The Dentist delegating to an EFDA has the responsibility of direct supervision. While a dental team member MAY have one or more Expanded Function permits that allow for the delegation, the supervising dentist IS NOT required to delegate any expanded functions.
The following is the definition of direct supervision from the Missouri Dental Practice Act. This can be found in Chapter 2, page 3 of the Missouri Dental Board General Rules.
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.
The following are the responsibilities of a supervising dentist with an EFDA in practice (Chapter 2, page 10 of the Missouri Dental Board General Rules).
- 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, and nature and condition of the patient.
- If a dentist wishes to delegate expanded functions to an assistant, he or she must display the any and all assistants' Expanded Function permit(s) in the office for which they are delegation procedures under.
- Review the course outline and the skills taught. Have your assistant observe these procedures in practice and ask questions.
- Review the Skills Standards Evaluation for the course modules. These are the skills that will be graded in the EFDA clinical course. We encourage doctors and assistants to discuss these skills to ensure both feel confident about the assistant's readiness for the EFDA course.
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 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.
- 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.
Expanded function dental assistant 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 the "basics" 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 that 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.
Efficiency and productivity are two parameters that can be used to define a successful dental practice. Dental assistants can help maximize efficiency and productivity. Maximizing auxiliaries' skills will allow the dentist to become more efficient, more productive, and even enjoy dentistry more.
- Read an article printed in the MDA Focus, September/October 2014, (read online or download PDF) that covers a variety of topics, including preparation for success, comments about the Restorative II curriculum, an overview of supervision and more.
- Read a DentistryToday.com article by Dr. Howard Hopenwasser where he discusses a step-by-step approach to increase your efficiency and at the same time reduce your stress level, by delegating to an EFDA.
332.011 Definitions, Expanded-functions dental assistant
332.093 Practice as a dental assistant defined
332.098 Expanded-function duties, delegation of (requirements, rule-making authority)
Expanded Functions Rules
CSR 2110-2.120 - Dental Assistants
20 CSR 2110-2.130 - Dental Hygienists