Preparing for Success

Dental Auxiliaries

Prerequisites & Experience

Missouri rule states that to be eligible to take Expanded Function courses, assistants must have proof of certification as a  Certified Dental Assistant (CDA) or a Certified Orthodontics Assistant (COA) or proof of passing the Missouri Dental Assisting Skills (MDAS) exam. 

The Dental Assisting National Board (DANB) offers testing and certification for the three pathways for EFDA course eligibility (learn more). While DANB has specific study guides and recommendations for the CDA/COA exams, there is no specific study guide for the Missouri Dental Assisting Skills exam. Fortunately, the MDA has an in-person Basic Skills Review course that assistants can attend to assist in successfully passing the Exam.

Once a candidate has successfully passed one of these required exams, they may register for courses.

Specific to the Restorative II Course, MDA requires assistants have a Restorative I Permit as an additional prerequisite for registration. While these prerequisites are required, there are other things dentists and assistants can do to help ensure success at the course and to ensure the assistant is better prepared to begin being delegated expanded functions safely, efficiently and effectively.

As best practice, the MDA recommends assistants who are considering attending EFDA courses have at least one to two years on-the-job training before seeking EFDA certification.

EFDA training begins with understanding the terminology of clinical dentistry. Words are the key to how we effectively relate to one another professionally, and the best preparation and coaching involves bringing the EFDA candidates (and new EFDA graduates) fully into the conversation of the ideals of the delegated procedures and how their product either meets or falls short of those ideals. Learn more about preparing for success.

Auxiliary's Professional Responsibility

Complaints regarding work that was delegated to an EFDA could result in the supervising dentist's license or EFDA's permit 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, and for which a permit has been issued by the Missouri Dental Board. 
  • 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.
    • Direct Supervision is 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 (all supervision definitions can be found here, page 3).
  • The EFDA should request to be monitored by the supervising dentist 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 whom she/he has performed delegated procedures until the finished procedure has been evaluated and approved by the supervising dentist who delegated the procedure.


Helping Your Assistant Prepare

As the supervising doctor for an EFDA candidate, you play an important role of engaging with your assistants as they progress through the online learning process and coaching them through pre-clinical exercises, such as restoring preps  or Restorative courses and fabricating custom trays for Removable Prosthetics. 

Supervising dentists should begin their participation at or before the time a team member registers for an EFDA course. MDA suggests dentists become familiar with the EFDA course content, including online review materials and the clinical skills that will be taught and tested. Have your assistant observe these procedures in practice and ask questions and discuss the skills standards to ensure confidence in the assistant’s readiness for the EFDA course. 

Expectations of a New EFDA

EFDA training is designed to bring participants to pre-clinical competence in performing dental procedures. Through the courses, assistants will be practicing skills on models, with their performance evaluated accordingly. Upon completion of  the training, assistants will be minimally competent in performing expanded function skills and must demonstrate the ability in practice to successfully perform these same procedures on patients, under the supervision of their dentist. 

EFDA training gives assistants a fundamental knowledge of the procedures that they will be performing. A doctor shouldn’t expect that the assistant will come back ready for full speed the first day. In fact, EFDAs aren’t allowed to legally perform the functions they have just been certified on until they receive their permit from the Missouri Dental Board.

Doctors must realize the main part of the EFDA training will be in their offices after the course. Take your time; explain to your assistants why they do each step that they are doing. A good idea for the first several patients for each procedure is to act as an assistant to the new EFDA. 

Be a positive coach during the learning process. Speak your vision for the future team functioning and indicate your confidence in the skills of your new EFDA. Positive coaching enrolls the team and patients in welcoming the advancement in provision of care. 

Dentist's Professional Responsibility

Since the inception of the EFDA curriculum in 1998 — and especially since Restorative II was passed by the Dental Board in 2014 — the MDA EFDA Committee has as its primary concern protecting the public through proper delegation of the EFDA duties.

It is the responsibility of the supervising dentist to determine if an EFDA in their practice can successfully complete, to the standard of care, the procedure being delegated. This ensures the safety and care of the patient and the quality of the procedure provided by the EFDA.

Regarding all delegable Expanded Functions, it is important to note:

  • A dentist is NOT required to delegate any expanded functions. 
  • Supervising dentists (under their professional license) are responsible for all patient care, whether rendered by the dentist or by an EFDA under Direct Supervision. 
    • Direct Supervision is 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 (all supervision definitions can be found here, page 3).
  • Supervising dentists are responsible for determining the appropriateness of delegation, as the dentist considers the EFDA’s skill level, task difficulty and nature and condition of the patient. 
  • Supervising dentists should always check the work of the EFDA before releasing the patient. Therefore, it is highly recommended doctors continue working with an EFDA after the clinical course completion and only delegate procedures when the EFDA’s delivery and standard of care matches that of the dentist.

Clinical Aides

Modern Dental Assisting eBook

Modern Dental Assisting is the official textbook recommended by the MDA EFDA Program for all courses offered. We recommend assistants own a personal copy or have a dental office copy they can access for additional information related to topics discussed and procedures shown. Where applicable throughout the curriculum, the Modern Dental Assisting reference will be noted.

To facilitate assistants/supervising dentists owning this text, the MDA offer Modern Dental Assisting as an eBook for a reduced price. This has been negotiated with the book publisher, Elsevier, so that we may provide EFDA students with this excellent resource to assist in study for the course preparation, but also to accompany their life-long learning in the dental profession.

Click for an order form to purchase the Modern Dental Assisting eBook.

Dental Loupes

Visual sharpness is imperative to accomplish acceptable restorations for assistants being delegated Expanded Functions. Dental loupes—preferably with a light—are highly recommended for accomplishing the small, detailed work of restoring, finishing and polishing restorations.

  • Loupes are available from 2.0X to 6.0X magnification. Many operators are comfortable with2.5X; others prefer greater, such as 3.5X. A magnification greater than 3.5X is less likely to be as adaptable as your first pair of loupes.
  • Online prices of loupes, including an LED light and battery pack, can range from $55 to more than $1,500.
  • Consult with your dentist about a loupe purchase, and for additional information, you may read one of these recent Focus magazine articles on the topic of loupes: 

Typodont Mounts, Indirect Vision & Mouth Mirrors

For some courses, such as Restorative II, during both the clinical session and competency exam, procedures will be performed on the typodont that has been mounted on a dental chair.

When you enroll in a Restorative II course, along with a typodont, you will receive a numbered chair mount for your use during the pre-work period and the course and exam. You are required to bring the chair mount with you when you attend your clinical course and exam. It is to be returned to the trainer at the completion of the exam. If the mount is not returned, you will be responsible for the cost.

  • Students are required to use a mouth mirror to perform maxillary restorations with indirect vision.
  • Students will want to practice the prework restorations in the same manner. They will not be able to work on the typodont that is opened up on a flat surface.
  • Most practices will have some type of mounting system that can be utilized in the same way.
  • If you would like to purchase a mount for your practice, you may do so at this link. We have compared other product sites and have found this mount to be the most affordable.