OpenNotes in dentistry as a strategy for patient engagement: opportunities, barriers, and a framework for implementation

Abstract

Patient engagement is increasingly recognized as a cornerstone of high-quality, patient-centered care. Although the OpenNotes initiative, which gives patients direct access to their clinical notes through electronic health records, has demonstrated significant benefits in medicine, its application in dentistry remains largely unexplored despite the elective and decision-intensive nature of dental care. This targeted narrative review was informed by a PubMed search conducted on March 26, 2026, using the terms (“OpenNotes” OR “shared clinical notes” OR “patient access to records”) AND (“dentistry” OR “dental”), which identified 12 articles and no studies directly addressing OpenNotes implementation in dental practice. Consequently, the anticipated benefits for dentistry are derived by analogy with medical evidence and should be regarded as hypotheses requiring empirical testing rather than established findings. We examined the potential of OpenNotes as a patient engagement strategy in dentistry, including its benefits, the structural and technical barriers unique to dental documentation, and the enabling role of emerging technologies such as artificial intelligence and teledentistry, and found that, based on evidence from medical OpenNotes programs, note sharing may improve treatment adherence, shared decision-making, and patient empowerment in dentistry as well, although important barriers remain, including procedure-centric documentation, specialized terminology, fragmented electronic health record adoption, and privacy regulations; overall, OpenNotes appears to hold substantial promise for enhancing patient engagement in dentistry, but realizing this potential will require coordinated efforts in documentation standardization, clinician training, technology infrastructure, and regulatory compliance, with pilot implementation in academic dental institutions representing a pragmatic first step toward building an evidence base for broader adoption.