To determine the potential impact of OPA-EFDAs, the calculation is not complex. Simply calculate: • The portion of a clinic’s appointments necessary to be served by dental hygienists under the current workforce model.


• Subtract the portion of a clinic’s appointments devoted to peri- odontitis patients. Those patients are outside of OPAs scope of practice.


• Add in the portion of a clinic’s appointments devoted to on- boarding new patients. Those patients are within OPAs planned scope of practice because collection of periodontal diagnostic information is often the bottleneck in onboarding new patients in areas of workforce shortages.


CALCULATION


Step 1. Research the percentage of dental clinic appointments al- located to dental hygienists in the current workforce model.


Safety-net clinics like FQHCs and CHCs maintain the best data- base for researching the percentage of dental hygiene appointments relative to total clinic appointments. The outcomes of the research demonstrate the strain between what clinics believe is required and what is actually occurring due to workforce shortages. • Benchmarking planning sessions held by CareQuest, Koday Consulting, and the North Carolina Community Health Center Association indicate the safety-net clinics aspire to a ratio of 30–38% of dental hygiene visits to total appointments in order to provide both preventive care and interventional care for peri- odontitis patients.4,5,6,7


• Analysis of the 2024 HRSA Uniform Data System that records dental clinic information from FQHCs and CHCs shows that the ratio of dental hygiene appointments to total appointments was 20.4%. That’s a big gap between what is deemed necessary and what is really happening. The reason for the gap is workforce shortages. Those shortages are both numerical and geographi- cal.1,8


• A range of 20–30% for hygiene visits to total clinic visits is a realistic and appropriate metric for the purpose of estimat- ing the potential impact of OPA-EFDAs. This is perhaps a little short of the aspirational goals of FQHCs and CHCs, but 20–30% represents a realistic range of hygienist deployment that could be achieved with addition OPAs to the workforce to leverage the expertise of hygienists to see more patients.


Percentage of Periodontitis Appointments in Dental Safety Net Clinics that are Outside the scope of OPA-EFDAs: Reviewing the data from March–October of 2024 and 2025 of this pilot project for the seven clinics participating in the OPA-EFDA Pilot Project, delivery of periodontal services comprised 9% of all clinic appointments.3


Percentage of New Patient Onboarding Appointments in Dental Safety Net Clinics: Reviewing the data from March–October of 2024 and 2025 of this pilot project for the seven clinics participating in the OPA-EFDA Pilot Project, delivery of new patient onboarding proce- dures comprised 12% of all clinic appointments.3


Calculating the Percentage of Patients Appointments that OPA- EFDAs Could Contribute Care • Lower Boundary Calculation: Appointment Estimate = 20% - 9% + 12% = 23%


• Upper Boundary Calculation: Appointment Estimate = 30% - 9% + 12% = 33%


Answer: OPA-EFDAs should be able to contribute to between 23–33% of a Missouri dental clinic’s appointments.


CONCLUSION


• One OPA-EFDA per hygienist or dentist. Having an OPA-EFDA participate in 23–33% of clinic appointments would approximate the contributions of one FTE OPA-EFDA per hygienist or dentist.


• Four to 10 times the impact on clinic capacity and access than compared to the pilot study. That would equate to four times the impact on capacity of the three clinics that participated in the Pilot Project and demonstrated higher levels of deployment and 10 times the impact on clinic capacity for average of the seven participating clinics.


• The projected OPA-EFDA impact is consistent with published research in Journal of Public Health Dentistry. According to a 2025 article published in the Journal of Public Health Dentistry by Pang, “visits for any oral health service increased significantly with each additional [clinical] full-time equivalent (FTE) in all types of oral health staffing, ranging between 0.8–13.7% increase in visits per additional FTE added.”9


Because OPAs scope focus


on procedures associated with new patient intake, it is reason- able to believe that clinics utilizing OPAs would increase new patient intake in the upper range of Pang’s projection, a 5–13% increase in patient visits.


Dr. Guy Deyton is the Principal Investigator of the Missouri OPA-EFDA Pilot Project. He is a former Director for the Missouri Office of Dental Health, former Missouri Dental Board Member, MDA Past President, and retired practice owner and clinician. He has been involved with the MDA EFDA program since its inception, was integral to its development more than 30 years ago, and has since been an EFDA advocate and educator. Contact him at guydeyton@gmail.com.


BIBLIOGRAPHY


1. Missouri Oral Healthcare Report on Workforce. Missouri Office of Dental Health. February 2023


2. Deyton, G. Conversation with Dr. Tim Ricks, current chair of IHS Periodontal Treat- ment Initiative, Retired Chief Dental Officer of the US Public Health Service, Retired US Assistant Surgeon General. May 2, 2023.


3. Missouri Oral Preventive Expanded Function Dental Assistant (OPA-EFDA) Pilot Proj- ect Final Report. Missouri Dental Association, Health Policy Institute-American Dental Association. March 20, 2026


4. CareQuest Institute for Oral Health. (2019). Safety Net Solutions: Productivity Bench- mark Guide.


5. Beazoglou, T. Federally Qualified Health Center dental programs: Financial and prac- tice management trends. JADA 141(3), 289–295.


6. North Carolina Community Health Center Association. (2022). Defining Key Program Goals and the Plan for Succes. https://www.ncchca.org.


7. Koday, M. (2019). Operationalizing Dental. Dental Quality Alliance. 8. Health Resources and Services Administration (HRSA), Bureau of Primary Health Care. Uniform Data System (UDS) national data: Table 5–Staffing and utilization, dental services, 2024 [Internet]. Rockville (MD): HRSA; 2025 [cited 2026 Jan 29].


9. Pang J. Key factors associated with oral health services at federally qualified health centers. J Public Health Dent. 2025 Jun;85(2):113-124.


ISSUE 1 | SPRING 2026 | focus 19


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