AI SOAP Notes for Dentists: How AI Writes Your Dental Notes (With 3 Examples)
How AI SOAP notes get written from the conversation in your operatory: what AI captures, what you still check, and 3 sample AI-drafted notes.
Quick Answer
An AI SOAP note is a dental note drafted by an AI scribe from the conversation during the appointment. The AI listens while you treat, sorts what was said into Subjective (what the patient tells you), Objective (what you find), Assessment (your diagnosis) and Plan (what you did, discussed and decided), and writes the note in your format. You review it, sign it, and it saves to your PMS (for supported systems). Marea Documentation does this for dental practices, with dental-specific formats, tooth-by-tooth detail and no stored audio. The AI only knows what is said in the room, so the dentist still checks every note.
Key Takeaways
- An AI SOAP note is drafted during the visit, not rebuilt from memory at the end of the day.
- AI is strongest at what tired dentists skip: the patient's exact words, every option discussed, consent and refusals.
- AI only writes what it hears. Saying findings out loud is the single biggest thing that improves AI notes.
- The dentist still signs. Recordkeeping rules don't make an exception for AI notes.
- Pick a scribe built for dentistry. Marea writes in dental formats, captures findings tooth by tooth, never stores audio and saves notes straight to supported PMSs.
A lot of dental notes get written at 6:40pm, from memory, after the last patient leaves. That's how "pt tolerated procedure well" ends up carrying an entire visit. It's not laziness. It's a full schedule and a blank note at the end of it.
AI SOAP notes flip that. Instead of rebuilding the appointment hours later, an AI scribe captures it while it happens and has the note drafted by the time the patient stands up. At Marea, this is what we build: Marea Documentation listens from the corner of the operatory and writes the note in your format while you treat.
Below: how AI turns a visit into each part of the note, three examples, how AI notes measure up to recordkeeping rules, and what to look for in an AI scribe.
25 min/day. "It has saved me approximately 25 minutes per day writing notes and sending reports." Dr. Michael Fuller, University Pointe Endodontics (Marea customer, customer-reported)
What Is an AI SOAP Note?
A SOAP note is a structured clinical entry in four parts: Subjective, Objective, Assessment and Plan. It comes from the problem-oriented medical record developed by Dr. Lawrence Weed, and the ADA's documentation guidance says to "consider using the SOAP (Subjective, Objective, Assessment, and Plan) method for chart entries."
An AI SOAP note is the same note, drafted by AI. A conversation in the operatory jumps between all four parts: the patient describes their pain, you call out a test result, you explain a diagnosis, you talk through options. The AI's job is to sort that conversation back into S, O, A and P and write it up the way you would.
Here's how it compares to the ways most practices write notes today.
| Method | When the note gets written | What tends to get lost |
|---|---|---|
| Typing from memory | After the visit, often end of day | Patient's exact words, options discussed, instructions given |
| PMS templates or snippets | After the visit, by filling in blanks | Anything the template didn't expect. Default text left unchanged |
| Dictation | After the visit, spoken instead of typed | Whatever you forget to say when recapping |
| AI SOAP note | During the visit, from the conversation itself | What was never said out loud, or was misheard. You review before signing |
Related read: AI scribe vs. traditional charting: what actually changes in the operatory.
How AI Writes a Dental SOAP Note, Step by Step
Here's the flow with Marea Documentation. Other dental AI scribes follow a similar pattern, but the details (especially around audio and your PMS) are where they differ.
01. It listens while you treat. Marea listens from the corner of the operatory. No buttons to press, no dictation to remember. You run the appointment the way you always do.
02. It transcribes live and discards the audio. The conversation is transcribed in real time. The audio and raw transcript are discarded the moment the note is written. Nothing is recorded, so there's nothing to store or leak.
03. It sorts the conversation into S, O, A and P. The patient's complaint goes to Subjective. Your findings and test results go to Objective. The diagnosis goes to Assessment. The treatment, options, consent and instructions go to Plan.
04. It drafts the note your way. SOAP, narrative or your own template, with formats for exams, hygiene, endo, perio and oral surgery. Marea learns how each provider documents and matches it, so the note reads the way you'd write it.
05. You review and sign. The draft isn't final until the dentist approves it. Same rule as a note your assistant writes.
06. It saves to your chart, and can become a letter. The note writes straight back to your PMS (integration depth varies by system, so confirm yours in a demo). If the patient needs a referral or the referring dentist needs a report, Marea drafts the letter from that same note in seconds.
Why "no stored audio" matters. Some AI scribes keep recordings of your appointments. Marea doesn't. Audio is held only in memory while it's transcribed, then discarded. Your finished note goes to your PMS (for supported systems), and every practice gets a signed BAA before go-live. Read more in what dental software actually does with your patient data.
