A National Analysis of Factors Associated with the Prevalence and Practice of Expanded Function Dental Assistants in the United States

Background The scope and regulation of expanded function dental assistants (EFDAs) vary according to state. The authors explored predictors of EFDA workforce participation rates and quantified EFDA regulation, delegation patterns, and perception nationally. Methods The authors applied a cross-sectional design using secondary data collection and 2 online surveys to dentists (n = 558) and dental assistants (n = 1,016). Licensed dentists and dental assistants working in a dental practice in the United States were eligible to participate. Results In states with registered EFDAs, nearly one-half (46.9%) had low EFDA rates. More established EFDA levels were associated with higher EFDA rates. Dentists delegated preventive functions to dental assistants frequently, but only 32.9% delegated direct restorations. Delegation depended on both environmental and personal factors. Dentists were approximately twice as likely to delegate direct restorations if they felt it saved them time, nearly 12 times more likely to delegate in states with function-specific certificates (compared with states without EFDA registration), and more than 4 times more likely to delegate in public health settings than in dental support organizations. Overall, both regulations and workplace environment strongly influenced how much responsibility dentists gave to dental assistants. Conclusions EFDAs represent a valuable, yet underdeveloped, component of the dental workforce. There are opportunities to increase EFDA rates and delegation. Although this study has limitations, the authors point to key considerations and opportunities for future workforce development and research. Practical Implications States aiming to introduce or expand EFDA roles should collaborate with associations and schools to provide EFDA training, guidance on how to fully use EFDAs, and information on the associated productivity benefits.