Our Workforce Blog Series explores multiple areas that impact North Carolina’s oral health ecosystem, from programs that influence dentists to practice in rural communities to the implementation or expansion of dental hygiene and dental assistant programs at community colleges across the state.
This month, we’re taking a closer look at Expanded Functions Dental Assistants (EFDAs). EFDAs receive advanced education and training that allows them to perform more a broader range of clinical duties than dental assistants. To learn more about EFDAs, NCOHC sat down with Mrs. Genise Kelley, Director of Dental Operations at the Charlotte Community Health Clinic, a Federally Qualified Health Center (FQHC). Mrs. Kelley brings more than 20 years of experience in dentistry and has worked as both an EFDA and a prosthodontic dental assistant.
Genise Kelley, Director Dental Operations, Community Care Health Center
Mrs. Kelley began her dental career in the U.S. Navy, where her training allowed her to take on responsibilities similar to those of an EFDA before moving to Washington, D.C., where she spent more than 20 years as a prosthodontic dental assistant. Mrs. Kelley credits much of her professional growth to her time working with Dr. Markowitz, who gave his dental assistants opportunities to be actively involved in patient care. That hands-on experience, she said, deepened both her skills and her passion for dentistry because she was able to contribute more meaningfully to the patient experience rather than simply working from the sidelines.
What is the difference between an EFDA, DA I, and DA II?
Mrs. Kelley explained that dental assisting roles are typically tiered based on training, experience, and the procedures an assistant is qualified to perform. A DA I generally has more limited clinical responsibilities and may hold foundational certifications such as HIPAA compliance and radiology, but may not yet be trained in expanded functions such as coronal polishing. After completing additional requirements, including approximately 3,000 hours of dental assisting experience, an assistant may qualify as a DA II.
Becoming an Expanded Function Dental Assistant (EFDA) requires further education and clinical preparation. Depending on the state, EFDA programs may last roughly four to nine months and are generally available only to dental assistants who already have a specified amount of chairside experience. Mrs. Kelley also noted that requirements vary considerably from state to state, making the scope of the role different depending on where an assistant practices.
EFDA training can prepare dental assistants to take on a broader range of responsibilities and work with greater independence as part of the dental team.
GENISE KELLEY
How Does EFDA Education Expand the Dental Assistant’s Role?
When asked whether EFDA education prepares dental assistants to perform functions beyond those currently assigned to a North Carolina DA II, Mrs. Kelley’s answer was an enthusiastic yes! She explained that EFDA training can prepare dental assistants to take on a broader range of responsibilities and work with greater independence as part of the dental team.
The exact scope of practice depends on state law and regulations, but EFDAs may be permitted to provide additional hands-on patient care after the dentist has completed the portions of treatment that require their expertise. In some states, for example, EFDAs can perform restorative functions such as placing fillings—procedures that would generally fall outside the scope of a traditional dental assistant. This additional training allows EFDAs to take a more active role in delivering patient care while continuing to work under appropriate dental supervision.
Complementing the Entire Dental Team
Mrs. Kelley emphasized that adding an EFDA classification would be intended to complement—not replace—dentists, dental hygienists, DA IIs, or other members of the dental team. Instead, the role can help each team member make the best use of their training and expertise.
When appropriate procedures can be delegated to a trained EFDA, dentists are able to devote more of their time to diagnosing patients, developing treatment plans, and providing services that specifically require a dentist’s expertise. At the same time, EFDAs can continue providing delegated care, creating a more efficient workflow for both the practice and the patient. This team-based approach can help practices serve more patients each day, improve efficiency, and support stronger financial performance while maintaining appropriate oversight by the dentist.
Could an EFDA Classification Benefit North Carolina Practices and Patients?
From a practice management perspective, Mrs. Kelley believes an EFDA classification could benefit both dental practices and the patients they serve. With appropriate delegation, an EFDA may be able to continue certain portions of a procedure after the dentist has completed the work requiring their expertise, allowing the dentist to begin caring for another patient.
EFDAs can continue providing delegated care, creating a more efficient workflow for both the practice and the patient. This team-based approach can help practices serve more patients each day, improve efficiency, and support stronger financial performance while maintaining appropriate oversight by the dentist.
The inclusion of an EFDA classification and an increase of their delegable duties with appropriate training and dentist supervision would promote a team-based model that would allow dental practices, especially safety-net clinics, to use their workforce more efficiently, increase the number of patients they serve, and support the financial sustainability of dental practices. For patients, greater efficiency within the dental team could ultimately mean increased access to timely oral health services.
Building a Stronger Dental Workforce for North Carolina
For Mrs. Kelley, expanding opportunities for EFDAs is one potential strategy for addressing North Carolina’s broader dental workforce challenges, particularly in rural and underserved communities. She sees EFDAs as especially valuable to FQHC dental programs and other safety-net settings, where workforce shortages can limit the number of patients who are able to receive care.
Looking ahead, she believes North Carolina will need creative approaches to building the dental workforce, including introducing students to dental assisting careers at the high school level or before, creating clearer pathways into advanced dental assisting education, and considering incentives that encourage dental professionals to work in communities with the greatest need.
Expanding opportunities for EFDAs is one potential strategy for addressing North Carolina’s broader dental workforce challenges, particularly in rural and underserved communities.
Ultimately, addressing North Carolina’s oral health workforce shortages will require collaboration and innovation across the dental profession, education systems, policymakers, and communities. Expanding the roles and career pathways available to dental assistants is one opportunity to strengthen the entire dental team and help ensure more North Carolinians can access the oral health care they need.