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. 

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.

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. 

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.

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.

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: 
  • Selecting Dental Loupes 
  • Are Loupes Loopy

• 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.