Expanded Function Assistant Placing Restoration Without Dentist On-Site
A certified expanded function dental assistant (EFDA) is scheduled to place a Class II composite restoration on tooth #19. The dentist has prepared the tooth, placed the matrix band, and then leaves for a 45-minute meeting at a nearby office. Before leaving, the dentist instructs the EFDA to finish the restoration and adjust the occlusion. No other dentist is in the office. The EFDA has a valid Ohio EFDA certificate and has placed many restorations under direct supervision. The patient is an adult with no complicating medical conditions. The dentist is reachable by cell phone and is only five minutes away. The office receptionist is present. The EFDA proceeds to place the composite and finishes the restoration before the dentist returns. The dentist later reviews the bite and makes a minor adjustment. The EFDA documents the procedure in the chart.
1. What level of supervision does Ohio law require for an EFDA to place a composite restoration? Was the dentist’s absence permissible?
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Ohio law requires direct supervision for expanded functions performed by an EFDA, including placing restorations. Direct supervision means the dentist is physically present in the office, has examined the patient, and is available to provide immediate assistance. The dentist’s absence for a 45-minute meeting, even if reachable by phone and five minutes away, does not satisfy direct supervision. The EFDA could not legally finish the restoration without the dentist on the premises. The fact that the dentist prepared the tooth and placed the matrix does not change the supervision requirement for the restorative procedure itself. Therefore, the EFDA’s completion of the restoration violated Ohio law.
2. What are the potential consequences for the dentist and the EFDA?
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The dentist could be disciplined by the Ohio State Dental Board for failing to provide required supervision, aiding unlicensed practice, or permitting an EFDA to practice beyond the authorized scope. Potential sanctions include a reprimand, fine, suspension, or probation. The EFDA could also face Board action for practicing without direct supervision, jeopardizing their EFDA certificate. The patient may have a claim if the restoration fails, although that is separate from licensure. The office’s documentation could be used as evidence. Because the dentist returned and adjusted the bite, the patient may not have been harmed, but the violation is still actionable. The dentist should expect a Board inquiry if a complaint is filed.
3. How should the dentist have structured the appointment to comply with Ohio law?
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The dentist should have remained in the office until the restoration was completed and the occlusion verified. If the meeting was unavoidable, the dentist should have scheduled it at a time when no direct-supervision procedures were underway, or arranged for another licensed dentist to be physically present. The dentist could have completed the restoration personally or assigned the EFDA only tasks that do not require direct supervision (e.g., patient preparation, charting). The dentist should also ensure that office policies clearly define supervision levels and that the EFDA’s scope of practice is respected. Documenting the supervision level for each procedure is prudent.