases, prescriptions, and completed forms.
Image tabs for image categories marked to show in the Chart module, so clinicians can glance at recent radiographs without switching modules.
A Perio Chart button that opens the perio charting window.

Tooth numbering

Open Dental supports four tooth nomenclatures, set in Preferences: Universal (the US standard, 1 to 32 for permanent teeth and A to T for primary), FDI (11 to 48 and 51 to 85), Haderup, and Palmer. US practices almost always use Universal. Set it once before anyone charts.

Chart views

The Show tab controls what appears in the progress notes grid: procedures by status (treatment planned, completed, existing, referred, conditions), procedure notes, notes for selected teeth only, other items such as appointments and commlogs, and a date filter. You can save combinations as named chart views; the first view in the list becomes the default. Build a small set: a "Today" view for chairside work, a "Clinical history" view with notes, and a "Full" view that shows everything.

Configure this first

Most of the speed in Open Dental charting comes from setup the clinical team never sees directly. Get these right before go-live, or schedule a cleanup if your office is already live.

Clinical setup checklist

Procedure code defaults at Lists > Procedure Codes. For each commonly used code, check the Treatment Area (surface, tooth, mouth, quadrant, sextant, arch, or tooth range), the Paint Type (how it draws on the chart, such as filling, crown, extraction, implant, or RCT), the Time Pattern, the Abbreviation, the Layman's Term used on patient-facing documents, and the Is Hygiene flag.
Default procedure notes on codes that need a standard note. Default notes are copied into the procedure when it is set complete.
Procedure buttons at Setup > Chart > Procedure Buttons. Buttons appear in the Enter Treatment tab, organized into categories. The Quick Buttons category is the default view when you open the setup window.
Auto Codes at Setup > Auto Codes, which insert and validate the right code based on conditions such as number of surfaces, anterior versus posterior, and primary versus permanent teeth.
Auto Notes at Setup > Auto Notes: prompt-driven note templates (covered below).
Definitions: Chart Graphic Colors, Prog Note Colors, Treat' Plan Priorities, and Image Categories.
Tooth numbering in Preferences, and perio preferences such as whether perio exams skip missing teeth and whether implants are treated as missing.
Security: who can edit completed procedures, delete treatment-planned procedures, and edit treatment plans, and whether lock dates apply (see Module 1).

Auto codes are what let an assistant click one "composite" button and get the right code for a three-surface posterior tooth. When a user selects surfaces that do not match the chosen code, the auto code can suggest the correct one. The manual also describes a "less intrusive" option that applies the auto code only to procedure buttons rather than checking codes entered in the procedure edit window.

Office manager tip: Ask each dentist and hygienist for their twenty most-charted procedures, then build procedure buttons and Quick Buttons around that list. A clean button panel with the right auto codes behind it prevents more coding errors than any after-the-fact audit.

Procedure statuses: the vocabulary of the chart

Every procedure in Open Dental has a status, and each one means something different downstream. The manual defines them as follows:

Status	Meaning	Use it for	What it affects
TP	Treatment Planned	Recommended treatment not yet done	Appears on the active treatment plan; can be attached to appointments
C	Complete	Work finished in your office	Posts to the patient's account as a charge and counts as production
EC	Existing, Current Provider	Work your office did before you started using Open Dental	Clinical history only
EO	Existing, Other Provider	Work done elsewhere, such as crowns placed by a previous dentist	Clinical history only
R	Referred Out	Treatment to be done by another office	Tracks referrals on the chart without creating your own charge
Cn	Condition	Findings and conditions charted separately from treatment, such as a watch	Documents findings without implying treatment
TPi	Treatment Planned Inactive	Alternatives on an inactive treatment plan	Kept off the active plan until chosen

Common mistake: Charting a new patient's existing restorations as Complete instead of EO. Every one of them posts to the ledger as a charge and inflates production for the day. It gets noticed at end-of-day reconciliation, if you are lucky, and it takes someone with completed-procedure editing rights to fix. At first visits, the entry status should almost always start on EO or Cn, and only switch to TP for recommendations.

Charting existing work and planned treatment

Charting existing conditions at the first visit

A new patient's baseline chart is worth doing carefully because everyone will rely on it for years. A clean sequence:

Confirm the correct patient is selected (name and birthdate in the title bar).
On the Missing/Primary Teeth tab, select teeth and click Missing for teeth that are absent. Use Hidden only when you want the tooth and its number removed from the chart entirely, and Edentulous to mark every tooth missing at once. For children, Set All Primary or Set Mixed Dentition sets up the right mix of primary and permanent teeth.
On the Enter Treatment tab, choose the ExistOther status and chart existing restorations done elsewhere, tooth by tooth. Use ExistCurProv only for your own office's pre-conversion work.
Chart conditions and findings with the Condition status.
Switch to TreatPlan and chart recommended treatment (next section).
Review the chart graphic once more before the patient leaves the chair.

