Program History

Member Contributions

Throughout the history of the MDA EFDA program, one thing is certain: The program would not be in existence, or furthered to its current state, without the tireless efforts of many MDA members who have dedicated their time and care to this program. From curriculum development and updates, hosting courses in their offices, traveling to be a trainer in other offices, as well as advocating for workforce upskilling and improvements, our MDA members dentists/EFDA trainers support and contribute to our EFDA programs on a daily basis. The MDA staff would absolutely not be able to offer these programs without their participation. For this, we express our sincere gratitude. 

Getting Started

The Expanded Function Dental Assistant (EFDA) program became a reality with the passage of the Dental Board Rule in September 1994, which allowed dentists to delegate 19 specific expanded functions to dental assistants who have approved training and have successfully passed competency testing.

Over a four-year period prior to 1994, the MDA Council on Professional Affairs and Laboratory Relations worked extensively to develop a master plan to not only bring about a rule change, but also, to provide the educational piece to make the program a reality. The Council spent numerous hours conducting focus groups with dental assistants, dental hygienists, dentists, and others to listen to all viewpoints about dental manpower shortages. A master plan was identified to proactively approach the problem before there was a crisis. The steps of the plan were:

  • Revise the rules regulating dental assisting to remove the legal limitations creating structural unemployment in the dental assisting field;
  • Create a career path for dental assistants that offered growth opportunities to practicing dental assistants and reduced the exit of talented dental assistants from the field;
  • Create an opportunity differential which allowed more highly trained dental assistants to be more economically productive;
  • Create a master plan that delivered the opportunity for advanced training to all geographic areas of the state of Missouri, so that any dental assistant who wished to advance would not need to leave the field to do so;
  • Develop accredited dental assisting training programs that would be traditional, geographic based programs and outreach programs using distance learning methodologies; and,
  • Recruit to these programs using member dentists.

Out of this strategic direction and with approval and support from the MDA House of Delegates, the EFDA rules and the Expanded Function Dental Assisting programs offered by the Missouri Dental Association were born. Program modules developed included orthodontic, restorative, periodontic and prosthodontic.

This was not something that occurred overnight. This took years, with an enormous amount of time and dedication to make this a reality, including education to the dental profession; legislative rule changes; development of pathways for dental assistants to become eligible for expanded functions; consent from the Dental Board to approve MDA as competency testing agents; acceptance and development of EFDA education in current dental assisting programs; the development of the four expanded functions modules that could be delivered in various sites around the state; the training of dentists to deliver the programs; and, the cooperation and persistence of many institutions (MDAA, UMKC, MDA, Dental Assisting Educators and others).

In 1998 the first pilot programs were delivered at UMKC, and grew to be offered at various locations throughout the state.

In Recent Years

At the January 2007 MDA Board of Trustees meeting, a resolution recommending amendment of the current Expanded Functions Rule was adopted. These recommendations on the EFDA rules were requested of the MDA by the Missouri Dental Board. The MDA met with the Missouri Dental Board Policy Review Committee later that year to further discuss the EFDA rules and workforce change proposals, and would continue to work for several years on this rule change.

Between the years of 2009-2012, the MDA, supported by the UMKC School of Dentistry, embarked to update the existing MDA EFDA Program Curriculum through a multi-year grant from the Missouri Foundation for Health (MFH). Those grant funds accomplished the following:

  • Updated the Curriculum from paper manuals to online curriculum, as well as an updated clinical course structure.
  • Increased the number and location of courses to train more doctors to teach the clinical curriculum.
  • Expanded the number of clinical training venues.
  • Expanded the number of EFDA trainees and provided tuition assistance

Finally, in February 2013, long-awaited new EFDA rules were promulgated, after many years of deliberation. The rule change had two major effects: it allows assistants who are properly trained and permitted in expanded functions to place and carve all classes of amalgam and composite restorations and assistants who have been previously certified in expanded functions will now have to receive a permit from the Dental Board in order to be delegated expanded functions procedures (formerly they only had to have a certificate of course completion).

Additionally, in 2013, the MDA received a new grant from MFH to create Restorative II curriculum for the newly promulgated rule. The MDA completed this project in the summer of 2014 and in August2014, the Missouri Dental Board approved the MDA's Restorative II Curriculum.

Today, the MDA offers all five expanded functions courses in an updated online environment and with updated clinical course processes. The MDA licenses courses to several CODA accredited dental assisting programs in Missouri.


Functions delegable to a dental assistant possessing a Missouri Dental Board-issued permit to perform expanded functions are divided into five categories: Restorative I, Restorative II, Removable Prosthodontics, Fixed Prosthodontics and Orthodontics. On September 30, 2022, there were slight changes to some of the categories and functions. 

Expanded Function courses, whether provided by the MDA or by a CODA-accredited dental assisting program, must provide teaching on the skills listed for each of the five categories. Five total courses are offered according to the category.

In April 2023, the Missouri Dental Board passed the allowance of an Oral Preventive Assistant Pilot Project coordinated by the Missouri Department of Health and Senior Services (DHSS) Office of Dental Health (ODH). The pilot project will examine the use of an Oral Preventive Assistant (OPA) Expanded Function Dental Assistant (EFDA) (herein referred to as OPA EFDA) to deliver preventive care, including supragingival scaling limited to patients who are diagnosed as periodontally healthy or with gingivitis. Learn more.