Winter 2017-18

30 New Mexico Dental Journal, Winter 2018 NMBDHC Report What is an EFDA? By Charles Schumacher, DDS— Chair New Mexico Board of Dental Health Care What is an EFDA? By statute, an Expanded Function Dental Auxiliary is an individual, who could be a dental assistant or a dental hygienist, that is able to perform restorative procedures under the direct supervision of a dentist. Direct supervision means that the dentist: 1)  is physically present throughout the entire procedure(s); 2)  orders, controls and accepts full responsibility of such procedures; and 3)  evaluates and approves the procedures before the patient leaves. Procedures allowed by an EFDA under direct supervision: •  Placing and shaping direct restorations •  Taking final impressions of single unit crowns •  Cementing indirect and provisionals temporarily •  Sealants •  Placing temporary and sedative restorative material in hand-excavated carious lesions and unprepared tooth fractures •  Removal of ortho bracket cement •  Fitting and shaping of stainless steel crowns to be cemented by a dentist Temporary or permanent crowns may be re-cemented with temporary cement under general supervision if the dentist deems it an emergency. Please refer to Part 46 of Rules and Regulations for details on practice and supervision. To apply for certification, there are basically three tracks, all spelled out in Part 42 of the Rules and Regulations: 1)  completion of an EFDA course at an institution accredited by CODA; or 2)  “independent preparation” by those who have had five years experience and have successfully passed recommended and board-approved courses listed in Part 42; or 3)  by credentials from another state with similar requirements for EFDA. Candidates must pass a clinical restorative exam from a board approved testing agency such as CRDTS or WREB, complete a jurisprudence exam, and pass an apprenticeship under the close supervision of the dentist within six months. The board is likely to pass new requirements that all EFDA who are assistants, get certified for all four expanded functions— radiology, sealants, fluoride and coronal polishing. These educational courses may or may not be available within each EFDA program, so those affected assistants must take notice. Hygienists will already have those certifications via their licensure. As of this writing, two programs in NM are approved by the board: Santa Fe Community College Dental Assisting Program (CODA-approved) and Quality Health Management. It is extremely important that dentists know they have the ultimate responsibility of patient care while utilizing EFDAs, and that the dentist must be present in the facility and do a final approval of any restoration that an EFDA performs. In other board news, we will have a Rules Hearing on February 9, 2018 in Santa Fe. The most important of the proposed rules are an entire re-write of Part 15, Anesthesia and Sedation Administration. The impetus of the necessary changes is due to the new guidelines passed by the ADA House of Delegates in 2016, which include updated definitions of levels of sedation, and new recommendations of educational requirements. All those certified as CS I and II will be grandfathered into the Moderate Sedation (Enteral and Parenteral respectively) category, however there will be new requirements and monitoring, as well as an increased amount of continuing education hours for renewal. EtCO2 capnography or precordial stethoscope monitoring will be required for IV sedation. Dentists who utilize CRNAs for sedation must have the same level of certification of the sedation performed and ACLS certification. For children, AAPD guidelines still apply. And, no more temporary permits for IV sedation. A notarized affidavit, and written and oral examinations will be required for most Moderate Parenteral (IV) sedation certifications. Those are the highlights, and you can review the proposed rules on the board website as soon as they are available. Due to legislation, there are now many layers of state oversite to new rules as they are being proposed, and thus the entire process is often delayed. A personal note and many thanks to Drs. Jason Flores, Robert Gherardi, and Paul Balderamos for helping me with the task of updating the sedation rules. Dr. Gherardi got us started by reorganizing the entire chapter while sitting on two long plane rides, making it easier to read. Dr. Flores, with the help of the Anesthesia Committee of which he chairs, carefully crafted the ADA rules into our rules and worked out all the language specifics. Dr. Balderamos, as always, added his keen insight to how these procedures affect patient care and safety, while keeping it practical for those of us who perform these services. I am very grateful and honored to work alongside these gentlemen.