When Janel Puma comes to class at Case Western Reserve University School of Dentistry, she is greeted by "Sam," who resembles a human being in head shape and shoulder size.

But when Sam's mouth opens for the dental assistant, the state-of-the-art simulator reveals his typodont—a high-tech set of removable false teeth—on which Puma is learning the technical art of filling teeth and other dental skills that will enable her to grow in her career and how she interacts with patients.

Dental assistants, enrolled in the Expanded Function Dental Auxiliary Training Program (EFDA) at the Case Western Reserve University School of Dentistry, learn dental procedures, such as placing amalgams, bonding and adjusting crowns, in one of the most high-tech dental classroom in the country, according to Shelley Feiwell, CWRU's EFDA program director and 1992 alumna of the program.

The CWRU program is one of only four in the state that trains dental assistants in the expanded skills of an auxiliary, who can step in and take on certain responsibilities performed by dentists.

With the dental school's renovations of classrooms and installation of the new teaching technology this year, the EFDA program has opportunities to double its enrollment to 40 students for fall 2003.

While in CWRU's program, each auxiliary has a "Sam" or simulator, which is positioned like the dental patient in a work station that simulates the dental office. They train on some of the same equipment that dental students use. They also progress throughout the year from simulators to real patients in CWRU and neighborhood clinics as they gain competency with their new skills.

EFDA is open to dental assistants, who have two years of job experience in general dentistry, are certified as a dental assistant through the Dental Assisting National Board or have Ohio certification as a dental assistant. Enrollment also is open to registered dental hygienists, who hold an Ohio dental hygiene license.

In addition to CWRU, the other schools to offer EFDA training are Ohio State University, Sinclair Community College and Jefferson Community College. Since 1977, the CWRU program has graduated 616 auxiliaries, who have traveled from as far away as Toledo, Youngstown and the suburbs of Columbus to attend the CWRU program.

Two certified auxiliaries from the early classes-Karin Hein (1975) and Gail Ogle (1976)-now teach alongside Feiwell.

Both view the increased professional opportunities as an artistic expression where the art of filling teeth is almost like being a "sculptor," where each individual tooth has its unique shape and size and requires special treatment. They said it gives the dental assistant more time for direct interactions with patients.

The EFDA Program is nine months in length and meets for classes and labs once a week from 8:30 a.m. to 4:30 p.m. from mid-August to the end of May. Next year's auxiliaries will have the option of enrolling in either a Wednesday or Friday class. Applications for next year's class will be available in March, with an application deadline in May.

In offices that utilize the dental EFDA, it frees the dentists to work on oral health problems that cannot be delegated or sudden emergencies, according to Feiwell.

She adds that as part of the EFDA Program, the student's employer is also given classes in scheduling and the effective use of the new auxiliary's skills in the office.

Ronald Occhionero, CWRU associate dean of clinical affairs, was instrumental in establishing the EFDA Program in the state. In the late 1960s, the U.S. Department of Health Education and Welfare provided grants to teach dental students how to utilize expanded function dental auxiliaries in their practices. CWRU was one of the first six dental schools in the country that received a training grant. In 1976, the Ohio Dental Board recognized the EFDA Program and established a certification process to ensure public safety.

"Everyone is helped by having auxiliaries in the office," Occhionero said. "An EFDA is someone who knows dental materials and relates well patients."

Occhionero said he also sees this as a natural career path for the dental assistant.

To become an EFDA, each graduate must pass a written and typodont examination. For the past decade, Occhionero has worked to seek licensing of EFDAs. At the recent House of Delegates meeting of the Ohio Dental Association, the organization approved licensure for EFDA, according to Occhionero.

"We will be the first state in the nation to license EFDAs," he adds. For information about applying for the program, call Feiwell at 368-3252.