Return to Colombia

Assessing the dental health needs of this South American country’s most vulnerable patient populations
December 5th, 2016
Colombia dental mission

After completing oral health screenings on these youngsters at a children’s home in Medellin, Colombia, Texas A&M College of Dentistry faculty members Dr. Tiffany Finn and Dr. Helena Tapias presented them with toys.

The man’s question caught her off guard. Would it be OK for us to share a toothbrush? It wasn’t just that he had asked the question — it was that he was referring to himself and eight other family members. Dr. Helena Tapias was at a loss for a response, if only for a moment. Then reality set in. The person posing the question was a coffee farmer who worked the land for his living, and it wasn’t often he and his family made it to Rionegro, a city tucked into the Colombian Andes. When they did make that trip, it was quite possible what money they had was not spent on toothbrushes. It was here in Rionegro and neighboring Medellin that Tapias was conducting research in preparation for dental mission work.

“Yes,” she told him. She explained the pitfalls — susceptibility to a host of oral and general health problems — but encouraged the man to keep with his and his family’s oral hygiene routine. Before leaving, she gave him a stack of toothbrushes; a temporary fix, at least.

An appeal for help

The request first came through Tapias’ inbox in spring 2015. It was from the North Texas Latin American Physicians Association. Could she help them, the physicians wanted to know. As part of the organization’s outreach work, it had partnered with the Latin American Medical Assistance Association — an interprofessional network of physicians, surgeons, nutritionists, gynecologists, obstetricians, pharmacists and others — dedicated to providing care throughout the region. In the Antioquia province, vulnerabilities in the dental health of the very old and very young had become apparent, prompting the call for help.

Tapias, clinical assistant professor in restorative sciences at Texas A&M College of Dentistry, was a natural fit. Born and raised in Colombia, she started her dental career in the country. In the years since earning her master’s in geriatric dentistry at the University of Minnesota School of Dentistry and joining the faculty in Dallas, she has devoted her career to advancing care for the elderly population. She furthered this cause by initiating the annual Linda Niessen Geriatric Dentistry Symposium in 2013.

Her response was certain, and prompt. A study would be necessary to pinpoint the exact needs of the area’s patient population. Since these efforts would require screening dozens of people, she would need help. This took the form of Dr. Tiffany Finn ’92, clinical assistant professor in restorative sciences, who teaches with Tapias in the clinic and lab. In late summer 2016, they made the trip to the South American country and brought along a special assistant: Finn’s teenage daughter, Lily, who 15 years before at just 11 days old, had been adopted from Medellin, Colombia.

Country of origin

There’s an extra hurdle that all aspiring dentists in Colombia must clear before earning their dental degrees: a year of mandatory service in public health dentistry.

“I felt this experience was like standing on the edge of a swimming pool, with someone telling me, ‘To be able to swim, you need to move your arms like this, and you need to move your legs like this, and you need to be calm,’” Tapias says. “And then someone pushes you from the edge into the swimming pool. But I survived.”

When given the chance, Tapias did more than merely tread water. She swam, found her own style, at that. She practiced dentistry but took efforts a step further, training community leaders to provide oral health education to their villages. Even concepts as simple as diet counseling and teaching parents to avoid putting their babies to bed with bottles made all the difference. So much so, she was offered a job to continue these efforts, and so she stayed on for another year.

“It’s kind of an amazing experience,” Tapias says. “But at the same time you are shocked with the reality in your country.”

The concept of coupling dental care with community-based education isn’t too different from what she is coordinating now.

“Rionegro was a new area for me, but it was pretty much the same thing I saw when I was working my mandatory year,” Tapias says. “It was the same situation: the same lack of access to care, the same poverty, the same thing.

“We are going to build a program that will help these people, but at the same time we can teach them how to be leaders in the community. They don’t necessarily have to be dentists, but like social workers, they can be counselors in oral health, and they can advise the families on how to brush their teeth.”

A chiva bus on the streets of Rionegro, Colombia

Tapias took this photo of a chiva while in Rionegro. These vehicles are a traditional form of transportation in rural Colombia; in urban areas, they’ve evolved into party buses.

While the trip included screening individuals at a government run-geriatric center and a children’s home, the latter marked a first for Finn’s daughter, Lily. While her family has vacationed on the country’s coast, never before had their travels taken them back to the area where Lily was born. In the dining room of a children’s home in Medellin, as Finn and Tapias screened tiny patients in makeshift dental chairs with the light of iPhone flashlights, those not being examined flocked to the American teenager carrying face paints.

Finn with two of the residents at the children's home.

Finn with two of the children’s home patients.

“We were like magnets,” Finn recalls. “The kids were just holding our hands and our arms. They were just so cute, and so happy to have attention.”

Two days later, the experience took on new relevance for Lily when they took her to see the center where she was adopted all those years ago.

Lost teeth, decay

The faculty members started their study at the geriatric center. It was there Tapias was met with more than one surprise.

“When I left my country 20 years ago, this place didn’t exist, because the family takes care of the elders,” Tapias says. “I was surprised that this place was there.” These residents had no family left to care for them, so the task was left for the state.

From the looks of things, oral health care was not a high priority, as 90 percent of the home’s residents were completely edentulous, with no teeth at all. Their dentures were not faring much better.

“They were talking, and the dentures were practically falling out, probably because of lack of access to dental care,” Tapias says.

Finn screens pediatric patients at the children's home in Medellin.

Finn screens pediatric patients at the children’s home in Medellin.

At the children’s home, Tapias and Finn discovered an interesting trend in the 75 patients they screened: 60 percent of the children had absolutely no decay, but of the other 40 percent who did, decay was extreme. Tapias attributes the dichotomy to a new government-run program created to address a lack of access to dentistry among the very young. It appeared that the children reached by the program were better off for it, but it was painfully obvious that those with rampant decay had not received any dental care or oral hygiene instruction.

Next steps

After sharing her findings with the North Texas Latin American Physician’s Association, Tapias is already coordinating a return trip for summer 2017.

The work at the nursing home will require partnering with a lab technician: “The main thing we can do is provide dentures and work on the current dentures to try to make things comfortable for them,” Tapias explains.

For children, they’ll take a two-pronged approach: prevention and hands-on care, with instruction and restorations. A partnership with the local hospital means they can utilize the facility’s four-chair clinic to provide care, and the hospital will screen for children with the most urgent dental needs to be seen. Tapias will bring the supplies, including everything from composite and amalgam to disposable mirrors and gloves.

Finn plans to be there, and Lily, too: “She’s been asking when we are going back,” Finn says. “She’s going to be painting faces again.”

— Jennifer Fuentes