OPA: Improving MO Dental Care & Workforce Efficiency

Understaffed dental practices lead to underserved communities.

In a state where patients are waiting many months for care and dental practices are struggling to staff enough providers, the Oral Preventive Assistant (OPA) certification is an efficient solution to multiple systemic challenges.

Currently in its pilot phase with legislation on track to appear during the 2025 Missouri Legislative Session, the OPA certification is one that will upskill the current workforce, provide more career opportunities, and increase access to dental care state-wide.

What is an OPA?

An Oral Preventive Assistant (OPA) is a type of Expanded Function Dental Assistant (EFDA) who is specifically trained in scaling teeth on healthy patients to assist dentists and hygienists in providing routine preventive care.

As an assistant, OPAs provide care under the direct supervision of a dentist or hygienist.

What is scaling?
Scaling is the removal of hard build up from the visible tooth. OPAs may provide this care to patients diagnosed as healthy by a dentist.

Who can become an OPA?
An OPA indication would be one of six Expanded Functions certifications available to dental assistants.

There are currently five other Expanded Functions Dental Assistant (EFDA) certifications that exist. The MDA originated this training program that has been helping increase dental practice efficiency since 1998.

How does the education work?
The OPA must complete the OPA training curriculum, which is a Missouri Dental Board-approved course. After which, there is hands-on clinical training with mentoring and guidance from dentists and hygienists.

Once the didactic and clinical training are completed successfully, they must pass the OPA certification exam and receive a permit from the Missouri Dental Board before they are authorized to provide care under the direct supervision of a dentist or hygienist.

Improving Access to Care with OPAs

Rural clinics especially feel the pain of increased patient wait times, many noting 3-9 months (or longer) for basic preventive services.

Because dentists and hygienists are currently responsible for preventive care in addition to their top-of-scope procedures, Missouri dental practices are in a constant state of catch-22: Prioritize preventive care and let more serious conditions progress OR treat complex cases first and risk healthy patients developing more advanced afflictions.

It’s a difficult balancing act for clinics, which negatively impacts the oral health of our communities.

OPAs can help restore balance and alleviate wait times by assisting with preventive services — opening appointments for patients who require care from dentists and hygienists, working at the top of their scopes of practice, to address more difficult dental needs.

Boosting Workforce Efficiency with OPAs

By upskilling current team members to OPAs, dental practices can treat more patients and help more people during a time fraught with hiring difficulty, especially when it comes to hygienists.

Current workforce shortages are bleak:
  1. 57% of practices with an opening for a dentist stated they were unable to fill that open position.1
  2. There are approximately 3,488 licensed dental hygienists in Missouri, and they are concentrated in metropolitan areas.
  3. The Office of Dental Health (ODH) classifies 56 of Missouri’s 114 counties as being critically short of hygienists with less than 50% of the recommended level of hygienists. These are predominantly rural counties with a larger portion of the population dependent on Medicaid.
  4. More than 20% of responding hygienists were considering retirement in the next 5 years due to age, job stress, or other reasons.2
  5. 44% of offices with an opening for a hygienist stated they were unable to fill an open position.

1According to a 2022 survey by the Missouri Office of Dental Health (ODH)
2Oral Healthcare Workforce survey coordinated by ODH in 2022

But the Missouri dental assistant pipeline is growing:

Each of these programs makes the path to becoming a dental assistant more accessible to Missourians, encouraging workforce growth.

  • The Missouri Office of Dental Health has collaborated with Pike/Lincoln, St. Charles Career Centers and DESE to develop new dental assisting programs so high school students can graduate with their diploma and ready to begin a career in dental assisting. ODH also is bolstering current dental assisting vo-tech programs to ensure they have the necessary certification to take courses for expanded function skills. 
  • The Missouri Primary Care Association, through grant funding, is taking a two-pronged approach to help address oral health workforce shortages in rural areas of Missouri. MPCA is implementing a dental assistant apprenticeship training program in four rural Missouri community health centers and is developing and disseminating an oral health careers recruitment platform for Missouri high schools.
  • The Missouri School of Dentistry and Oral Health is researching development of programs to train dental assistants and hygienists on current and emerging technologies (i.e., digital impressions, intra oral photography) to upskill these dental workforce members to serve current and future dental workforce needs.

Recent shortage maps and increased dental assistant efforts make it clear that when teams need to grow, hiring and training dental assistants and Expanded Functions Dental Assistants (EFDA) is often a more realistic option than recruiting dentists or hygienists.

These new hires can be put through the OPA certification program to help support the needs of understaffed dental practices in a time-efficient and cost-effective manner — giving the dental workforce a much-needed infusion of preventive care personnel without compromising quality of care.

OPA programs in Illinois, Kansas and the U.S. military are proof of this concept. These upskilled dental assistants are already offering relief to dental teams with no adverse incidents on record.

Supporting Economies with OPAs

The integration of OPAs has implications beyond dental care access and daily productivity.

When more patients are seen and dentists and hygienists can work top-of-scope, local and state economies see the impact.

Dentists contributed $7,145 million to Missouri’s economy in 2022 alone.3 Adding the clinical support of OPAs drives unseen potential for these contributions and more.

3According to a 2022 Economic Impact Report Completed by the ADA Health Policy Institute:  Total economic impact and total number of jobs supported by offices of dentists, 2022 (XLSX) (February 2024). 

Here's how it all comes together.

OPA Drives Earning Potential
Continued education and skills training elevate any profession. Dental assistants with EFDA certifications already earn an average of $2.67 more per hour than those without.4 With the OPA certification, expanded functions dental assistants will be able to bring additional value that merits a higher salary — building financial security and encouraging freer use of funds within the community.

4DentalPost’s 2022 Salary Survey. Data available at dentalpost.net/dental-jobs/content/heres-why-expanded-function-dental-assistants-earn-more.

OPA Reduces Lost Patient Time & Wages
OPAs allow practices to treat more patients. Delegation of preventive care not only improves our state’s oral health, but also reduces patients’ need to disrupt work or school days for urgent and emergency oral care — a blight that costs the US an estimated $45 billion each year and disproportionately affects rural citizens and those identifying as female or Hispanic.5

5According to findings from CareQuest Institute's State of Oral Health Equity in America survey.

OPA Increases Dental Practice Productivity
As little as a 20% increase in delegation of procedures to an EFDA has been seen to increase productive capacity by 12.9% — a direct measurement of possible patient visits.6 The potential only increases with the addition of OPAs. The more patients each practice can see, the more revenue each practice can generate. For our independently owned clinics especially, this unlocks the opportunity to impact local and state economies like never before.

6Expanded function allied dental personnel and dental practice productivity and efficiency study (view PDF) and analysis (view PDF).
It’s no wonder dental teams are excited to see OPAs come to Missouri, too. Hear their thoughts in our video: The Value of an OPA
Value of an OPA

Overview of the OPA EFDA

Questions About OPAs? Let’s Connect!

Legislators, dental professionals, and patients alike are invited to learn more about the positive impact of the OPA certification.

Simply complete the form or give us a call at (573) 634-3436 to chat.