Open Wide and Say 

Dr. Lin Hong-jin and assistants work on a disabled patient. It often takes more than one person to care for such a patient.


Dentist Lin Hong-jin (林鴻津), 60, drives 40 minutes every Tuesday morning from his home to the Bali Ai-Hsin Home for Persons with Disabilities in New Taipei City, northern Taiwan. This has been his weekly routine for the past 11 years. He has an important job to do, working “up close and personal” with the residents there.

On this day, attendants lifted a resident, Meng-meng (盟盟), from his wheelchair onto a dental chair. Meng-meng suffered from a severe case of cerebral palsy and had limited control over his movements. The attendants had to use restraining belts to prevent his arms and legs from jerking and interfering with his treatment.

Lin proceeded to examine Meng-meng’s teeth. “You’ve been snacking more lately, haven’t you? Your gums are a little puffy. You might want to go easy on the snacks,” Lin said to his patient. “Let me clean your teeth. This may make your gums a little sore, but bear with me.” Meng-meng recognized the dentist’s familiar voice and shouted “OK!” in reply. Then he opened his mouth wide without any drama.

After working on the patient for a while, Lin noticed Meng-meng was becoming tense. The dentist said, “You’re doing great! You can swallow your saliva if you like. Just relax!” Meng-meng relaxed accordingly.

It was fascinating to see how Dr. Lin was able to put Meng-meng at ease. What we were witnessing was not magic, but rather the result of Lin’s 11 years of tender loving work with these types of patients.

Dr. Lin recalled his first trip to the home 11 years earlier. He could see that the children were well cared for, but there was an odor in the air that he knew only too well. “The teachers and volunteers might have worked there for so long that they’d gotten used to it, but it’s an odor a dentist would never miss.” The smell was bad breath as a result of periodontitis.

Afterwards, he invited a dozen dentists to conduct oral checkups for all the children at the institute. They found many dental problems. Lin pointed out to the home’s administrators that the kids’ oral health problems could be best managed at the root just by keeping their teeth clean.

That was truly much easier said than done. Chen Yu-zhen (陳毓珍), head of health maintenance at the home, recalled the time when they attempted to implement Lin’s recommendations. It was total chaos. “All the children bled badly when we brushed their teeth because their periodontitis was so bad,” Chen said. “Some children just wouldn’t cooperate; they screamed and struggled. Sometimes, it took several of us to brush one kid’s teeth. Even those who obediently let us do the job cried like hell. Bystanders would have thought that we were torturing them.”

Despite the kids’ initial resistance, Dr. Lin and the staff at the nursing home were determined. Eventually, their persistence, patience, and love accomplished the impossible. Now the children gladly let their caregivers brush their teeth, and some of them even brush and floss their own teeth themselves. Like a proud father, Lin declared, “Now their teeth are even healthier than those of most other people.”



At the Bali Ai-Hsin Home for Persons with Disabilities, helpers assist a resident into a dental chair.

A caregiver brushes a resident’s teeth after a meal.

A resident with cerebral palsy brushes his teeth with his foot. Courtesy of Lin Hong-jin


Site two

On Saturday of that same week, Dr. Lin went to Shuang Ho Hospital in Zhonghe, New Taipei City, to treat patients at the Oral Care Center for People with Special Needs. He goes there every other Saturday to carry out his mission.

Bao-gui (寶貴, name fictitious), 37, is severely autistic. His parents take him to the center every three months to see Dr. Lin.

Bao-gui’s father, Qing-xiang (慶祥), says that Bao-gui begins yelling and wiggling in the car as soon as he recognizes the road they take to visit the oral care center. When they reach the center, he and his wife have to patiently cajole him, with three hospital staffers helping, to get him into the examination chair.

“Bao-gui can’t verbally communicate with others, and he gets nervous and edgy very easily. He may hit and knock people down,” Qing-xiang explained. “But whatever we do, we can never use harnesses on him or he’ll go absolutely berserk.”

Though it is quite a job to get him ready for the dentist, the staff at the hospital have always been patient and empathetic. Their care is not lost on the grateful Qing-xiang and his wife.

They used to take Bao-gui to other hospitals for his dental care. “They had to put Bao-gui under general anesthesia before they could treat him, so each visit usually took two hours. Afterwards Bao-gui would feel groggy and quite uncomfortable,” Qing-xiang recalled. But things greatly improved after they switched to Shuang Ho Hospital and chanced upon Dr. Lin.

“When Dr. Lin told us that there would be no need for anesthesia, I was honestly a bit dubious,” Qing-xiang admitted. “But then we saw him massaging Bao-gui to relax him, and before long the whole mouth-cleaning procedure was complete. He’s just awesome.”


A scene at a free dental clinic that Dr. Lin once organized to serve people in Kiribati, an island country in the central Pacific. Courtesy of Lin Hong-jin

Cracking a hard nut

Data from the Ministry of the Interior shows that there are about 1.14 million people with disabilities in Taiwan, approximately 4.88 percent of the population. A 2005 survey conducted by the Health Promotion Administration indicates that 91 percent of the disabled had cavities, far more prevalent than the 69 percent in the general population. Furthermore, only 31 percent of the disabled had had their cavities filled, compared with 74 percent of the general population.

Dental health is apparently a big problem for the disabled population, but it does not have to be. If they practice good oral hygiene, they are doing much more than just fighting against cavities and periodontitis. They also help themselves ward off germs and viruses, lower their risk of respiratory infections, reduce oral hypersensitivity, eliminate bad breath, boost self-confidence, and improve their relationships with others. If brushing their teeth becomes part of their daily routine, they will also be less frightened during dental visits. Furthermore, the act of brushing their teeth trains their hands to carry out precision movements and improves their hand-eye coordination.

