What is the highest level of dental assistant?
What is the highest level of dental assistant?
What Is the Highest Level of Dental Assistant?
In the dental field, not all dental assistants are the same. While many start in entry-level roles, some choose to climb the professional ladder to positions of greater responsibility, autonomy, and compensation. The highest level most dental assistants can achieve—without becoming dental hygienists or dentists—is the Expanded Functions Dental Assistant, or EFDA. This role combines clinical expertise with advanced skills and is highly valued in both private and institutional dental settings.
Expanded Functions Dental Assistant (EFDA)
An EFDA is a dental assistant who has completed additional education and training that allows them to perform a range of advanced procedures directly on patients. These duties go far beyond those of a standard dental assistant and often overlap with what general dentists handle, though they are non-diagnostic and non-surgical in nature. EFDAs function as the “right hand” of the dentist and are trusted with tasks that can significantly increase the efficiency of the dental practice.
Common EFDA Duties Include:
Placing and shaping temporary restorations and fillings
Taking and pouring impressions for crowns or bridges
Applying fluoride, desensitizers, and dental sealants
Placing matrix bands, wedges, and liners
Coronal polishing of teeth (where permitted by law)
Fabricating temporary crowns or bridges
Using intraoral cameras or advanced suction/isolation tools
Removing cement from crowns or brackets (post-placement)
Managing infection control protocols with greater authority
Each state has its own regulations defining which expanded functions are allowed and under what supervision level (direct, indirect, or general).
How to Become an EFDA
The pathway to becoming an EFDA varies by state, but generally includes:
High School Diploma or Equivalent
Completion of a CODA-accredited Dental Assisting Program
Many states require graduation from an approved dental assisting program, which typically takes 9 to 12 months for a certificate or 18 to 24 months for an associate degree.DANB Certification
The Dental Assisting National Board (DANB) offers several certifications, including the Certified Dental Assistant (CDA), which is often a prerequisite for EFDA training. Some states may also require you to pass DANB’s Expanded Functions or Radiology exams.State-Approved EFDA Program
You must complete coursework in expanded functions at a program approved by your state’s dental board. These programs usually last 6–12 months and include clinical hands-on experience in tasks like placing fillings and taking impressions.Licensure or Registration
Many states require EFDAs to apply for licensure or registration separate from their CDA. You may also need to pass a jurisprudence (law) exam and hold CPR certification.Continuing Education
Maintaining EFDA status often requires completing continuing education credits annually or biannually, depending on state requirements.
Salary and Career Benefits
Dental assistants who reach EFDA status typically enjoy significantly higher pay and more job stability. Nationally, the average dental assistant earns around $48,000 per year, while EFDAs often earn between $55,000 and $75,000 depending on location, years of experience, and the specialty of their practice. In high-cost or high-demand metro areas, EFDAs can earn over $80,000.
Additionally, EFDAs are often the first choice for:
Office leadership roles (Lead Assistant or Clinical Supervisor)
In-house trainers or mentors for junior staff
Candidates for transition into dental hygiene or dental school
Treatment coordinators or office managers in practices that value clinical knowledge
Other Advanced Dental Assisting Roles
While EFDA is the peak of clinical dental assisting, there are other roles that represent advancement in different directions:
Orthodontic Assistant: Specializes in supporting braces, aligners, and ortho-specific appliances
Surgical Assistant: Works in oral surgery or implant practices, often assisting with sedation procedures
Lead Dental Assistant: Oversees daily workflow, trains new staff, manages supplies
Dental Office Manager: Combines dental knowledge with administrative oversight
Dental Assisting Instructor: Teaches in technical schools or community colleges; often requires teaching credentials and significant experience
Each of these positions offers a chance to earn more, enjoy greater job autonomy, and contribute to the practice in meaningful ways.
State-by-State Variability
It’s important to understand that what qualifies as an EFDA—and what tasks EFDAs are allowed to perform—varies widely across the United States. For example:
Ohio has one of the most robust EFDA programs and permits assistants to place fillings after dentist preparation.
California distinguishes between Registered Dental Assistants (RDAs) and RDA-EFs, with strict licensing and education requirements.
Texas does not use the EFDA title but has a defined scope for Registered Dental Assistants who complete additional training.
New York does not recognize EFDA as a formal title but allows expanded functions with proper training.
Always check with your state’s dental board or licensing authority before pursuing a particular credential.
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