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A Bright Smile Begins with Nice Teeth

Tzu Chi Singapore has been co-operating with the Agency for Integrated Care (AIC) to provide home-based medical, nursing, and physiotherapy services to residents who are unable to leave their homes for various reasons. After these services were launched in April last year, the Tzu Chi home care team found out that a number of its home care recipients needed dental care, too, and invited Tzu Chi Medical Association (TIMA) dentists to help in home-based diagnosis and treatment.

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Dr. Ong Chin Kian (first from right) and his team visited Mr Tan on 12th July 2015 to clean his teeth and also did fillings for him. (Photo by Pua Poo Toong)

Have you ever complained about having to brush teeth twice a day? Or worried about having to check your gums regularly?

Brushing is the most common activity in our daily lives, and brushing our teeth daily in the morning and evening ensures that we can remove food debris and plaque from our mouth. However, even though a toothbrush may be as light as a pen, there are still some people who are unable to lift it up; and their caregivers also need professional guidance in order to assist them in maintaining their oral health.

After Tzu Chi Singapore launched its home care services to needy residents in April last year, its home care team discovered that a number of the home care recipients needed dental care, too. Thus, they invited TIMA dentists to help in providing home-based diagnosis and treatment to these patients.

The inaugural home dental service was carried out on 12th July, 2015. On that day, a dental team made up of members from TIMA and Tzu Chi’s home care services visited the homes of two care recipients: 69-year-old Mr. Tan, and Mdm. Kee, who suffers from severe physical disabilities. The leader of the dental team, Dr. Ong Chin Kian, and two TIMA nurses had specially taken time off to conduct the home visit, bringing along with them mobile dental equipment, medications, etc.

Providing Much-Needed Help, Twice in a Row

"Ah ma! Ah ma, we are here!" The Tzu Chi dental team called out affectionately at the door, and Mdm. Toh opened the door with an expectant face. 

Mr. Tan had been suffering from Alzheimer's disease for the past three years. Three months ago, he slipped and fell and was even hospitalized. After being discharged from the hospital, he had been bedridden and could not take care of himself, depending entirely on his wife Mdm. Toh. Mdm. Toh had to take care of both Mr. Tan as well as an eight-year-old grandson. Due to lack of physical strength and time, Mdm. Toh only managed to help her husband bathe and brush his teeth once every two days. When brushing his teeth, she realized that his gums were bleeding, and she thought that she had brushed too hard; it was only later that she learned that Mr. Tan had gum problems.

The Tzu Chi home care team has been visiting Mr. Tan since June 2015, and they detected bad breath emanating from his mouth while caring for him. Dr. Ong Chin Kian and his team members accepted the invitation to conduct some preliminary examination, and diagnosed the case as periodontal disease. Prior to the actual home dental treatment, the medical team started to teach Mdm. Toh the proper tooth-brushing methods, and by the time of the second visit by the dental team, Mr. Tan’s gum problems had already shown significant improvement.

The dental team had originally planned to help Mr. Tan extract a loose tooth, but when Dr. Ong found out that the tooth was not very loose, he decided to give him fillings instead. Mr. Tan’s teeth were covered with tartar, and scaling had to be done first to determine which of the teeth needed fillings. Since the scaling and restorative work was not carried out in a proper dental clinic, the work had to be carried out by an experienced dental team because of the need for proper lighting, adequate equipment as well as materials etc.

Dr. Ong Chin Kian said, "The real challenge is that we must pay attention to his health condition while carrying out the dental treatment, and we must also make sure that we have all the required equipment." In addition, Dr. Ong also carefully examined the 8-year-old grandson and found his teeth in good condition.

"My husband has not been to the dentist in the last 10 years. After he was afflicted with Alzheimer's disease, he needed to move around in a wheelchair, and I had to take care of my grandson, so I have never thought of taking my husband to a dentist for dental check-ups,” Mdm. Toh lamented.

Before the Tzu Chi home care team started visiting him, Mr. Tan used to pass motion only once in two weeks, but under the careful guidance of the home care team members, Mdm. Toh managed to provide proper hydration and nutrients to her husband, thus both his constipation problem as well as his overall health had improved. In addition to medical support, the home care team also provided nutritious supplements to Mr. Tan as well as gave emotional support to Mdm. Toh. 

