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Team players: dental assistants have a unique position in addressing shortage areas and access to dental care.

All health care professionals and their organizations are interested in access to care. Access is a complex issue. There are many barriers to care and no single organization can resolve them all. As a team--the dental team--we must work together to address the availability of quality care. The Academy of General Dentistry (AGD) recognizes the contribution to oral health that dental assistants and their organization, the American Dental Assistants Association (ADAA), plays in providing quality oral health care in America.

The AGD has long been a proponent of the dental team. The AGD stated in its white paper, On Increasing Access to and Utilization of Oral Health Care Services, that auxiliaries play the key role in patient education and preventive care within the dental team. Dentistry focuses on preventive care, which is why the AGD supports the dental team concept as the best approach to providing the public with quality comprehensive dental care. Further, the AGD recommends the advanced training of auxiliaries to provide greater expertise of preventive care and treatment within the dental team concept under the direct supervision of a dentist.

One of the barriers to care is the capacity of the dental office. Some areas of the country have insufficient capacity to meet demand. The Health Resources and Services Administration (HRSA) has defined shortage areas for many years. Dental assistants have a unique position in addressing shortage areas and access to dental care. As Dr. Leon Stanislav of the Tennessee Dental Association (TDA) wrote in the Journal of the Tennessee Dental Association (Winter 2010), "According to the HRSA definition, a dentist using up to four properly trained auxiliaries can produce as much as one and a half Full Time Equivalents (FTE). This is especially significant for inner city and rural areas where distribution problems are more likely to exist. The key is to educate more auxiliaries and expand their training as they work under the supervision of the dentist."


Because lifelong learning through continuing education is one of the AGD's core values, its members are encouraged to promote this same commitment toward professional advancement to the other members of the oral health care team. The education of dental team auxiliaries will advance the interests of patient health. As noted in the "February 2010 AGD Workforce Report of the Dental Practice Council," expanded function dental assistants (EFDA) under the direct supervision of a dentist doing only reversible dedicated procedures is one of the most cost-effective, safest, and fastest ways to increase capacity, and therefore reduce the cost of dental care while also increasing access to care.

Dental assistant laws vary significantly from state to state. Many states, like Tennessee, have already addressed access in a very substantial way with EFDAs. Tennessee enacted a law in 2002 that provided for their EFDAS (TCA 63-5-108) and has seen a substantial increase in the number of registered dental assistants since this regulatory change took effect. Since the University of Tennessee opened its program for EFDA training, more than 240 registered dental assistants have successfully completed the course work and become EFDA-certified in Tennessee. Tennessee has seen an increase in registration and interest in dental assisting as a career. EFDAs, under the supervision of the dentist, reduce the cost of care by freeing the dentist to perform irreversible surgical procedures. This increases access to care by increasing capacity and it reduces office overhead, thereby reducing inflationary pressures on fees.

We must be mindful that oral health illiteracy, or a lack of the understanding of the need for and importance of oral health, is a great but surmountable challenge of access to care. For example, a parent's understanding of the importance of early oral health care is necessary to get children on the route to preventive care. It costs much more to restore a tooth and maintain that restoration over a lifetime than it does to prevent the restoration in the first place.

Dental assistants play a critical role in educating patients. Dentists who have worked in rural or underserved settings know this, as they have seen first-hand how vulnerable populations, especially young mothers, need dental assistants working within the dental home to educate them about the infectious nature of caries and encourage them to seek and keep regular preventive appointments for themselves and for their families. However, that is just one example of the need for the dental assistant, and moreover, the EFDA, within the dental home concept, is key to solving the access to care problem. In that vein, both the AGD and the ADAA must continue to support the advancement and growth, in education, numbers, and distribution, of dental assistants working side-by-side with dentists as part of the dental home, to truly further prevention and access as cornerstones of oral health care in our society.

David F. Halpern, DMD, FAGD

David F. Halpern, DMD, FAGD, is currently serving as the 2009-2010 President of the Academy of General Dentistry (AGD). He has championed the areas of continuing education and the value of student representation and involvement, as well as corporate and allied group collaboration. He received the AGD's Distinguished Service Award in 1992 and is a Fellow of the American College of Dentists, the International College of Dentists, and the Pierre Fauchard Academy. Dr. Halpern has maintained his private practice in Columbia, Md., since 1982.
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Title Annotation:Dental Business
Author:Halpern, David F.
Publication:The Dental Assistant
Geographic Code:1USA
Date:May 1, 2010
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