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Ink Matters in
Dental Charting

Are gel pens acceptable for patient charting, or is the preferred implement still a black ballpoint pen?

Dental offices require the completion of patient charting in addition to signatures on a variety of documents such as medical histories, treatment plans, Health Insurance Portability and Accountability Act forms, and consents. Thorough dental charting and capturing signatures make documents within the patient record legal and binding. Although electronic records — including electronic signatures — are becoming the norm, paper charting and what is sometimes referred to as a “wet signature” are still utilized in some dental practices. A wet signature is a physical mark on documents created by a person.1 Typically, a wet signature consists of writing a name in cursive on a sheet of paper. If an office still relies on paper records and obtaining wet signatures, questions arise regarding the type of pen that can be used (gel or ballpoint) and the color of ink required to be legally binding.

Gel and ballpoint pens each have advantages and disadvantages, but both can be legally used for patient charting and to obtain signatures. First developed in the 1980s, gel pens use an ink that is a combination of permanent oil-based ink and water-based ink. Gel pens provide a smoother, more consistent impression across the paper, which helps create a clearer line and reduces the likelihood of skipping. However, the ink from gel pens takes longer to dry on paper than ballpoint pens, so if the writing is touched within a few seconds, smudges may occur.

Compared with gel pens, ballpoint pens have a longer lifespan, and the ink dries much faster. The ink is more viscous, which makes the writing clear and ink consumption is small. However, its viscosity also increases the risk of ink blobs being left behind after use.

There isn’t consensus when it comes to appropriate ink color for patient charting and signing legal documents. For dental charting, using assorted colors to document data, such as existing restorations, suspected decay, furcations, and bleeding, is preferred to make each aspect easy to identify. Gel pens may be advantageous for dental charting due to their vibrant colors.

Concerning signatures, some suggest that black ink is the only acceptable color as it is the most formal and traditional. Others believe that using any dark color ink, such as blue or brown, is acceptable. The reasoning behind this is that these colors will stand out among the black text on the document while still being dark enough to read. Utilizing blue ink indicates that the document is an original and not a copy. Red ink, as well as colors such as green or purple, are not deemed professional and may not show up well on photocopied or scanned documents. The bottom line is that choosing black or blue ink for signatures is best. These colors are the most common for legal documents and will help ensure that the signature will be legally binding if records are requested for legal reasons.


1.Upcounsel. Wet Signature: Everything You Need to Know. Available at: Accessed January 5, 2024.


From Dimensions of Dental Hygiene. Jan/Feb 2024; 22(1):46

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