Exploring a New OPA EFDA Through a Pilot Project I


n April 2023, the Missouri Dental Board passed the allowance of an Oral Preventive Assistant Pilot Project coordinated by the Mis- souri 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. The results of the pilot proj- ect will be reported to DHSS through ODH and other oral healthcare stakeholders in the state, and with proven safety and efficacy, will be offered for subsequent rule promulgation to allow new delegable duties. Creating an OPA EFDA position would build on the proven approach of allowing dental assistants, under direct supervision, to as- sist with restorative, orthodontic, and fixed prosthetic and removable prosthetic care. All OPA EFDA candidates would be required to satisfy the same prerequisite as other assistants wanting to pursue EFDA cer- tification, and must successfully complete all online learning, including module quizzes, prior to matriculation into clinical training.


WHAT WOULD THE OPA EFDA DO?


Dental assistants who successfully complete all parts of the OPA EFDA curriculum and training (including prework, hands-on clinical sessions and competency exams) will be eligible (within the pilot pro- gram at approved clinical sites) to assist dentists and hygienists (under direct supervision) with:


• Documenting periodontal probe readings and bleeding spots. • Supragingival scaling, limited to patients diagnosed as periodon- tally healthy or with gingivitis.


By performing these and other clinical skills that alleviate the simpler but time-consuming tasks typically associated with a hygienist’s daily workflow, we hope this will allow dental hygienists (and dentists) the time necessary to practice at the top of their scopes to provide care. It should be noted that if a patient is diagnosed as outside of periodon- tally healthy or with gingivitis, they can only be seen for the initial di- agnostic exam and no proposed delegated functions can be performed by an OPA for that patient thereafter.


OVERVIEW OF OPA EFDA MODULES


The OPA EFDA curriculum is a comprehensive suite of educational modules. The opening modules will require assistants to review and reacquaint themselves with fundamental principles. The subsequent modules will prepare assistants for the delegable functions with required hands-on clinical sessions and competency exams. Some modules (such as Modules 10-11) offer additional education and train- ing on procedures already delegable to all dental assistants (no EFDA certification required).


The curriculum workgroup, comprised of practicing dentists and dental faculty, has consulted existing, similar curriculum from Indian Health Services, among other texts and sources. The curriculum will be presented to the Missouri Dental Board at its October meeting, for review and approval to formally commence the pilot. As with all EFDA


Dentist In Relation to the OPA PilotTe Dental Team


Tis is a basic hierarchal flow of dental team members in Missouri, including the Oral Preventive Assistant – a new type of Expanded Function Dental Assistant – whose creation is being proposed through a workforce pilot study. Below is more specific information about the dental team roles.


DENTIST


EDUCATION – Graduate of an accredited dental school; dental specialty degrees require additional education. Licensed to practice by the Missouri Dental Board.


ROLE – Provides diagnosis and treatment plan for a patient. A dentist can then delegate this treatment to other members of the team, depending on the type of treatment and supervision required. Delegation of treatment also depends on a team members’ license or permit that specifies scope of practice (what they are allowed to do).


SUPERVISION – A dentist is not supervised but provides various types of supervision to others on the dental team.


CAREER – A dentist may have been a dental assistant and/or dental hygienist before receiving their dental degree.


DENTAL ASSISTANT


EDUCATION – Formal education program or on-the-job training (OJT). Formal programs vary in length. Credentials may be obtained (such as Certified or Registered Dental Assistant) but neither ensures more dental care may be performed versus OJT.


ROLE – Assists dentist to carry out treatment plan for patient, but with the most limited scope.


SUPERVISION – May work only under the direct supervision of the dentist and may not be delegated care that requires an EFDA permit.


CAREER – Dental Assistants provide many valuable services. However, without EFDA upskilling a Dental Assistant is limited in the types of care they may assist with. Tis role is important as an entry into careers within the dental profession, and additional continuing education and certification opportunities are available.


LEADS TEAM IN PATIENT DIAGNOSIS, TREATMENT PLANNING & DELEGATION


Dental Hygienist


DELEGATION & SUPERVISION OF HEALTHY PERIO CARE + ADVANCED PERIO CARE


Expanded Functions Dental Assistant – INCLUDES OPA PILOT PROJECT –


ADDITIONAL CERTIFICATION & PERMIT + NEW OPA TYPE WOULD ADD CAPACITY


Dental Assistant DENTAL HYGIENIST


EDUCATION – Graduate of an accredited dental hygiene program. Licensed to practice by the Missouri Dental Board.


