Expanded Function Dental Assistant Toolkit

Description of Tools

Journal Article: Expanded Function Dental Auxiliaries and Dental Practice Productivity and Efficiency


This study published in the Journal of Dentistry Education examines the impact of expanded function dental auxiliaries on the productivity and efficiency of general dental practices.

Conclusion: This study of 154 general dental practices in Colorado indicates that the majority of sample practices are assigning many reversible services related to the provision of operative and prosthetic services to EFDAs. In contrast, relatively few practices use dental hygienists to provide local anesthesia. The impact of delegation on practice productivity and efficiency are substantial. As delegation increases, practices see more patients and generate higher gross billings and net incomes. Larger practices (e.g., more dentist and staff hours and space) are the primary employers of expanded function dental auxiliaries.

Click here to download the full article.


An Economic Study of Expanded Duties of Dental Auxiliaries in Colorado

By: Tryfon Beazoglou, PhD, L. Jackson Brown, DDS, PhD, Subhash Ray, PhD,
Lei Chen, MA, Vickie Lazar, MA, MS
This study was published by the American Dental Association as a part of their Dental Health Policy Analysis Series in 2009.

This study intended to quantify the relationship between delegation patterns and productivity; and therefore, capacity. The goal was to identify the most effective patterns of delegation, in terms of their impact on dental practice productivity. To do this, dentists were asked what treatment actions they delegated, the number of patients seen and procedures performed over a certain time period, the resources used to provide these services, and the gross billings generated. This allowed the researchers to calculate the effects on types and quantities of services delivered as well as the financial impact of different decisions about delegation on each dental practice.


Production: With respect to delegation, the estimates from the Cobb-Douglas regressions indicated that delegation in general, as well as delegation of specific procedures/activities to dental hygienists and assistants, has an important effect on gross billings, patient visits and value-added.

Efficiency: Similarly, delegating specific procedures/activities to dental hygienists and assistants has an important effect on the clinical (technical) efficiency of a general dental practice based on gross billings

Income: One of the most powerful effects of delegation seems to be on practice net income. The average difference in net income was over $100,000.

Click here to download the full report

Click here to download the report summary


Dental Assisting National Board Website

This website contains state-specific information on dental assisting job titles, recognition of DANB exams, allowed dental assisting functions and requirements: http://www.danb.org/main/statespecificinfo.asp.


Executive Summary: Position Paper of the ADAA/DANB Alliance: Addressing a Uniform National Model for the Dental Assisting Profession, September 2005

In November 2000, a joint committee of the American Dental Assistants Association (ADAA), the national membership association for dental assistants, and the Dental Assisting National Board, Inc. (DANB), the nationally recognized and accredited dental assisting testing and credentialing organization, initiated a four-phase study of dental assisting core competencies. The goal of the study was to rank dental assisting tasks from most basic to most complex and to classify these tasks into clearly delineated categories or task groupings, each associated with a pre-defined level of education, training, and experience. In classifying these tasks, the joint committee, known as the ADAA/DANB Alliance, sought to create a unified set of definitions related to dental assisting tasks, career levels, and educational/training/credentialing requirements and to lay the foundation for nationwide acceptance and recognition of a uniform national model for the dental assisting profession.

The ADAA/DANB Alliance discusses the findings of this study and the implications of those findings in the Position Paper of the ADAA/DANB Alliance Addressing a Uniform National Model for the Dental Assisting Profession.1 This Executive Summary will outline the issues addressed in the ADAA/DANB Alliance’s position paper, including the factors affecting current dental assisting practice, the findings of the DANB/ADAA Study to Define and Rank Core Competencies for Dental Assistants, and the implications of the study’s findings as they relate to the profession of dental assisting, the delivery of oral healthcare services, and the health and welfare of the public. (See Appendix A for the Table of Contents of the complete Position Paper of the ADAA/DANB Alliance Addressing a Uniform National Model for the Dental Assisting Profession.)

Click here to download the executive summary of the position paper.

Click here to download the full position paper


Current Initiatives for Expanded Duties for Dental Assistants

This PowerPoint presentation contains an overview of DANB as well as employment statistics for dental assistants. Additionally, it presents an overview of state trends related to non-dentist dental professionals. The DANB model for the Expanded Function Dental Assistant (EFDA) is presented, including a history of the position, description of duties and an overview of the Colorado experience. According to the presentation, DANB believes that

  • Passing various state mid-level provider laws is not the only way, and likely not the best way to address access to quality oral healthcare
  • A uniform national model for an expanded functions dental assistant is possible
  • Such a model will enhance Public protection
  • Dental assistant mobility and thus intrastate reciprocity Dental practice efficiency

Click here to download this PowerPoint presentation.

The Role of the Expanded Functions Assistant

"As an assistant with 30 years of experience who dearly loves her profession, the EFDA program allows me to spread my wings."

Click here to read the full article.


ADA Synopsis of state laws regarding the use of Dental Assistants

This chart, developed by the ADA provides an overview of each state’s practice laws related to expanded functions/duties allowable for various levels of dental assisting certifications/qualifications. The chart includes expanded functions, certification requirements and supervision. The chart relates each state's job titles to the standardized DANB job titles for dental assisting.

Click here to download the chart.


Scope of Practice Legislative Examples

As states address the issue of scope of practice efforts on behalf of the hygiene community, state dental associations and other interested parties sometimes benefit from making a scope of practice request to their state's office of licensing and professional regulation. This is a regulatory process - not a legislative one. The following documents were presented to the Connecticut Practitioner Licensing and Investigations Section, Department of Public Health by the Connecticut Society of Pediatric Dentists (CSPD) in response to an effort put forth by the CT Dental Hygiene Association to broaden the scope of the practice of dental hygiene in the state. The CSPD developed two scope requests:

  • One in opposition to the scope of practice change proposed by the Connecticut Dental Hygienist Association (CDHA), which would allow for the implementation of a new model for the practice of dental hygiene called the Advanced Dental Hygiene Practitioner (ADHP) (available here), and
  • One which would increase the scope of practice for dental assistants in public health and private settings (available here).

Both documents contain information that is state specific and information that is relevant in any state. In order to obtain the background information helpful in constructing the requests, it is helpful to read and understand the state's oral health plan, which will allow you to address specific goals in the plan within the context of the scope request.


For additional information contact the Center's Assistant Director Robin Wright at rwright@aapd.org.