5.3 Expanded Function Dental Auxiliaries (EFDA): Restorative Placement Rules
Key Takeaways
- A dental hygienist, or a certified or graduate dental assistant, may qualify as an expanded function dental auxiliary to place, contour, and adjust direct restorative materials (RSA 317-A:21-g; Den 302.07(a)).
- EFDA candidates need at least 4,500 hours of dental clinical experience, a recommendation from a New Hampshire-licensed dentist, and current BLS-HCP (Den 302.07(a)(1)).
- The EFDA course must be at a CODA-accredited institution, with at least 50 didactic and 100 pre-clinical hours, followed by at least 6 weeks and 120 hours of supervised in-office training (Den 302.07(a)(2)).
- No more than 2 EFDAs may be employed in a dental practice regardless of the number of dentists, and dentists must notify the Board within 10 days of employing one (Den 302.07(b)).
- EFDAs work under direct supervision, renew their permit in odd-numbered years before May 1, and complete 10 restorative CEUs each biennium.
Expanded Function Dental Auxiliaries (EFDA)
Statutory authority — RSA 317-A:21-g
- A licensed dental hygienist or a dental assistant may obtain a permit from OPLC to practice as an expanded function dental auxiliary by applying and completing the education and training the Board's rules require.
- An EFDA works under the supervision of an actively licensed dentist.
- The Board adopts rules on application and permit requirements, education, supervision level, and scope. The rulemaking power is RSA 317-A:12, XII-e, although RSA 317-A:21-g, III refers to XII-d.
Who may qualify — Den 302.07(a)(1)
EFDA status is limited to registered dental hygienists and to dental assistants who are DANB-certified or graduates of a CODA-accredited dental assisting school. Traditional assistants cannot become EFDAs. Every candidate must:
| Prerequisite | Requirement |
|---|---|
| Credential | RDH, CDA (DANB), or graduate dental assistant |
| Experience | At least 4,500 hours of dental clinical experience |
| Recommendation | Recommended for the course by a dentist with an active New Hampshire license |
| Oral inspection | Dental assistants other than graduate assistants must be qualified to perform a preliminary inspection of the oral cavity |
| Life support | Current BLS-HCP |
The EFDA restorative course — Den 302.07(a)(2)
- Offered by an institution accredited by CODA.
- At least 50 didactic hours and 100 hours of pre-clinical training in a Board-approved curriculum.
- Required subjects: dental materials; low-speed and high-speed handpieces; placing and finishing amalgams and composite resins; dental occlusion; and dental jurisprudence.
- An assessment certifying successful completion, with a signed completion certificate.
- Followed by 6 weeks, at least 120 hours, of training in a dental office under the direct supervision and monitoring of faculty of a CODA-accredited school or its designate.
Rules that apply to every EFDA — Den 302.07(b)
| # | Rule |
|---|---|
| 1 | Register with the Board, submit proof of training and experience, and pay the fee to obtain the EFDA permit |
| 2 | Renew the permit in odd-numbered years before May 1, if EFDA employment continues |
| 3 | Display the permit prominently where the EFDA works |
| 4 | No more than 2 EFDAs per dental practice, regardless of the number of dentists |
| 5 | Dentists must inform the Board within 10 days of employing an EFDA |
| 6 | Complete 10 CEUs each biennium in restorative dentistry |
| 7 | Endorsement: a person qualified in direct restorations in another jurisdiction may qualify with documentation of equivalent training and a supervising dentist's letter about direct-restoration experience within the previous 2 years |
| 8 | Practice under the direct supervision of a New Hampshire-licensed dentist |
The renewal addendum for hygienists asks whether the applicant is an EFDA and, if so, whether the 10 restorative CEUs were completed (Den 401.04(e)(7)). For hygienist EFDAs, Den 406.03(a)(5) makes those 10 CEUs additional to the regular 20.
What an EFDA does, and what stays with the dentist
Den 302.07(a) authorizes an EFDA to place, contour, and adjust direct restorative materials within the oral cavity. Compare the neighboring roles:
| Role | Restorative authority | Source |
|---|---|---|
| CDA or graduate assistant with at least 400 hours | Place amalgam before the dentist condenses it; place liners and bases | Den 404.02(l) |
| Hygienist | Place amalgam before condensing; place liners and bases; remove excess restorative material, including with a low-speed handpiece | Den 405.01(c) |
| EFDA | Place, contour, and adjust direct restorative materials (amalgam and composite) | Den 302.07 |
| Dentist only | Diagnosis and treatment planning; surgical procedures and any intraoral procedure resulting in irremediable alteration of the oral anatomy | RSA 317-A:23, I |
Den 302.07 authorizes restorative placement, not diagnosis or tooth preparation. The dentist still diagnoses, plans, and prepares, and must be in the office (direct supervision) while the EFDA works.
Worked scenario
A group practice with five dentists wants to hire three EFDAs, one RDH and two CDAs, all with 5,000 hours of experience and completed training.
- The third EFDA is not allowed. Den 302.07(b)(4) caps EFDAs at 2 per practice regardless of the number of dentists.
- For the two it does hire, the practice must notify the Board within 10 days of employment. Each EFDA must hold and display a permit and must work only while a New Hampshire dentist is in the office.
- Each EFDA will renew the permit before May 1 of the next odd-numbered year and must show 10 restorative CEUs for the biennium.
The practice cannot solve the cap by having the third CDA place restorations as an ordinary assistant. Outside EFDA status, a CDA may only place amalgam before the dentist condenses it. Contouring and adjusting restorations is EFDA work.
Common exam traps
- "EFDA = any experienced assistant." Wrong. Traditional assistants are excluded however long they have worked. The credential must be RDH, CDA, or graduate dental assistant.
- "General supervision is enough once trained." Wrong. EFDAs always practice under direct supervision (Den 302.07(b)(8)).
- "The cap is per dentist." Wrong. It is 2 per practice.
- "EFDA CE replaces regular CE." Wrong for hygienists. The 10 restorative CEUs are in addition to the 20 (Den 406.03(a)(5)).
- "The permit renews with the dentist's license." Wrong. EFDA permits renew in odd-numbered years before May 1.
A dental practice with four dentists wants to employ three EFDAs. What does Den 302.07(b)(4) allow?
Which candidate is eligible to enroll in the EFDA direct restorations course under Den 302.07(a)(1)?
After completing the EFDA didactic and pre-clinical coursework, what further training does Den 302.07(a)(2)e require?