ROLE – Assists dentist to carry out treatment plan for patient, especially periodontal care.


SUPERVISION – May work under direct, indirect or general supervision of the dentist, depending on the treatment being delegated.


CAREER – Dental Hygienists sometimes become dentists. Dental Hygienists also can obtain one or more Expanded Functions permits to provide that specific type of care, in addition to their typical role in periodontal care.


EFDA (EXPANDED FUNCTIONS ASST)


EDUCATION – Pass an EFDA course for specific type of care and have Missouri Dental Board permit, plus dentist delegation to provide expanded functions. To attend any EFDA course, assistant must have passed a prerequisite exam.


ROLE – Assists dentist to carry out treatment plan for patient. An EFDA may have one or more permits for five types of care: Restorative I (basic fillings), Restorative II (advanced fillings), Removable Prosthetics (dentures), Fixed Prosthetics (crowns and bridges) and Orthodontics (braces).


SUPERVISION – May work only under the direct supervision of the dentist.


CAREER – EFDAs may become dental hygienists or dentists. Typically, an EFDA has one or more permits they use in a general dental practice, or they may use a specific permit in a specific practice type, such as those limited to Orthodontic or Prosthodontic specialties.


ENTRY LEVEL TEAM MEMBER WITH UPSKILLING OPPORTUNITIES


OPA (ORAL PREVENTIVE ASST)


EDUCATION – Because an OPA is a type of EFDA, completion of an Expanded Function course for this type of care. An OPA may or may not already hold other EFDA permits.


ROLE – Assists dentist AND hygienist to carry out treatment plan for patient, especially periodontal care.


SUPERVISION – May work under the direct supervision of the dentist OR hygienist.


CAREER – Te OPA is a new type of EFDA who will focus on periodontal care. Te OPA concept and pilot study is unique because it is suggested an OPA be able to work under the direct supervision of the dentist OR hygienist aſter a dentist has provided a treatment plan. Different from a hygienist who can care for patients with varying degrees of periodontal health, an OPA would be limited to assist in providing care to adults and children diagnosed as periodontally healthy or with gingivitis.


DIRECT SUPERVISION – Te dentist has authorized the procedure for a patient of record, remains in the treatment facility and evaluates the procedure prior to patient dismissal.


INDIRECT SUPERVISION – Te dentist has authorized the procedure for a patient of record and remains in the treatment facility while the procedure is performed.


GENERAL SUPERVISION – Te dentist has authorized the procedure for a patient of record and which does not require the physical presence of the dentist in the treatment facility during the performance of the procedure. Te patient must be informed that the dentist is not in the treatment facility and the authorization is valid only 12 months from the most recent examination.


PATIENT OF RECORD – One for whom the dentist has obtained a relevant history, performed an examination and evaluated the condition to be treated.


curriculum, the workgroup will continue to review and update the cur- riculum, especially as the pilot provides information and feedback.


• Introductory Modules – Overview/Introduction; Infection Control; Positioning


• Module 1 – Anatomy, Physiology and Morphology • Module 2 – Periodontal Etiology and Classification • Module 3 – Armamentarium • Module 4 – Maintenance and Sterilization • Module 5 – Oral Hygiene Instructions • Module 6 – Patient Assessment and Data Collection • Module 7 – Imaging & Evaluation • Module 8 – Using a Periodontal Probe, Principles & Techniques (proposed delegable functions) − Initial diagnostic periodontal probing depth and bleeding spot recording.


− Recall periodontal probing depth and bleeding spot recording on patients who have been classified healthy or with gingivitis.


• Module 9 – Supragingival Scaling (proposed delegable functions) − Use supragingival hand and ultrasonic scalers on healthy or gingivitis patients.


− Initial supragingival gross debridement in preparation for periodontal evaluation.


• Module 10 – Coronal Polishing • Module 11 – Placement of Sealants, Fluoride Varnish and Silver Diamine Fluoride


Find a full size version of the above chart and additional information about the OPA EFDA Pilot Project at modental.org/opa.


ISSUE 3 | FALL 2023 | focus 35


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