OPA EFDA Pilot Project

This Missouri Office of Dental Health (ODH) asked the Missouri Dental Board (MDB) at it's April 2023 meeting to support a pilot project to address the urgent workforce challenges and provide increased access to care.

The project will examine the use of an Oral Preventive Assistant (OPA) Expanded Function Dental Assistant (EFDA) (herein referred to as OPA) to deliver preventive care, including supragingival scaling on healthy patients. This document is intended to outline the reasons and supportive details for this consideration.

The shortage of dental health care workers, specifically the shortage of RDHs, is significant. The ODH has been examining this issue for more than two years and feels global decisions to increase care for the underserved, especially in rural populations, needs to be addressed immediately. Creating an OPA position would build on the proven approach of allowing dental assistants to, under supervision, assist with restorative, orthodontic and fixed prosthetic and removable prosthetic care. It would be conducted and measured within the statute allowing pilot projects to exist.

The results of the pilot project will be reported to all major stakeholders, including the Missouri Dental Board and the Missouri Department of Health and Senior Services through the Office of Dental Health.

Supporting Documents 

• Briefing: Post Pandemic Oral Healthcare Workforce in Missouri
• Missouri Oral Health Care Report of COVID-19 Impact on Workforce
• Missouri Dental Provider Distribution Maps

RSMo 332.325 allows for pilot projects to apply new methods of care delivery within small, scaled projects to address the needs of the underserved. Within the language, seven core competencies must be met to allow for examination of the project, including specific timelines and reporting. Read the following document for a further explanation.

• An Overview of the Oral Preventive Assistant (OPA) Pilot Project

• Dental assistants who complete the OPA curriculum and pass the written OPA qualifying exam, will then be eligible in the pilot program assist dentists and hygienists with:
  • Scaling supragingival calculus
  • Polishing teeth; and
  • Giving oral hygiene instructions.

• OPAs would work under direct supervision of a dentist or hygienist.
• OPAs would treat patients who are healthy or who have reversible gum inflammation, not patients with advanced gum infections.

• With Missouri’s significant shortage in dental healthcare workers, specifically hygienists and assistants, new approaches to deliver care are at a critical status, especially in rural areas.
• Having an OPA gives dentists another tool to manage their practice and deliver care efficiently.
• With the assistance of OPAs, dental hygienists and dentists will have more time to complete the complex procedures they have trained for.
• We need to provide an immediate solution to workforce challenges that utilizes the workforce we already have while we work to expand the RDH and DDS workforce.
  • ODH supports several workforce solutions, including increasing the number of schools and class sizes for hygienists in Missouri, but these solutions will take time.
  • Expanding the scope of current team members is a more immediate and less costly solution.

• Safety and patient care are our top priorities. That is why we are proposing that dental assistants complete an OPA didactic curriculum, pass a qualifying examination, and work under the supervision of a dentist or hygienist.
• The OPA will be supervised, and the patient checked before dismissal.
  • Allowing a trained assistant to scale will still be at the doctor’s discretion. As with other expanded functions, if the doctor is not comfortable delegating this, they do not have to allow it in their practice.
• Like any care provider, OPAs will require appropriate training for their scope of practice. We believe assistants can be trained to scale above the gum line safely, and this is what the pilot program will assess.
• We are proposing that dental assistants be trained to remove hard build up above the gum line on healthy teeth. The potential risks are far fewer than other tasks that assistants already perform. 
  • Under current law, assistants with proper training can trim fillings below the gum line with a high-speed handpiece or scalpel blade.
  • Assistants currently can utilize other sharp tools including scalpel blades, metal reduction discs and high-speed handpieces with burs.

• While OPAs would be new in Missouri, this is not a reinvention of the wheel. Other states and the U.S. military already allow assistants to practice scaling.
• Two neighboring states, Illinois and Kansas, have already implemented this change effectively.
  • There have been no reported incidents with assistants practicing scaling in these
    states.
  • The project is so successful, Kansas does not even track these very safe procedures.
  • As of last year, assistants in Illinois can work on children who are on Medicaid or are uninsured.
• The U.S. military has also allowed assistants to practice scaling for years.

• With the Missouri Dental Board support, ODH will seek to carry out the pilot program. The pilot project will:
  • Develop an appropriate curriculum for the scope of an OPA.
  • Identify sites to test the use of an OPA.
  • Educate eligible clinical staff using the OPA curriculum.
  • Establish clinical and testing protocols.
  • Ensure competency of clinical staff.
  • Collect data on clinical outcomes including the number of more advanced cases treated by hygienists and dentists. 
• Now with approval of the MDB, the MDA will undertake the OPA-EFDA pilot program, with ODH supervision.

In December 2022, the MDA created a workgroup to pursue Oral Preventive Assistant EFDA Pilot Concept. This flowchart shows the events that preceded the creation of the workgroup. The following are members of the workgroup.

Member Dentists

• Dr. Ron Wilkerson — MDA Legislative Chair, MDA EFDA Trainer
• Dr. Rolfe McCoy — Longtime EFDA Trainer, Dental/RDH Examiner, Previous MDA Trustee, Previous Missouri Dental Board Member
• Dr. Guy Deyton — Helped initiate EFDA Rules in 1995 and authored curriculum, Immediate Past State Dental Director, Previous MDA EFDA Trainer, MDA Past President, Previous Missouri Dental Board President 
• Dr. Tim Taylor — Profession Emeritus UMKC, Consultant with 2010 EFDA grant work to update curriculum, Previous EFDA Trainer

MDA Executive Committee

• Dr. Jeremy Bowen, President
• Dr. Jon Copeland, President Elect
• Dr. Mack Taylor, Treasurer 

MDA Staff

• Vicki Wilbers, MDA Executive Director
• Mandy Lewis, MDA Education & EFDA Program Manager
• Melissa Albertson, MDA Communications Director
• Halie Payne, MDA Professional Affairs Director 
• Olivia Wilson, MDA Legislative Liaison & Lobbyist
• Jorgen Schlemeier, MDA Lobbyist

Surveys

MDA/HPI Workforce Survey (Nov 2020) & Summary to MDA House of Delegates (Nov 2021)
Office of Dental Health Workforce Survey Responses (Spring 2022)
Missouri Dental Hygienists Workforce Survey Responses (Spring 2022) 
Economic Outlook and Emerging Issues in Dentistry (Ongoing Surveys, ADA Health Policy Institute, Select "Key Findings Presentations" for Summary

Articles

Spring 2023 (March) + Additional References Cited

Investigating Solutions to Address Workforce Issues: An Update (Vicki Wilbers) plus Pilot Project Updates on Developing a Dental Assistant Pipeline for Missouri Through High School Career Centers and Using Telehealth, Dental Team Collaboration to Provide Care in Nursing Homes

Workforce Discussions & Developments Flowchart (March 2023)
Missouri Oral Healthcare Report of COVID-19 Impact on Workforce
Economic Outlook and Emerging Issues in Dentistry (February 2023)
MDA Foundation Education Program Financial Contributions
State of Missouri Pilot Program Requirements (RSMo 332.325)
HB2149 (Missouri Dental Board Pilot Project)

Sep/Oct 2022
Letter to the Editor (Dr. Stacy Ochoa)

Jul/Aug 2022 
Workforce Shortages, Part 2: Leaders Plan Solutions (Dr. Guy Deyton)
Rising to the Challenges We Face (Vicki Wilbers)
My View (Dr. Ron Wilkerson)

May/Jun 2022
Workforce Shortages Pinch Care (Dr. Guy Deyton)
Reskilling & Upskilling: Keeping Workforce Stress From Crushing Us (Vicki Wilbers)