Help Dental Hygiene Students Make Bolivia Smile!

The Tooth Fairy in Bolivia:  A Dental Hygienist’s Reflection

by Kellie Whitcomb RDH, MSDH(c)

Co-Director of the Tooth Fairies School-Based Oral Health Program

Almost 20 years ago Elise Tanner and Nancy Alleman created and developed The Tooth Fairies, a school-based oral health program. Elise then became the sole director and provider for what had become a sustainable community outreach program all across Puget Sound serving elementary schools and more than thirty Early Childhood Education and Assistance Programs (ECEAP). The Tooth Fairies provide dental assessments, fluoride varnish applications, and most importantly, oral health education delivered in the ultimate kid-friendly way: dressed as a Tooth Fairy using an oversized tooth and fuzzy bacteria puppets. Fast forward fifteen years to a fortuitous meeting between Elise and myself at an Alliance of Dental Hygiene Practitioners forum, and a new chapter for the Tooth Fairies and me began.

A few years ago I decided to pursue what I am most passionate about, connecting access to care with those who are most vulnerable. My initial focus was on the Silver Tsunami, senior citizens that comprise the largest growing population group with many access to oral health care issues.  Sitting next to Elise at the forum, she turned to me and asked a simple question: “But what about the kids?”. Having two small children of my own, this question hit me. She invited me to join her Tooth Fairies for a day, just to see if it was something that I would want to be a part of. A day at Daffodil Valley Elementary had me convinced. I had to be a part of this program that was doing so much good. The children emphatically welcomed Tooth Fairy Elise and her team, but what struck me most was how they had retained her oral health message about the etiology, transmission, and prevention of decay she had delivered six months prior in their classrooms. Her unique approach dressed as a childhood icon related to teeth really captured the attention and interest of the children. I have been working with Elise and her team of registered dental hygienists for over two years now and proudly wear my Tooth Fairy dress and tiara as I advocate for children’s oral health.

Elise has imparted her knowledge related to independent practice as a hygienist within an educational setting to me and I am so grateful to her as a mentor and friend. Her passion for eliminating the experience of early childhood caries is contagious. The lofty vision of eradicating decay should be at the top of every registered dental hygienist’s list, for we are prevention specialists, after all.

During our time together, Elise told me about a friend and fellow hygienist, Sandy Kemper and her non-profit foundation, Smiles Forever. ‘Smiles’, as it is casually referred to, trains indigenous women to be dental hygienists and provides dental care for those living in Cochabamba, Bolivia. In addition, the Smiles dental hygiene training program has been providing oral health education, dental assessments, dental cleanings, and silver diamine fluoride treatments for an elementary school in Villa Tunari as a community outreach.  Elise joined Sandy and Smiles for one of their school visits and was indelibly convinced that Smiles Forever’s use of silver diamine fluoride was making a huge impact on the children’s experience of decay. Imagine my surprise and excitement when Elise asked me if I would return to Bolivia in her place and represent the Tooth Fairies for Smile’s next school visit.

Unfamiliar Tooth Fairy Wins Over Children Only Familiar with the Tooth Rat Myth

I learned many things from my trip to Cochabamba and to Villa Tunari in the Chapare. After delivering the oral health presentation as the Tooth Fairy with the help of a translator to several classrooms, I discovered that the cultural mythology of the Tooth Fairy does not exist in Bolivia. I felt embarrassed for not knowing this prior to donning my winged dress and tiara. I have learned through advancing my education that cultural sensitivity is imperative when approaching any type of outreach. The children in Bolivia believe in the Tooth Rat, a different myth related to the loss of a baby tooth. The Tooth Fairies intended to leave Smiles Forever with all the tools of our school-based program with the hope that our success in educating children about oral health in the states could be duplicated in Bolivia. Had the Tooth Fairies already missed the mark?

To add to this cultural oversight, another concern arose. I noticed a hesitancy from Smile’s dental hygiene students to be the Tooth Fairy in front of the elementary students. After inquiring about it, I was told that to wear a professional uniform was a symbol of esteem and sought after for any person in Bolivia. Wearing a costume while trying to engage in their work would be making a mockery of themselves. Now I had two hurdles to overcome!

Bolivian Hygenist Adela becomes a "Tooth Fairy" donning the Sequined Dress & Glittering Tiara:

For several class presentations, I modeled the oral health education portion of our program in front of eager and smiling students who clamored around me to fluff my dress, touch my wings, and hug me with outstretched arms. The students’ response to the Tooth Fairy put to rest my worry of our cultural differences. I learned that children have similarities no matter where they come from or what language they speak. Eye contact and a genuine smile can make a strong connection in the absence of a common cultural belief or even a common language. Glitter and sequins help, too. The hesitancy of Smile’s dental hygiene student, Adela, melted away as she saw how adored the Tooth Fairy was. That afternoon, this brave future prevention specialist put my dress on and replicated what I had demonstrated earlier in the classrooms. I was so proud to see her put aside her fear, knowing what a difference she will make by educating children in such a child-friendly way.

Kellie takes part in commemorating the signing of an agreement between a private university in Cochabamba and the Smiles Forever Foundation to assure a bright future for dental hygienist training in Bolivia:

I also learned that the profession of dental hygiene does not exist in Latin America.  Smiles Forever has been actively pursuing accreditation for their curriculum and licensure for their graduates, but has been met with opposition because it had never been done before. Leading up to the time of my visit, Smiles Forever had had a series of meetings with Universidad de Privada Abierta Latinoamericana (UPAL), a private university in Cochabamba, to discuss a possible partnership or adoption of the Smiles Forever dental hygiene program. An agreement has been made, and the future for a dental hygiene profession in Bolivia is bright.  

When I first heard about Sandy, I recall thinking what a change agent and difference maker a person with a passion could be. She and her team have not only provided dental care for tens of thousands of Bolivians, but also brought the profession of dental hygiene to Latin America for the first time. I am awed and humbled to have been in Cochabamba the day the agreement between UPAL and Smiles Forever was signed. For someone whose childhood dream it was to be a dental hygienist, I cannot express how meaningful it was to me to see my profession advance in such a major way right before my eyes. Because of Sandy Kemper and Smiles Forever, there will be future five-year-olds dreaming of making a difference for people as a dental hygienist, just like I did.

 Good-bye to these wonderful Bolivian children, until God-willing I can make the trip again!  Kellie