The following are the 19 expanded functions as listed in the Missouri Dental Practice Act. The functions are categorized into one of the four EFDA courses (restorative, orthodontic, removable prosthodontics and fixed prosthodontics).
The EFDA courses are designed to teach concepts and theory related to these functions (through the didactic online portion) and to ensure skills competency (through the hands-on clinical portion) to certify assistants are capable of performing expanded functions to an appropriate standard of care.
- Placement of post extraction
and sedative dressings - Placing periodontal dressings
- Sizing stainless steel crowns
- Placing and condensing
amalgam, class I, V & VI - Carving amalgam
- Placing composite, class I, V & VI
- Polishing the coronal surfaces
of teeth with an air polisher - Minor palliative care of dental emergencies (sedative filling)
- Minor palliative care of orthodontic emergencies (bend/clip wire; remove broken appliance)
- Preliminary bending of archwire
- Removal of orthodontic bands
and bonds - Final cementation of permanent appliances
- Making impressions for
removable prostheses - Placement of temporary soft liners in removable prostheses
- Placement of retraction cord in preparation for fixed prosthetic impressions
- Making impressions for the fabrication of fixed prostheses
- Extraoral adjustment of fixed prostheses
- Extraoral adjustment of
removable prostheses - Bonding of orthodontic bracket
and bands
The following is the definition of direct supervision from the Missouri Dental Practice Act:
A level of supervision in which the dentist has authorized the procedure for a patient of record, remains in the treatment facility while the procedure is performed and evaluates the procedure prior to patient dismissal. Definitions Rule: 20 CSR 2110-2.001 (page 3)
The following are the responsibilities of a supervising dentist with an EFDA in practice (Rule 20 CSR 2110-2.120). Remember, a dentist IS NOT required to delegate any functions.
- The dentist must satisfy all requirements of direct supervision when delegating any task to a dental assistant.
- The dentist is ultimately responsible for all patient care, whether rendered directly by the dentist or by a dental auxiliary practicing under his or her direct supervision.
- The dentist is responsible for determining the appropriateness of delegation. Factors to be considered are: assistant skill level, task difficulty Aden nature and condition of the patient.
- If a dentist wishes to delegate expanded functions, he or she must keep a copy of the assistants' certificate(s) of competence on file in the office.
- If requested, the dentist must provide the dental board a copy of the dental assistants' certificate of competence for the specific expanded function in question.
Responsibilities of Direct Supervision: Rule: 20 CSR 2110-2.120
While the Missouri Dental Board does not directly regulate dental assistants, the dentist under whose supervision the dental assistant is working is ultimately responsible for all aspects of care the patient receives. Complaints regarding work that was delegated to an EFDA could result in the supervising dentist’s license being subject to disciplinary action. Assistants should adhere to the following parameters when performing expanded functions duties:
- The EFDA can perform only the specific functions for which she/he has received a certificate of completion through an approved Missouri Dental Board course provider.
- The EFDA can perform only the specific functions that are delegated by a licensed dentist, under said dentist’s direct supervision.
- The EFDA should not perform procedures alone for which she/he does not feel she/he has achieved an adequate level of competency/proficiency. The EFDA should request that her/his employer monitor the assistant while performing these procedures until the assistant and employer are satisfied with the assistant’s ability to perform procedures independently under direct supervision.
- The EFDA cannot dismiss a patient on whom she/he has performed delegated procedures until the finished procedure has been evaluated and approved by the supervising dentist who delegated the procedure.
Read the EFDA Rule from the Missouri Dental Practice Act (Begins page 9)