Note the difference between marking a tooth missing and charting an extraction. When an extraction procedure with the extraction paint type is completed, Open Dental marks the tooth missing automatically. If that procedure is later deleted, the tooth stays marked missing until someone manually marks it Not Missing.

Entering planned treatment

The Enter Treatment tab follows the same pattern every time:

Select the tooth or teeth on the Graphical Tooth Chart (skip this for mouth-level procedures).
Choose the entry status with the radio buttons: TreatPlan, Complete, ExistCurProv, ExistOther, Referred, or Condition.
Set the date. Leave Today checked, or uncheck it and enter a different procedure date.
Add optional details such as Diagnosis, Prognosis, and Priority. Priority controls how procedures sort on the treatment plan, so set it now rather than later.
Select surfaces with the surface buttons (B/F, V, M, O/I, D, L). Click again to remove one.
Enter the procedure using one of four methods: a procedure button, a Quick Button, the procedure list, or by typing the code directly (the leading D is optional) and clicking OK.
Check the result on the chart graphic and in the progress notes grid. Double-click any procedure to open it and change details or status.

Repeat for each finding. Because the status radio button stays where you left it, the single most common error is forgetting to switch it. Build the habit of glancing at the status before every entry.

Inside the procedure

Double-clicking a procedure opens the Procedure Info window. Beyond the code, tooth, and surfaces, it shows the fee from the patient's fee schedule, the treating Provider, diagnosis, priority, dates (including the date it was treatment planned), notes, and a signature box. Changing the provider on a completed procedure affects how payments are split, so do it before payments are posted when you can. The Prosthesis Replacement section records whether a crown, bridge, or denture is an initial placement or a replacement, which matters for insurance (see Module 5).

Completing procedures and writing progress notes

There are two ways to set procedures complete: complete the appointment they are attached to (from the Appointments module, as covered in Module 3), or open individual procedures and use Set Complete. Either way, Open Dental changes the status to Complete, sets the date and provider, and inserts the code's default note. Completing the appointment is usually better because it keeps the appointment and procedures in sync and updates recall in one step.

Auto Notes

Auto Notes are templates for long, frequently used notes such as hygiene visits, root canals, anesthetic, and post-op instructions. Each Auto Note can contain prompts: text entry, one-response choices, and multi-response choices. To use one, place the cursor in a procedure's note box and click the Auto Note button above it (many other text boxes support it through a right-click). Double-click the Auto Note you want and answer the prompts; the finished text drops into the note. A preference can prompt for an Auto Note automatically when procedures are completed.

The manual describes an approach some offices prefer: leave default notes blank on individual codes and write one comprehensive visit note with Auto Notes, attached to a non-billing clinical note code. Either approach works. What does not work is a mix of both, where some visits get three overlapping default notes and others get nothing.

Signatures and incomplete notes

Procedure notes can be signed electronically. If a signed note is edited, or the user changes, the signature clears, which is exactly what you want in a record meant to show who wrote what and when. Auto Notes can leave unfilled prompts in quotation marks, and Open Dental can report incomplete notes so an office manager can chase them before they become old.

Common mistake: Editing old clinical notes to "clean them up." Clinical records are legal documents, and the Audit Trail records edits to charts. If a note needs correcting, follow your office's written policy for addenda and corrections, and confirm your state's record-keeping requirements with your state dental board or attorney. Our compliance chapter covers records retention more broadly.

Office manager tip: Use lock dates on completed procedures so that ordinary users cannot edit them after a set number of days, and give the Completed Procedure Edit permission beyond that window only to the owner or office manager. That protects both the clinical record and your month-end numbers.

Building, presenting, and signing treatment plans

The three kinds of treatment plans

The Treatment Plan module is where charted recommendations become something a patient can understand and agree to. It holds three kinds of plans, all listed in the Treatment Plans grid in the upper left:

The Active Treatment Plan. One per patient. It contains all procedures with TP status, and as work is completed, procedures drop off it.
Inactive Treatment Plans. As many as you want. They can hold TP procedures (which also show on the active plan) and TPi procedures (alternatives that stay off the active plan until chosen).
Saved Treatment Plans. Snapshots saved as a permanent record of what was presented. These can be signed and presented through eClipboard.

