Increased Use of Expanded Function Dental Auxiliaries Would Benefit Consumers, Dentists, and Taxpayers

HRD-80-51: Published: Mar 7, 1980. Publicly Released: Mar 7, 1980.

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Making better use of expanded function dental auxiliary (EFDA) personnel is one way to increase the efficiency of dental health care delivery and the availability of care. EFDA's are dental assistants or dental hygienists who have obtained additional education or training to perform a wide range of expanded clinical functions and patient care procedures under dentists' supervision. Using an EFDA to complete restorations (fillings) enables a dentist to concentrate on more complex dental tasks and treat additional patients. This increased productivity can help alleviate dental shortages and, to the extent dentists are willing to pass on savings realized from productivity gains, can also help contain dental care costs. Because experts believe and Congress has recognized that EFDA's are most productive when used to complete restorations, the study focused on this area. Questionnaires were sent to dentists in private practice in both States that allow the use of EFDA's in this manner and those that legally preclude the use of EFDA's to complete restorations. City public health department administrators in various cities in both types of States were contacted, and public health dental clinics in both types of States were visited.

Most States have dental laws or regulations prohibiting private dentists and public health departments, if they so desire, from employing EFDA's to complete restorations. The American Dental Association (ADA) also opposes using EFDA's to complete restorations because it believes that performing this procedure effectively and safely requires knowledge acquired in professional dental education. While the emphasis of the Federal Government has been on training additional dentists, since the early 1970's, Congress has increasingly supported the training and use of EFDA's. State dental boards, consisting mostly of dentists, are responsible for enforcing dental laws to protect the public from poor quality dental care and unqualified practitioners. Although the boards believed that EFDA's do not have the training and skill to safely perform this function, factual evidence to support this position was not provided. GAO believed the boards' rationale, and the ADA policy could not be supported or justified by available evidence and that the States should change laws to permit dentists to employ EFDA's to complete fillings. Dentists and public health departments in States precluding the use of EFDA's to perform expanded functions indicated that they would employ EFDA's in this manner if legally permitted to do so. Federally operated dental programs can employ EFDA's to perform a full range of expanded functions, but the Office of Management and Budget (OMB) has not established an overall policy requiring their use to the extent possible in all Federal direct care dental programs.

Recommendation for Executive Action

  1. Status: Closed

    Comments: Please call 202/512-6100 for additional information.

    Recommendation: The Secretary of Health, Education, and Welfare (HEW) should: resume and intensify the HEW efforts in cooperation with the Council of State Governments and the dental profession, to persuade States to change laws and allow EFDA's to complete restorations under a dentist's supervision; monitor States' progress in amending laws; determine whether enough trained EFDA's exist in States where they can be legally employed and whether additional Federal support is needed to alleviate any shortage; publish the results of research on the use of EFDA's to complete fillings; seek appropriate legislative action if States do not change their laws; meet with ADA representatives to urge them to reconsider their policy and to encourage State governments to modify their dental practice acts; implement promptly the HEW policy on employing EFDA's in Public Health Service agencies, and develop a similar policy for HEW grant- and contract-funded programs; and direct the Administrator of the Health Services Administration to conduct expeditiously the study of the appropriate conditions for the assignment and use of EFDA's in HEW-designated dental shortage areas. The Secretary of Defense should establish a policy requiring the military services to employ EFDA's to complete fillings whenever and wherever feasible. The Administrator of Veterans Affairs should expand the employment of EFDA's in the Veterans Administration dental care system. The Director of OMB should establish a policy (1) requiring the employment of EFDA's to complete restorations to the extent possible in all federally operated dental programs, (2) promoting their use in federally funded programs, and (3) requiring budget examiners reviewing dental program budget requests to consider whether agencies have adopted this approach when feasible to do so.

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