Oral Preventive EFDA

An OPA EFDA is an expanded function dental assistant role designed to help dental teams address workforce shortages and improve access to preventive care. In Missouri’s pilot project, the model evaluated the OPA EFDA as a trained team member who could safely provide limited preventive services for healthy patients and patients with gingivitis under supervision.

The purpose of the OPA EFDA model is not to replace dentists or dental hygienists. It is to help dental teams work more efficiently so dentists and hygienists can devote more time to patients with more complex needs while maintaining patient safety and quality of care.

An OPA is a type of EFDA who has completed additional education and clinical training to provide preventive services for patients who are healthy or have gingivitis. These services may include removal of supragingival calculus, coronal polishing, oral hygiene instruction, and fluoride application.

By performing these and other clinical skills that alleviate the simpler but time-consuming tasks typically associated with a hygienist’s daily workflow, the goal of an OPA EFDA is to allow dental hygienists (and dentists) the time necessary to practice at the top of their scopes to provide care.

Missouri’s pilot project demonstrated that training and supervision are central to the OPA EFDA model. The curriculum included classroom education, clinical simulation training, written and clinical examinations, and structured evaluation and mentoring during practicum training.

The OPA EFDA curriculum is a comprehensive suite of educational modules. The opening modules will require assistants to review and re-acquaint themselves with fundamental principles. The subsequent modules will prepare assistants for the delegable functions with required hands-on clinical sessions and competency exams. Some modules (such as Modules 10-11) offer additional education and training on procedures already delegable to all dental assistants (no EFDA certification required).

• Introductory Modules – Overview/Introduction; Infection Control; Patient & Provider Positioning
• Module 1 – Anatomy, Physiology & Morphology
• Module 2 – Periodontal Etiology & Classification
• Module 3 – Armamentarium
• Module 4 – Maintenance & Sterilization
• Module 5 – Oral Hygiene Instructions
• Module 6 – Patient Assessment & Data Collection
• Module 7 – Imaging & Evaluation
• Module 8 – Using a Periodontal Probe, Principles & Techniques (proposed delegable functions)
• Module 9 – Supragingival Scaling (proposed delegable functions)
• Module 10 – Coronal Polishing
• Module 11 – Placement of Sealants; Application of Fluoride Varnish & Silver Diamine Fluoride

The OPA EFDA model builds on Missouri’s longstanding, proven approach to expanded function dental assistant (EFDA) education and training.

The MDA has been a national leader in EFDA education for almost 30 years. Since 1998, MDA has developed and delivered expanded functions training programs that have helped dental practices improve efficiency while maintaining high standards of patient care. Today, five EFDA certifications exist within this established framework.

Building on this foundation, in 2023 the MDA began working with the Missouri Dental Board to develop a short-term pilot program to evaluate the OPA EFDA role. This model was specifically designed to address the needs of Missouri patients, particularly those in underserved and rural communities (which includes most Missouri counties), while maintaining the same emphasis on education, supervision, and patient safety that defines all EFDA training.

The OPA EFDA role represents a natural and thoughtful extension of an already proven system. National organizations, including the American Legislative Exchange Council (ALEC), have expressed support for this model as part of broader efforts to help states address dental workforce challenges.

Missouri launched its pilot project to evaluate whether OPA EFDAs could safely assist dentists and dental hygienists by providing preventive care for healthy patients and patients with gingivitis, helping expand access to care. The pilot was a collaboration among the Missouri Dental Board, the Missouri Office of Dental Health, and the MDA.

The study observed more than 1,600 patient visits. Key findings included:

• 9.6 / 10 average clinical performance rating from supervising dentists
• 9.8 / 10 average patient satisfaction rating
• Zero adverse incidents
• No patient complaints reported
• Evidence of increased clinic capacity in clinics with higher OPA EFDA deployment

The pilot examined three core questions: whether OPA EFDAs could provide safe and effective preventive care, whether the role could improve clinic capacity, and whether sharing routine preventive care could allow dentists and hygienists to spend more time on patients with more serious periodontal needs.