Creating alternatives, step by step

Chart every procedure for every option in the Chart module with TP status.
In the Treatment Plan module, click +New TP to create an inactive plan for each alternative, and give each a clear heading.
Double-click a plan to open the Edit Treatment Plan window. Use the arrow buttons to move procedures between the Treatment Planned Procedures column (in this plan) and the Available Procedures column.
When the patient chooses an option, open that plan and click Make Active Treatment Plan. The previously active plan becomes inactive.
If you delete an inactive plan, its procedures are not deleted: TP procedures stay on the active plan and TPi procedures move to an Unassigned inactive plan.

Hypothetical example: A patient is missing a lower first molar and has two teeth needing restorations. The dentist charts two fillings (Priority 1), then charts both an implant with abutment and crown and a three-unit bridge (Priority 2). Three inactive plans are created: "Option A: implant," "Option B: bridge," and "Option C: fillings only for now." Each includes the fillings plus its own replacement option. After the consultation, the patient chooses Option A, the coordinator makes it active, and the bridge procedures remain on the inactive plan as a documented alternative that was offered.

Priorities

Procedures on a treatment plan are always sorted first by priority, then by date. Priorities are defined at Setup > Definitions > Treat' Plan Priorities, with a name and a color used for procedure text on the plan. Many offices use simple sequence priorities (1, 2, 3) that map to visits or phases; others use words like "Urgent" or "Elective." Choose one scheme and use it consistently so subtotals by priority mean something.

Presenting, saving, and signing the plan

The Treatment Plan module's Show options control what the patient sees on screen and on paper: fees, insurance estimates, discounts, subtotals by priority, totals, whether insurance maximums and deductibles are applied, and whether completed treatment appears on the printed chart graphic. The lower right area shows the family's and individual's remaining insurance benefits, and a preauthorization box in the upper right lists any preauthorizations. The toolbar includes Save TP, Print TP, Email TP, Sign TP, Preauthorization, Discount, Update Fees, +Plan Appt, and eClipboard, among others.

Click Update Fees so fees and insurance estimates reflect current fee schedules and benefits. Module 5 explains why estimates are only as good as your insurance setup.
Choose which Show options to display for this patient. Subtotals by priority help patients see phases.
Highlight the procedures being presented and click Save TP to create a saved plan.
Have the patient sign with Sign TP or through eClipboard, or print it with Print TP.
Submit a preauthorization if the case calls for one.
Create planned appointments with +Plan Appt (next section) before the patient leaves.

Once a saved plan is electronically signed, it cannot be edited unless someone uses Clear Signature. That is a feature. The signed saved plan is your record of what the patient was told and agreed to at that point, and it should stay intact even as the active plan changes.

How the plan is presented matters as much as what is in it. Our chapter on case presentation and treatment acceptance covers the conversation, who should have it, and how to track acceptance over time.

Planned appointments: the bridge from plan to schedule

A treatment plan says what should happen. A planned appointment says what the next visit is, which procedures it includes, and how long it takes. Create them from the Treatment Plan module with +Plan Appt, or on the Chart module's Planned Appts tab with Add, which opens the Edit Appointment window with procedures attached.

Use Up and Down to put planned appointments in sequence.
Click Pinboard to send a planned appointment to the Appointments module and drag it to the schedule chairside, or let the front desk schedule it from the patient's appointments with Copy to Pinboard.
When all planned treatment is finished, check Done, which clears the planned appointments and tells the front desk there is nothing left to schedule.

The manual's advice is to enter planned appointments only for treatment that is ready to schedule, because plans change. Unscheduled planned appointments appear on the Planned Appointment Tracker in the Appointments module's lists, which is the front desk's worklist for diagnosed but unscheduled treatment.

Office manager tip: Make it a rule that no patient with accepted treatment leaves without either a scheduled appointment or a planned appointment on the tracker, and review the Planned Appointment Tracker weekly. Unscheduled treatment is one of the largest sources of lost production in most practices, and this list is where it hides.

Perio charting

Open the perio chart from the Chart module with Perio Chart. The window records pocket depths, gingival margin, clinical attachment level, mucogingival junction, mobility, furcation, bleeding, suppuration, plaque, and calculus. Features worth knowing:

Advance Sequence controls the order in which the cursor moves from tooth to tooth, and you can change the current direction as you go.
Triplets lets you enter three measurements at a time, which suits a hygienist reading numbers to an assistant.
Single keys mark plaque, calculus, bleeding, and suppuration (P, C, B, and S).
Voice perio charting is available through a microphone button, except for Open Dental Cloud users per the manual.
Up to six of the most recent exams show together for comparison, with prior exams in gray, and values above thresholds you set can display in red.
Skip Teeth and the preferences for skipping missing teeth and treating implants as present control which teeth the cursor visits.
Graphical shows a graphical perio chart, Save to Images stores a copy in the Imaging module, and Print prints it.