What AI Puts in Each Section of the Note
For each part of the note, here's what the AI listens for, what it writes, and what to glance at when you review.
| Section | What the AI listens for | What it writes | What you check |
|---|---|---|---|
| S: Subjective | The patient describing their problem and answering history questions | Chief complaint in the patient's words, onset, triggers, pain level, medical history updates | That the medical history was actually reviewed |
| O: Objective | You calling out findings, test results, perio readings and radiograph findings | Tooth-by-tooth findings, test results, probing depths, what the radiographs show | Tooth numbers and surfaces. Anything you saw but didn't say |
| A: Assessment | You explaining the diagnosis to the patient or your assistant | Diagnosis by tooth or condition, pulpal and periapical diagnosis for endo | The diagnosis, especially if you changed your mind mid-visit |
| P: Plan | The treatment conversation, anesthetic call-outs, consent, instructions, booking | Treatment done, options discussed, patient's decision, anesthetic, materials, instructions, next visit | Anesthetic amounts. That every option discussed is listed |
3 AI SOAP Note Examples
Each example shows a few lines of what was said in the operatory, then the SOAP note an AI scribe drafts from the full visit. These are illustrative samples written for this guide. Patients are made up. Tooth numbers use the Universal system, with FDI in parentheses for our Canadian readers. Example 3 follows the patient from Example 1 to the endodontist.
Example 1: Emergency visit (limited exam)
General practice • Sample AI-drafted note
In the room
Patient: "It's been throbbing for three days. Cold makes it worse and it doesn't go away. I barely slept."
Dentist: "Cold on 30... that's lingering. 29 and 31 are normal. Tapping on 30, tender. The PA shows deep decay on the distal, close to the nerve. Irreversible pulpitis on 30, and it's tender to tap, so symptomatic apical periodontitis."
Dentist: "Your options are a root canal and then a crown, taking the tooth out, or leaving it, which means the pain and infection will likely get worse."
Dentist: "I can start the root canal today, or get you in with the endodontist." Patient: "I want to save it. I'll see the specialist."
| Sample AI-drafted note | |
|---|---|
| S | CC: "It's been throbbing for three days. Cold makes it worse and it doesn't go away." Pain 8/10, disrupting sleep. Ibuprofen gives partial relief. Medical history reviewed: no changes. No known drug allergies. |
| O | No extraoral swelling. #30 (46): large MOD amalgam, recurrent decay at distal margin. Cold: #30 lingering. #29 (45) and #31 (47) normal. Percussion #30: tender. Palpation: within normal limits. PA #30: deep distal radiolucency approaching the pulp. Slight PDL widening at mesial root apex. |
| A | #30: symptomatic irreversible pulpitis with symptomatic apical periodontitis. |
| P | Options discussed: root canal treatment followed by a crown, extraction with replacement options, or no treatment (risk of worsening pain, infection, tooth loss). Patient chose root canal treatment. Emergency pulpectomy offered today. Patient preferred endodontist referral. Referral sent with PA and findings. Advised over-the-counter pain relief as directed on the label. Patient to call if swelling develops. |
What the AI caught: the patient's own description of the pain and all three options, including no treatment. With Marea, this note can also become the referral letter to the endodontist in seconds.
Example 2: Hygiene recall
General practice • Sample AI-drafted note
In the room
Hygienist: "Any changes to your health since last time?" Patient: "I started a blood pressure pill a few months ago. And my gums bleed a bit when I floss the top right."
Hygienist: "Numbers on the upper right: 2 and 3 have some 4s with bleeding. Everything else is 2s and 3s. That's some gingivitis back there, but no bone loss on the x-rays."
Hygienist: "I'd like you to try these little interdental brushes back there. Want fluoride today?" Patient: "No thanks."
| Sample AI-drafted note | |
|---|---|
| S | 6-month recall. Reports bleeding when flossing upper right molars. Medical history updated: started blood pressure medication since last visit (name and dose not stated; confirm and add to medication list). No known drug allergies. |
| O | BP 128/82. Extraoral and intraoral exam within normal limits. Oral cancer screening: no findings. Perio: generalized 2 to 3 mm. Localized 4 mm with bleeding on probing at #2 (17) and #3 (16). Light calculus on lower anterior linguals. 4 BWs: no new caries, no bone loss. |
| A | Localized plaque-induced gingivitis, upper right molars. 4 mm probing depths with BOP at #2 (17) and #3 (16), no attachment loss noted. No radiographic bone loss. |
| P | Adult prophy. Fluoride varnish offered, patient declined. OHI: interdental brushes for upper right molars, demonstrated. Dentist exam completed. Recall in 6 months. Re-probe #2 (17) and #3 (16). |
What the AI caught: the medical history update, the probing depths as they were called out, and the declined fluoride. Small refusals like that rarely make it into a note typed hours later. The one thing to add on review is the medication name and dose, since the patient didn't say them. More on this in what AI changes for dental hygienists.
