Which EHRs Should a Dental Health AI Startup Integrate With in 2026?

Dental software in the US is fragmented across legacy practice-management systems, newer cloud platforms, specialty tools, and vendor-specific workflows. For health-AI companies, that means supporting dental practices is rarely a one-integration problem.

The market is large enough for that fragmentation to matter. The American Dental Association's Health Policy Institute reports $189 billion in US dental expenditures in 2024. The US Census Bureau counted 135,665 dental-practice establishments in 2023.

Tross builds EHR, practice-management, and payer-portal integrations for healthcare products, including workflows that need data written back into the systems practices already use.

Key takeaways

• Dental is a large, fragmented software market. More than 135,000 US dental establishments operate across a long tail of practice-management and clinical systems.

• Dentrix, Eaglesoft, and Open Dental remain important. Ciro's revised 2023 survey of 10,866 practices ranked them first, second, and third. A later 2024 Ciro analysis of 40,501 practices estimated single-location shares of 32.5%, 20.8%, and 15.9%, respectively.

• The long tail still matters. The same 2024 analysis showed meaningful adoption across Dentrix Ascend, SoftDent, Curve Dental, Denticon, Dolphin, Ortho2/Edge, CareStack, PracticeWorks, and others.

• Reading data is only part of the integration problem. AI products often need to create or update appointments, notes, patient records, documents, claims, or other workflow data inside the practice system.

30 dental EHRs and practice-management systems to know

The current Tross dental market map includes these 30 systems:

Market adoption across dental PMS platforms

There is no single market-share number that applies cleanly to every dental practice type. The mix changes between solo practices, multi-location groups, DSOs, and specialty practices.

Two useful datasets point to the same broader conclusion: the market is concentrated at the top, but still fragmented enough that an integration roadmap cannot stop at three vendors.

• Ciro, Q3 2023: its revised survey of 10,866 dental practices ranked Dentrix, Eaglesoft, and Open Dental as the top three PMS products.

• Ciro, May 2024: an analysis of 40,501 practices estimated Dentrix at 32.5%, Eaglesoft at 20.8%, and Open Dental at 15.9% among single-location practices. The multi-location mix was different, with Dentrix, Open Dental, Denticon, Eaglesoft, and Dentrix Ascend all appearing prominently.

• Dental Tech Hub, 2026: its smaller survey produced a different mix, with Denticon and Dentrix at 20% each and Eaglesoft at 18%, illustrating how practice type and sample composition can change the apparent leaderboard.

Integration friction after read access

For many healthcare AI products, pulling patient or appointment data is only the first step. The product becomes operational when it can complete the workflow inside the dental PMS or EHR.

That can mean creating an appointment, updating patient information, uploading a document, writing a clinical note, posting claim-related data, or triggering another action that changes the source system. Those write workflows are where vendor permissions, local deployments, customer-specific configuration, and API coverage start to matter.

API and developer access across dental PMS platforms

Some do, but the integration models vary significantly.

• Open Dental: publishes a REST API with GET, POST, PUT, and DELETE methods. Its developer setup uses both developer and customer API keys, and Open Dental provides a test database for developers.

• Denticon: Planet DDS publishes a developer portal with REST APIs, webhooks, batch data, and write-back capabilities for patient, appointment, revenue-cycle, financial, clinical, and practice workflows.

• Eaglesoft: Patterson documents its Innovation Connection API for licensed and authorized vendors. The public documentation available online is older and refers to an NDA-governed vendor integration process.

A published API does not automatically mean every workflow is available to every developer. Access rules, customer enablement, resource permissions, and write scope still need to be checked system by system.

How to prioritize dental integrations

Start with the systems already showing up in your customer pipeline, then use market adoption to decide what comes next. For a broad US dental product, Dentrix, Eaglesoft, and Open Dental are obvious systems to evaluate early because they consistently appear near the top of adoption datasets.

After that, the right order depends on your buyers. Multi-location groups and DSOs may pull the roadmap toward cloud platforms such as Denticon, Dentrix Ascend, Curve Dental, CareStack, tab32, or Archy. Orthodontic, pediatric, or specialty workflows can surface a different set of systems entirely.

The important point is not to build a generic ranking. Build around the customers you are trying to close and the exact read-and-write workflow your product needs to complete.

What this means for teams building dental AI

Dental AI products increasingly sit inside workflows rather than beside them. A voice agent needs to book or move appointments. An RCM product may need claims and insurance data. A documentation product may need to put structured output back into the chart.

That makes integration coverage part of product coverage. Supporting one dental PMS can unlock a customer, but the next customer can be on a completely different system.

For a broader comparison of the infrastructure options behind multi-system workflows, see our guide to API platforms for EHRs and payers.

Tross handles the integration layer across EHRs, practice-management systems, and payer portals so product teams do not have to build and maintain every connection themselves. You can also browse the current Tross integrations.

Frequently asked questions

What are the most common dental practice-management systems in the US?

Dentrix, Eaglesoft, and Open Dental consistently appear among the most widely used systems in available US datasets, although exact shares vary by practice type and sample.

What is the difference between a dental EHR, EMR, and PMS?

A dental EHR or EMR generally refers to the clinical record, while a dental practice-management system adds operational workflows such as scheduling, billing, insurance, claims, payments, and reporting. Many dental platforms combine both functions, so the terms often overlap in practice.

Do dental PMS platforms offer APIs?

Some do. Open Dental publishes a REST API with read and write methods, Planet DDS publishes Denticon APIs with write-back capabilities, and Patterson documents an authorized-vendor integration path for Eaglesoft. The available scope and access model still vary by vendor.

Why is write-back important for dental AI products?

Many products need to complete a workflow, not just read data. Scheduling, documentation, patient updates, and revenue-cycle workflows often require creating or changing data inside the dental system.

Sources

1. National Dental Expenditures, 2024 - American Dental Association Health Policy Institute

2. Offices of Dentists, 2023 County Business Patterns - US Census Bureau

3. Q3 2023 revised dental PMS survey, 10,866 practices - Ciro Data / Richard Lee

4. Dental PMS market share analysis, 40,501 practices, May 2024 - Ciro Data, reproduced by Frazier & Deeter

5. The State of Dental Technology 2026 - Dental Tech Hub

6. Open Dental API Specification - Open Dental

7. Open Dental API Developer Setup - Open Dental

8. Denticon API Developers - Planet DDS

9. Eaglesoft Innovation Connection documentation - Patterson Dental