Perio charting applies to permanent teeth only, not primary or supernumerary teeth.

Confirm the patient, open Perio Chart, and add a new exam for today.
Check the Advance Sequence and Triplets settings match how your hygienist probes.
Enter measurements, then bleeding and other indicators.
Compare against prior exams, then save a copy to Imaging if your office keeps one there.
If findings change the patient's hygiene category, update their recall type in the Family module during the same visit (Module 3).

Imaging integration

The Imaging module stores radiographs, photos, scanned documents, and forms, organized in a tree of image categories that mirror folders in the patient's A to Z folder. Single images save as JPEG and multi-page scans as PDF. The toolbar supports scanning (documents, multi-page documents, radiographs, and photos), importing files, pasting, exporting, moving images to a different patient, signing, drawing and annotation, and windowing adjustments for radiographs.

You have two broad options for capture:

Open Dental's own imaging. The manual now states that its integrated features mean most practices should not need separate imaging software. Set up sensors at Setup > Images > Imaging Devices (the exact menu label varies slightly by version), choosing a TWAIN device type: Twain Radiograph for individual sensors or Twain Multi for devices that send a batch, such as phosphor plate systems. Set up mount layouts under Setup > Images > Mounts. The manual notes that active registration is required for capture features.
Third-party imaging software through a bridge. Setup > Program Links lists the supported bridges. Double-click one, check Enabled, confirm the path settings, and choose which toolbar gets a button. Clicking the button launches the imaging program with the current patient selected.

Whichever you choose, define image categories at Setup > Definitions > Image Categories and mark the ones clinicians need to see as shown in the Chart module. Keep the category list short: radiographs, photos, scanned documents, consent forms, correspondence, and perio charts covers most offices. If you are shopping for capture hardware, our guides to digital x-ray sensors and intraoral scanners cover what to check, including software compatibility.

Common mistake: Importing images to the wrong patient. It usually happens when a sensor is triggered while the previous patient is still selected. Moving images between patients is possible, but the misfiled image may already have been viewed, printed, or sent. Confirming the selected patient before capture belongs in every assistant's checklist.

A charting quality checklist for office managers

Once a month, pick a handful of recent patients and check:

New patient baselines use EO and Cn, not Complete, for existing work and findings.
Completed procedures carry the correct provider, especially in offices with associates or hygienists whose pay depends on production.
Procedure notes are signed and have no unfilled Auto Note prompts.
Patients with accepted treatment have a saved, signed treatment plan and either a scheduled or planned appointment.
Perio patients have a current perio exam and a Perio recall type.
Radiographs are in the right image categories and the right patient.

Practice exercises

Complete these in the trial demo database or a designated test copy. Remember the trial uses placeholder codes in place of CDT codes.

Module 4 hands-on tasks

Open Lists > Procedure Codes, pick a filling code, and note its Treatment Area, Paint Type, Time Pattern, and default note.
Add a new procedure button in Setup > Chart > Procedure Buttons and use it in the Enter Treatment tab.
Chart a baseline for a demo patient: mark two teeth missing, chart three existing restorations as ExistOther, and chart one condition.
Chart the same three-surface filling twice, once with a procedure button and once by typing the code, and compare the results.
Build a short Auto Note with one text prompt and one single-choice prompt, then use it on a completed procedure.
Create two inactive treatment plans representing alternatives, move procedures between them in Edit Treatment Plan, and make one active.
Set priorities on four procedures and confirm the plan sorts and subtotals by priority.
Save and sign a treatment plan, then try to edit it and find the Clear Signature option.
Create two planned appointments in sequence, send one to the Pinboard, and schedule it.
Open the Perio Chart on the trial's sample perio patient, turn on Triplets, and enter a quadrant of readings.
Import an image file into a test patient in the Imaging module, then move it into a different image category.

What's next

With treatment charted and planned, the next challenge is getting it paid for. Module 5: Insurance Setup, Estimates, and Claims covers carriers, plans, subscribers, fee schedules, the insurance estimates that appear on your treatment plans, claims and attachments, and handling denials. For the business context around it, our chapter on insurance and the revenue cycle is a good companion read.

ChairsideSource is not affiliated with or endorsed by Open Dental Software, Inc. This is independent educational content. Menus and features change between versions: verify against the official Open Dental manual and contact Open Dental support before changing settings that affect live patient data. This guide is educational content and does not constitute legal, financial, tax, or clinical advice. Laws and regulations vary by state and change over time. Consult your own dental-specific attorney, CPA, and state dental board before acting.