The findings were encouraging. Safety outcomes were excellent, patient experiences were highly positive, and clinics with greater OPA EFDA deployment showed measurable capacity gains. Deployment during the pilot was limited due to study parameters, including restricting participation to existing full-time clinic employees and allowing OPA EFDA duties only when staff could be released from other responsibilities. Even with those constraints, the pilot demonstrated the model’s promise as a part of workforce solutions.

Missouri faces significant oral healthcare workforce shortages, especially in rural communities and clinics serving Medicaid-eligible patients. These shortages can lead to long wait times and reduced access to preventive care.

The OPA EFDA model matters because it can help dental teams expand appointment availability, reduce wait times, and better align team members with the care they are trained to provide. In this structure, healthy patients and patients with gingivitis can receive routine preventive services from a properly trained and supervised OPA EFDA, while dentists and hygienists can focus more attention on patients with more complex periodontal or restorative needs.

Importantly, Missouri’s pilot did not show a tradeoff between expanded team efficiency and patient safety. Instead, it showed that with proper education, evaluation, and supervision, the model can maintain the standards patients expect while helping practices serve more people.

Missouri’s findings are also consistent with earlier workforce research. Studies of similar periodontal assistant roles have found that these providers can contribute to approximately 23–33% of dental clinic appointments involving healthy patients or patients with gingivitis. A study conducted by Johns Hopkins University for the U.S. Indian Health Service found that deploying periodontal EFDAs full-time increased services delivered by 12.1% and access to care by 25%.

Together, this body of research suggests that broader deployment of OPA EFDAs could meaningfully improve access to preventive care.

Missouri’s pilot project provides clear, Missouri-specific evidence that OPA EFDAs can deliver safe, high-quality preventive care within a structured model of training and supervision. Clinical performance and patient satisfaction were exceptionally high, with outcomes comparable to care provided by dentists and hygienists.

The findings support a consistent and evidence-based conclusion: the OPA EFDA role is a safe, effective, and needed addition to the dental team. This model strengthens (not replaces) existing providers, allowing dentists and hygienists to practice at the top of their licenses while expanding access to preventive care.

Importantly, these results were achieved under real-world conditions, not ideal scenarios. Even with limited deployment, clinics experienced improved efficiency and increased access to care—demonstrating the model’s potential to meaningfully address workforce challenges across Missouri.

Across Missouri, especially in rural communities, patients often wait months for routine preventive care. At the same time, dental teams are forced to make difficult decisions: prioritize preventive care or treat more complex conditions first, knowing delays in either direction can negatively impact patient health.

The OPA EFDA model helps restore balance. By allowing trained team members to provide preventive services for healthy patients and those with gingivitis, dental practices can expand appointment availability, reduce wait times, and ensure patients receive care before small concerns become more serious problems.

This approach also reflects the realities of today’s workforce. Recruiting dentists and hygienists remains challenging in many areas, while upskilling dental assistants through proven EFDA training programs offers a practical, efficient path to strengthening the care team. With additional training, these team members can support preventive care needs while maintaining the same standards of safety and supervision demonstrated in Missouri’s pilot.

The impact extends beyond individual practices. When patients can access timely care, they are less likely to miss work or school due to urgent dental issues. When dental teams operate more efficiently, practices can serve more patients and remain strong contributors to their local communities.

At its core, the OPA EFDA model is about improving access, supporting the dental workforce, and strengthening the health and vitality of Missouri communities.

The Missouri pilot provides a credible, state-based model to inform next steps in strengthening the dental workforce. As Missouri considers implementation, including potential rulemaking, the findings offer a strong foundation for thoughtful integration of the OPA EFDA role into dental practice.

Broader deployment has the potential to significantly expand access to preventive care, particularly in rural communities and clinics serving Medicaid-eligible populations where workforce shortages are most acute.

The MDA remains committed to working collaboratively with the Missouri Dental Board, the Department of Health and Senior Services, and other stakeholders to ensure any framework is implemented safely, effectively, and in the best interests of patients and the profession.