CareStack vs Open Dental

PickMyPMS Editorial · Last reviewed Sep 28, 2026

Quick verdict

CareStack fits a practice that wants one cloud system with imaging, eligibility, claims and texting bundled together, and that would rather pay a higher flat monthly fee than run its own server. It also covers more specialties and DSO-scale practice sizes than Open Dental does.

Open Dental fits a practice that wants a published $149-a-month support fee after year one, is comfortable running Windows on its own server (or paying separately for Open Dental Cloud hosting), and wants direct control of an open MySQL database instead of a vendor-hosted one.

Cloud suite vs. a database you host

CareStack runs entirely in a browser, and CareStack hosts the software, so there’s no office server to maintain. Essentials already includes native FDA-cleared imaging, eligibility verification, claims submission, texting, email, online appointments and a patient portal.

Open Dental is Windows software your practice installs on its own server, with workstations connecting to that server. A hosted option, Open Dental Cloud, is in limited release for practices that don’t want to run their own server. Open Dental’s own site describes an open MySQL database that the practice can query and back up directly, which is part of why it appeals to practices that want to avoid being tied to one vendor’s export process.

We could not find a published statement on whether Open Dental includes native imaging; the product’s fee schedule and manual pages don’t cover it.

What each costs

CareStack publishes two tiers. Essentials starts at $829 a month and covers native imaging, eligibility checks, claims, texting and email, online appointments and a patient portal. Intelligence starts at $1,299 a month and adds AI clinical notes, AI voice perio charting, AI X-ray analysis and AI clinical diagnosis on top of Essentials. Both figures are starting prices; CareStack says the final number depends on your locations, chairs and providers, without stating the formula. An implementation fee may apply “in certain cases” depending on how complex your data migration is, but no amount is published.

Open Dental’s base cost is a monthly support plan, not a software license fee. It runs $199 per location for the first year, covering up to three dentists, then drops to $149 per location. Each additional dentist beyond three adds $20. An eServices bundle is a separate add-on at $165 per location, and texting costs extra on top of that: $5 for an assigned number or $20 for a landline number, plus $0.04 per message. All of these are recurring monthly charges. If you’d rather not run your own server, Open Dental Cloud starts at $430 a month for one provider, with each additional provider at $150 a month and a one-time $400 migration fee.

These aren’t the same kind of number. CareStack’s $829 is a bundled software price; Open Dental’s $149 to $199 is a support fee for software your practice already holds. Run your own provider and location counts through the cost calculator rather than comparing the headline figures directly.

Contracts and cancelling

CareStack’s initial term is set on your Order Form. Either party can terminate the agreement at any time, with or without cause, on 30 days’ notice. After the initial term, it renews automatically for successive one-year periods, and you need to give 30 days’ notice of non-renewal if you don’t want that renewal to happen.

Open Dental’s support plan runs for a 12-month initial term, then converts to month-to-month. It also offers a 90-day money-back guarantee on support fees. We could not find a published notice period or auto-renewal clause for what happens after the initial 12 months beyond the shift to month-to-month billing.

Getting your data out

CareStack will help you export your data during the contract term and for up to 90 days after it ends, in a format CareStack selects. You need to request the export at least 10 days in advance, and CareStack charges its then-current hourly rate for the work, with a 15-day delivery target. No flat export price is published.

Open Dental’s data sits in an open MySQL database that the practice controls. There’s no export request to make because you already hold the database; the tradeoff is that you’re also responsible for backing it up.

Switching between the two

CareStack says it has converted data from more than 60 practice management systems and runs a sandbox test before the final migration, but it doesn’t publish a conversion price; expect an implementation fee tied to how complex your migration is. Open Dental’s conversion pricing is public: $1,450 per database, $900 for X-rays, $850 for documents, and $400 for each additional clinic.

Before you commit to a move in either direction, get in writing what format CareStack will export your data in, since the terms only say CareStack chooses the format, and confirm that format is one Open Dental’s $1,450 conversion service can read. Also ask CareStack for its implementation-fee estimate up front, since it isn’t in the published pricing.

Imaging and features

CareStack’s Essentials plan includes native imaging at no separate fee, along with eligibility checks, claims and texting. We could not confirm from CareStack’s pricing page whether online forms are part of Essentials, so ask before you count on them.

We found no published list of what Open Dental includes, and no confirmed imaging status, so we can’t say from vendor sources which of eligibility, claims, online forms or online scheduling ship free versus paid. What is published points toward paying separately: the eServices bundle is an add-on, and texting carries its own per-number and per-message charges on top of the base support fee.

On review sites, CareStack holds 4.8 out of 5 from 219 Capterra reviews, with reviewers citing detailed reporting, one system for scheduling, billing and messaging, and responsive chat support, against complaints about the steps needed to post insurance payments and a learning curve for reports. Open Dental holds 4.6 out of 5 from 89 Capterra reviews, with reviewers citing published pricing and no long-term contract after year one, against complaints about a dated interface and paying for live support.

Who should pick which

Pick CareStack if you:

• Want imaging, eligibility, claims and texting bundled into one monthly price with nothing extra to assemble.
• Run, or plan to run, more than one location, or you’re a DSO.
• Treat specialties beyond general dentistry (pediatric, ortho, oral surgery, perio, endo) as part of your practice mix.

Stick with Open Dental if you:

• Want a published $149-a-month support fee after year one and are willing to run, or pay to host, your own server.
• Want direct access to an open MySQL database instead of a vendor-controlled export process.
• Are comfortable paying separately for the eServices bundle and for texting, which Open Dental prices on top of the support fee.

If neither description fits cleanly, the Find my PMS quiz scores both products, and other options, against your specialty, size and budget.