WORKFORCE


LEARN MORE ABOUT THE OPA-EFDA PROJECT AT MOEFDA.ORG/OPA


Serving More Patients In Missouri Dental Practices: How Much Could


OPA-EFDA Really Help? A recently published study of a new dental worker, an Oral Preventive Expanded Function Dental Assistant, looks at how the new worker did and explores if this new worker can really help dental practices serve more patients.


by GUY DEYTON, DDS M


issouri is trying to solve an oral healthcare workforce problem: there aren’t enough dentists and hygienists to take care of Missouri’s population.


The Covid-19 period from 2020–2023 made the problem worse when 5–10% of Missouri’s oral healthcare workforce exited.1


Patients are


waiting too long for appointments, especially in rural clinics and clinics serving Medicaid patients. Missouri decided they needed to think outside the box. They borrowed the concept of a dental worker from the Indian Health Service (IHS): a periodontal expanded function dental assistant. It just so happens that the IHS has been successfully training and deploying periodontal assistants in their clinics in workforce shortage areas for 47 years.2


Missouri calls its worker an Oral Preventive Expanded Function Dental Assistant; OPA-EFDA or OPAs for short. Missouri decided to develop its own training, educate a cohort of OPAs, and conduct a structured study analyzing the performance outcomes from a clinical and patient’s perspective. The hypothesis of OPA-EFDA study is that OPAs could assist in care of patients in rural and safety net dental clinics, where the workforce shortage is most acute. OPA’s scope includes assisting triage of patients in entry appointments, treating healthy patients for check-ups, and treating gingivitis patients that just need a good cleaning and some home hygiene coaching.


What does that mean in terms of creating more opportunities for patients to get dental care? The Missouri OPA-EFDA Pilot Project and a bit of research can answer that question.


OPA-EFDA STUDY OUTCOMES3


• 16 OPAs were trained using 10 didactic modules, a written exam, and a two-month clinical practicum. One OPA did not participate in the study due to medical leave.


• 15 OPAs practiced in 7 clinics for 8 months and were compared by patients and clinical supervisors to performance by dentists


18 focus | SPRING 2026 | ISSUE 1


and hygienists treating the same diagnostic group of patients.


• Dentist clinical supervisors graded OPAs global clinical performance as 9.6 out of 10 (excellent-strongly exceed expectations). In-depth details of the performance evaluations are in the full report.


• Patients graded OPAs equal to or slightly better than dentists and hygienists, grading them as a 9.7 out of 10.


• No adverse consequences or patient complaints were reported in 1,623 procedures.


WILL OPA-EFDAs ALLOW MORE PATIENTS TO RECEIVE DENTAL CARE?


The study didn’t fully answer that question because it was a pilot project and deployment of OPAs was limited to about 5–10% of a full-time worker. However, the study did collect enough information to extrapolate the impact OPA-EFDAs could make on available appointments, particularly in rural and Medicaid clinics that are most severely impacted by workforce shortages.


OPAs scope allows them to help clinics in three specific ways. OPAs can: participate in triage of new patients, provide preventive services for healthy patients, and provide interventional care for gingivitis patients.


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