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Expanded-function dental assistants can ‘bring real value’

October 01, 2018

By David Burger

Dr. Ratner
Dr. Ratner

Many dentists may not be aware of the benefits that expanded-function dental assistants can provide to their practices, according to a survey conducted by the ADA Council on Dental Practice.

The survey indicated that there was a need to further educate the profession about the capabilities of these assistants that have received more specialized training, said Dr. Craig Ratner, chair of the Council on Dental Practice.

“Expanded-function dental assistants bring real value to the dental team and improve efficiency throughout the practice,” said Dr. Ratner. “Our survey revealed a dentist can utilize his or her time and skills more efficiently when the EFDA performs, under supervision, additional tasks allowing the practice to schedule more patients each day.”

It is important to realize, Dr. Ratner cautioned, that while EFDAs can perform many more tasks in their expanded role, employer dentists alone are accountable for supervision.

“While EFDAs perform direct patient care and support the dental team, it is the dentist who remains responsible, ethically and legally, for all patient care delivered,” Dr. Ratner said.

Other key findings from the survey revealed that:

  • 59.9 percent of respondents reported employing EFDAs.
  • 44.6 percent reported that EFDAs are used to the fullest extent permitted.
  • 45.0 percent reported providing financial support or other incentives to encourage dental assistants to become EFDAs.

Having an EFDA on staff helped dentists:

  • Use time more efficiently — 92.1 percent of respondents.
  • See more patients daily — 67.5 percent.
  • Increase capacity to treat patients in managed care programs — 36.3 percent.
  • Lower overall operating expenses — 34.1 percent.
  • Increase capacity to treat patients covered by Medicaid, Medicare, Children’s Health Insurance Program, or another public assistance program — 27.9 percent.

Functions most frequently performed by EFDAs included:

  • Exposing radiographs — 90.6 percent.
  • Coronal polishing — 53.7 percent.
  • Monitoring nitrous oxide — 50.2 percent.
  • Applying pit and fissure sealants — 49.6 percent.

The survey was emailed to licensed dentists including those registered as general practitioners and specialists, and the survey received 858 responses. The survey’s results are posted at

Dr. Theurer
Dr. Theurer

According to Dr. Scott Theurer, chair of the Council on Dental Practice’s Practice Management Subcommittee, adding EFDAs can often be easier than expected.

“Dentists might think that integrating dental assistants with special training and credentials into the office workflow will be a challenge,” he said. “In reality, integrating those team members and knowing what procedures can be delegated is as easy as reviewing the state’s dental practice act.”

Reviewing the state’s dental practice act is “an easy and important step since the delegation of duties and the requirements for training, education and credentialing for EFDAs vary by state,” Dr. Theurer said.

“Delegating additional allowable duties to EFDAs can be a win-win for everyone,” said Dr. Theurer. “EFDAs feel valued and have an increased sense of professional pride when they can use their additional skills to improve patients’ oral health. These positive feelings can help patients feel more connected to the team and happy with the treatment and care they receive.”

EFDAs are addressed in current ADA policies. The Comprehensive Policy Statement on Allied Dental Personnel, last amended in 2010, states that “additional tasks, services or capacities, often including direct patient care services … may be legally delegated by a dentist to allied dental personnel. The scope of expanded functions varies based on state dental practice acts and regulations but is generally limited to reversible procedures which are performed under the personal, direct or indirect supervision of a dentist. Authorization to perform expanded functions generally requires specific training in the function.”

A 1996 policy, New Clinical Responsibilities for Dental Assistants,urges its constituents to develop new clinical responsibilities to become available to dental assistants … to be performed under the direct supervision of the dentist.”