Example 3: Endodontic treatment, first visit
Endodontic practice • Sample AI-drafted note (same patient as Example 1)
In the room
Patient: "It started about five days ago. Now it hurts to bite on it too."
Endodontist: "Cold on 30, lingering. Percussion positive. Palpation negative, probings normal. Symptomatic irreversible pulpitis, symptomatic apical periodontitis."
Endodontist: "The risks are things like a file separating, a perforation, or soreness after. You'll need a crown when we're done. The alternatives are taking it out or leaving it."
Endodontist: "Two carps of two percent lido with one to a hundred thousand epi, right block. Aspiration's negative."
Endodontist: "Three canals: MB, ML and distal. Calcium hydroxide in, temp on. We'll finish in two weeks."
| Sample AI-drafted note | |
|---|---|
| S | Referred by general dentist for #30 (46). Pain began 5 days ago, worse with cold, now tender to bite. Pain 6/10. Medical history reviewed. No known drug allergies. |
| O | Cold: #30 lingering, #29 (45) and #31 (47) normal. Percussion #30: positive. Palpation: negative. Probing within normal limits. No mobility. PA: deep distal decay approaching pulp, PDL widening at mesial root apex. |
| A | Pulpal: symptomatic irreversible pulpitis. Periapical: symptomatic apical periodontitis. |
| P | Consent: benefits, risks (file separation, perforation, post-op pain, need for a crown) and alternatives (extraction, no treatment) discussed. Consent signed. LA: 2% lidocaine with 1:100,000 epinephrine, 2 carpules (3.4 mL), right IANB, aspiration negative. Rubber dam. Access, 3 canals located (MB, ML, D). Working lengths with apex locator, confirmed on radiograph. Cleaned, shaped, irrigated with sodium hypochlorite. Calcium hydroxide placed, temporary restoration. Next: obturation in 2 weeks. Report sent to referring dentist. |
What the AI caught: both the pulpal and periapical diagnosis, every risk named in the consent talk, and the canal anatomy. Endodontists use Marea to turn this note into the report for the referring dentist, one reason referral letters don't have to take 20 minutes.
Do AI SOAP Notes Meet Recordkeeping Rules?
Recordkeeping rules don't make an exception for AI. What counts is what's in the note and who signed it. Ontario's RCDSO recordkeeping guidelines list what every progress note needs, and they line up with the ADA's guidance in the US. Here's how an AI SOAP note handles each one.
| What the note needs | Source | How AI handles it |
|---|---|---|
| Date and treating clinician | RCDSO, ADA | Recorded with the note. Make sure each provider uses their own login |
| Local anesthetic: type, amount, method | RCDSO | Captured when you say it out loud. Check the amount on review |
| Materials and procedural steps | RCDSO | Captured from your call-outs to the assistant |
| Drugs prescribed or given, with dose | RCDSO | Captured when discussed. Confirm doses on review |
| Advice and instructions given | RCDSO | A strength of AI: verbal instructions are written down as said |
| Risks, alternatives and the patient's decision | RCDSO, ADA | A strength of AI: the full consent conversation, including refusals |
| Dentist review and sign-off | ADA, RCDSO | Still required. The ADA says the dentist should sign off on all entries "regardless of the format" |
Two more rules apply to AI notes the same way they apply to any note. The ADA says to aim to complete notes within 24 hours, which an AI draft makes easy. And fixes are added, not overwritten: the ADA says belated entries and corrections should include the date and time, and to "never alter the record when faced with a dental malpractice claim, board inquiry, and/or patient complaint about the efficacy of treatment you provided."
US vs. Canada: who sets the rules? In the US, your state dental board sets recordkeeping rules, and the ADA publishes guidance. In Canada, your provincial regulator does (for example, the RCDSO in Ontario). Marea is HIPAA and PIPEDA compliant. Check your provincial health privacy law (for example, PHIPA in Ontario) and your board or college for specifics like retention periods.
Related read: Dentists are worried AI will get things wrong. They're right to ask.
How to Get Better AI SOAP Notes
The AI writes what it hears. These habits make the difference between a good draft and a great one.
- Call out findings to your assistant. "Cold on 30, lingering" gives the AI something to write. A silent cold test doesn't.
- Say the anesthetic. Type, amount and site, the way you'd say it to your assistant anyway.
- Name the diagnosis. Explaining it to the patient in plain terms is enough for the AI to put it in Assessment.
- Name every option. Including doing nothing. That conversation is the core of informed consent.
- Set up your format once. With Marea, your note formats and templates are set per provider, so every draft comes out the way you document.
- Tell patients. Let patients know an AI scribe is in use, and follow your state or provincial consent rules.
The 60-second review
Before you sign, check four things: tooth numbers, the diagnosis, anesthetic amounts, and anything you saw but didn't say. Then skim the rest for anything misheard.
