Expanded function dental assistants (EFDAs) have been available for over 50 years but remain significantly underutilized across US dental practices due to varying state regulations and limited delegation by dentists. Research shows that implementing EFDA training programs, establishing function-specific certificates, and improving collaboration between states, dental associations, and schools could dramatically increase workforce productivity and address dental care shortages.
- Nearly 47% of states with registered EFDAs have low participation rates, indicating widespread underutilization of this workforce resource.
- Dentists in states with function-specific certificates are 12 times more likely to delegate tasks to dental assistants compared to states without registration.
- Only 32.9% of dentists delegate direct restorations to dental assistants, though many more frequently delegate preventive functions.
- Dentists who believed EFDA delegation would save time were twice as likely to delegate direct restorations, showing time savings drive adoption.
- Collaboration across organizations, state regulations, and provider networks is essential to transform EFDA roles from theoretical positions into an actively utilized workforce.
Expanded function dental assistants (EFDAs) may have been introduced more than 50 years ago, but they remain an untapped part of the dental workforce in the U.S., according to a study published September 6 in the Journal of the American Dental Association.
By incorporating EFDA levels into dental practice operations and workflows, dental practices can better the workforce volume, rates, and use for these professionals, the authors wrote.
“States aiming to introduce or expand EFDA roles should collaborate with associations and schools to provide EFDA training, guidance on how to fully use EFDAs, and information on the associated productivity benefits,” wrote the authors, led by Hanna Aronovich of the Dental Assisting National Board in Chicago.
In the U.S., the scope and regulation of EFDAs vary depending on the state in which they work. Therefore, the picture of the U.S. workforce is unclear.
To better understand predictors of EFDA workforce participation rates and delegation patterns, the researchers conducted a study using two online surveys and secondary data collection. For the surveys, 558 dentists and 1,016 dental assistants in the U.S. participated.
Almost one-half (46.9%) of states with registered EFDAs had low EFDA rates. Overall, regulations and workplace environment firmly affected the level of responsibility dentists gave to dental assistants, the authors wrote.
Although dentists delegated preventive functions to dental assistants frequently, just 32.9% delegated direct restorations. Environmental and personal factors drove the delegation of these duties. Those dentists who believed it would save them time were about twice as likely to delegate direct restorations, they wrote.
Dentists in states with function-specific certificates, versus states without registration, were 12 times more likely to delegate duties. In comparison to dentists in dental service organizations, clinicians in public health environments were more than four times likely to delegate to dental assistants, the authors wrote.
Nevertheless, the study had limitations. For this study, all 50 states were included, however, some of the analysis was limited to states with EFDA registration data, which may limit generalizability, the authors wrote.
“Collaboration across organizations and providers is essential for translating an EFDA level ‘on paper’ into a robust workforce that is widely used,” Aronovich and colleagues wrote.