Keeping Faithful Company 

The Tzu Chi dental team then went on to visit Mdm. Kee. Forty-six-year-old Mdm. Kee suffers  from cerebral palsy as a result of an infection arising from a high fever while still an infant. Her limb muscles atrophied through years of lying down and this also resulted in curvature of her spine. As there is poor ventilation in her bedroom, her family would place her on a table in the kitchen. She spends most of her time lying there, and this is how she has been living her life for the past 30 years.  

Mdm. Kee is taken care of solely by her mother, as the other children have started families of their own. As Mdm. Kee is unable to chew, her mother used to cook only food, such as beans, cereals and milk etc. for her. Due to indigestion, Mdm. Kee would sometimes throw up all the food in the evening.

Because she resists tooth-brushing, Mdm. Kee would bite onto the toothbrush instead of co-operating. With her uneven teeth, it is difficult to clean the plaque, and that resulted in frequent bleeding from the gums. After some time, Mdm. Kee’s teeth were in a serious state of decay, which often attracted flies, and her mother had to use a food cover to cover her face ─ the sorry sight saddened the hearts of many. 

The mother shared that for nearly 50 years, she had been diligently taking care of her daughter and never departed from her side. But she is getting on in years, and is worried that she would no longer be able to take care of her daughter. The relentless pressure over the years had even caused her to entertain the thought of jumping down the building together with her daughter in order to end the pain. In the end, the mother managed to overcome her grief and persisted in caring for her daughter. At this point of her sharing, Mdm. Kee’s mother clasped her hands together; facing the altar; choking back tears, she said, "Would God please bless us by letting my child go first, otherwise who else would take care of her?"

The Tzu Chi volunteers patted Mdm. Kee’s shoulder and consoled her, “Please do not worry anymore. Take good care of yourself, so that you can take care of your daughter”.

Bringing Relief from the Pain of Suffering

Mdm. Kee had a mouth almost full of cavities and many teeth needed to be removed. Hoping to lessen her pain, the two dentists in the dental team decided to take out only three teeth in the first round, leaving other teeth to be extracted over the next few visits. Mdm. Kee co-operated with the dentists and nurses by lying still on the table. One of the dentists, Dr. Ho May Fung, carried out the procedure with much caution, saying that their challenge was to exercise special care in order to prevent the extracted tooth from being swallowed.

Dr. Ong Chin Kian, who was providing guidance at the side, said, “The patient is bedridden and suffers from gum infection; we can only do the best we can to alleviate her pain." Dr. Ong believed that what they were doing was very meaningful because, despite the service being chargeable, it would be difficult to find dentists who are willing to take up the challenge of providing dental treatment to patients with special needs. 

Mdm. Kee’s mother admitted that she did not have much knowledge in taking care of people with special needs. "Now that the volunteers are able to provide medical and psychological support, I am very much at ease now."  

After the dental service, Mdm. Kee’s mother made a sincere wish: "I hope my child will be happy and healthy." She kept thanking the medical team while sending them out the door. She was still waving her hand even as the team stepped into the elevator.

There is a Jing Si Aphorism that states: "Those who suffer cannot come out, so let the blessed ones go in to help them.” Isn’t the above story a testament to this saying?

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Since the scaling and restorative work was not carried out at a proper dental clinic, the work had to be carried out by an experienced dental team because of the need for proper lighting, adequate equipment as well as materials etc. (Photo by Pua Poo Toong) 

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While Mr. Tan was receiving dental treatment, Mdm. Toh ( right) shared some family photos with the home care team members. Thinking of the happy past, she burst into laughter. (Photo by Pua Poo Toong) 

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The process of extracting Mdm. Kee’s tooth required the assistance of two dentists and three nurses. Her mother (in purple) held on to her daughter’s hand to reassure her. (Photo by Pua Poo Toong) 

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Dr Ho Mui Fung ( in black) explained to Mdm Kee’s mother how to take care of her daughter’s oral hygiene. (Photo by Pua Poo Toong) 

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When the dental treatment ended, Dr. Ho Mui Fung ( second from left) and her team said their goodbyes to Mdm. Kee as she held on to Tzu Chi’s home care team leader Lim Kim Yan’s hand. (Photo by Pua Poo Toong) 

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