How to Choose an AI Scribe for SOAP Notes
Ask these questions in any demo. Here's why each one matters, and how Marea answers it.
| Question to ask | Why it matters | Marea's answer |
|---|---|---|
| Is it built for dentistry? | General medical scribes aren't built for dental detail | Yes. Formats for exams, hygiene, endo, perio and oral surgery. Tooth-by-tooth findings |
| Does it write SOAP in my format? | You shouldn't have to change how you document | SOAP, narrative or your own template, matched to each provider |
| Does it save to my PMS? | Copy and paste adds time and errors | Yes, for supported systems. Integration depth varies by PMS, so confirm yours in a demo |
| Is audio stored? | Stored recordings are a privacy risk | No. Transcribed live, discarded when the note is written |
| Will you sign a BAA? | Required under HIPAA for vendors that handle patient health information for your practice | Yes, with every practice before go-live, included as standard |
| Can the note become a letter? | Referrals and reports take time | Yes. Marea drafts the referral letter from the note in seconds |
We compared the main dental AI scribes side by side in our guide to the best AI dental scribes in 2026.
"It has completely eliminated the variability in note quality that can depend on which dental assistant is assisting. Our documentation is now consistently professional, accurate, and well-structured." Dr. Audrey Hsin, Citra Endodontics (Marea customer, customer-reported)
See an AI SOAP note written in your format. Book a 15-minute demo. We'll show Marea Documentation drafting a SOAP note in your format and how it saves to your PMS (for supported systems). Book a Free Demo.
What an AI SOAP Note Should Include (Template)
Use this to set up your note format in your AI scribe, or as a checklist when you review a draft. With Marea, this becomes your template and every note follows it.
Dental SOAP note template. Date • Treating clinician • Assisted by
| Fields | |
|---|---|
| S | Chief complaint (patient's words) • History: onset, duration, triggers, pain level (0 to 10) • Medical history and medications reviewed and updated • Allergies |
| O | Vitals (if taken) • Extraoral / intraoral findings • Tooth-by-tooth findings • Tests (cold, percussion, palpation, probing, mobility) • Radiographs taken and findings |
| A | Diagnosis by tooth or condition • Prognosis (if relevant) |
| P | Options discussed (including no treatment) and patient's decision • Consent / refusal • LA: type, amount, method • Procedure: materials and steps • Prescriptions / drugs given • Post-op instructions and advice • Next visit / referrals • Dentist sign-off |
Related read: Why dentists stay late charting (and what AI clinical notes change).
Frequently Asked Questions
What is an AI SOAP note?
An AI SOAP note is a clinical note drafted by an AI scribe from the conversation during an appointment. The AI listens, sorts what was said into Subjective, Objective, Assessment and Plan, and writes the note in your format. The dentist reviews and signs it before it becomes part of the record.
Can AI write dental SOAP notes?
Yes. Dental AI scribes like Marea listen during the visit and draft the SOAP note while you treat. A scribe built for dentistry writes in dental language, with tooth numbers, surfaces, canals and probing depths, and supports formats for exams, hygiene, endo, perio and oral surgery.
Are AI SOAP notes accurate?
They depend on what is said in the room and how clearly it is captured, which is why the dentist always reviews the draft. AI is strong at capturing the patient's words, the options discussed and the consent conversation. You still check diagnoses, tooth numbers and anything you saw but did not say out loud.
Are AI SOAP notes accepted by dental regulators?
Recordkeeping rules focus on what the note contains and who signed it, not how it was typed. The ADA says the dentist should sign off on all entries regardless of the format, and Ontario's RCDSO says that when staff write chart entries, the dentist should review each one. The same content and sign-off rules apply to an AI draft as to any other note.
Is it safe to use an AI scribe with patient data?
It depends on the vendor. Ask whether audio is stored, where the note is saved, and whether they sign a BAA (US) and meet PIPEDA (Canada). Let patients know an AI scribe is in use, and follow your local consent rules. Marea transcribes audio live and never stores it, signs a BAA with every practice before go-live, and saves the finished note into supported PMSs.
Does the AI note go into my practice management system?
With Marea, yes, for supported systems. Notes write straight back to your PMS, so there is no copy and paste and no second system to check. Integration depth varies by PMS, so confirm yours in a demo.
Sources & Further Reading
External sources
- American Dental Association: Documentation and Patient Records
- American Dental Association: What and How to Write, or Change, in the Dental Record
- Royal College of Dental Surgeons of Ontario: Dental Recordkeeping Guidelines (2019)
- StatPearls (NCBI Bookshelf): SOAP Notes
From Marea
Marea is the clinical documentation platform for dental practices. Marea Documentation writes the note, the letter, and the perio chart. Marea Inbound answers the call and completes intake — on the PMS you already use.