If there is so much to gain, why don’t more disabled people brush or have their teeth brushed?

Though brushing one’s teeth is easy for most people to do, it may be extremely difficult for some of the disabled. They may not have sufficient physical control over their own bodies to execute this simple act. Their caregivers may not recognize the importance of dental hygiene and so may overlook their need for proper dental care.

But even worse is that though Taiwan has a plethora of dental clinics, many dentists refuse to treat disabled people. For one thing, treating persons with special needs requires a lot more patience than treating able-bodied persons. For another, some dentists are worried about being accidentally hurt by disabled patients should they struggle or have uncontrolled movements while being treated. These roadblocks have contributed to the dental problems that plague many disabled people, and to the stereotype that it is difficult for such people to possess good teeth. However, Dr. Lin has successfully debunked that stereotype with the good work that he started at the Bali home in 2004.

Because of his successful experience, in 2006 the Ministry of Health and Welfare commissioned the Taiwan Dental Association to implement for the disabled population a nationwide program for dental care based on the model that Dr. Lin had established at the Bali home. In 2008, the ministry commissioned Shuang Ho Hospital to establish an oral care center for the disabled—the first of its kind in the nation. That was followed by six specialty dental treatment demonstration centers throughout Taiwan. Many disabled people have benefited as a result. The driving force behind all these government initiatives has been Dr. Lin.


Dr. Lin teaches oral hygiene to children in Cambodia. Courtesy of Lin Hong-jin

The driving force

Dr. Lin leads a busy life. Aside from serving at the Bali and Shuang Ho sites every Tuesday morning and every other Saturday morning respectively, he spends his weekends lecturing or training personnel at hospitals or nursing homes throughout the country. He is usually booked solid two months into the future. He reserves only Thursday mornings for his personal use, when he can sleep late or enjoy some free time. “I was diagnosed with high blood pressure a few years ago, so I occasionally need to see my doctor too,” he said.

Though his schedule is packed, he greatly enjoys what he is doing for the disabled. “I keep a private practice to make a living so I can pursue my dream of caring for the dental health of the disabled,” Lin said. “Working at Bali and Shuang Ho actually gives me a chance to have a needed breath of fresh air and to get me out of my groove.”

Dr. Lin’s do-good spirit has been on full display since his youth. He cut his teeth in social service when he was a freshman at Taipei Medical University by joining a club that served needy children. In his senior year, he and his schoolmates formed an oral hygiene service team. They went to backwater towns in northern Taiwan, such as Pingxi and Bitoujiao, to promote oral hygiene. However, their enthusiasm did not amount to much in the end because they lacked experience to execute such a campaign. Bruised but undeterred, these young people pledged to organize a professional medical service team after they began work and had gained more experience.

This pledge remained unfulfilled for quite a long time; the young dentists naturally became preoccupied with their own families and work. However, that changed in 1990 when Lin, at 35 years of age, joined his former classmates Drs. Xiao Yu-ren (蕭於仁) and Huang Chun-feng
(黃醇豐) in establishing the “415 Oral Care Service Team.” One day a month, members of this team would visit a remote town to provide free dental care and oral hygiene education. Such service—delivering both care and education at the same time—was the first of its kind in Taiwan.

Lin later helped the Tzu Chi Foundation organize its free clinic teams and establish the Tzu Chi International Medical Association. He has been active in free dental clinics inside and outside Taiwan.

Unlike other specialties, dentistry requires a full complement of equipment, lighting, and dental chairs. These are all very bulky and not particularly mobile. “We used to order lighter and more mobile equipment for our earlier free clinics,” Lin said, “but they didn’t always work well at the site. We often had to improvise as we went.”

In the mid 1990s, a universal health insurance program came into force in Taiwan. Access to medical care has also become more convenient over the years. These factors have made mobile dental clinics such as those offered by Lin’s group largely unnecessary. Nonetheless, those clinics gave Lin unique opportunities to observe the lives of his patients, which led him to be more firmly convinced that prevention is always better than cure, that education on oral hygiene is always more effective than treatment.

“No matter how hard we try, no matter how many resources we put in, there are always more cavities than can be filled,” Lin said. “Helping children form proper oral care habits early on is a much more efficient and lasting way to solve the problem.”



Though his motor coordination has been weakened by cerebral palsy, this resident at the Bali home spends more than ten minutes brushing his teeth after each meal. “I like brushing my teeth, and I like Dr. Lin,” he said.

The awakening

How did Dr. Lin find his calling to care for the dental health of disabled people? That can be traced back to a trip to Japan.

When he was close to 50 years of age, he joined a Taipei Medical University delegation on a visit to Fukuoka, Japan, to see how that country provided dental care for the disabled.

“It was a total shock,” said Lin of that trip.

Lin and the other delegation members learned that Japan had begun implementing a model of dental care introduced from Scandinavian nations as early as 1976. Based on that model, a three-tier dental care network was established in Japan that involved neighborhood dental clinics as well as medical centers.

Dental hygienists played a key role in this network. When they received notifications from neighborhood dentists, they took over the care of the patients. They helped disabled or elderly people get dental care, and they visited them at home to clean their teeth, conduct oral hygiene education, and offer dietary guidelines to help prevent cavities. Health insurance paid for their services.

The implementation of this policy led to a marked reduction in the incidence of cavities among the disabled, so much so that it stood at close to zero cavities. Since almost none of these patients had cavities or periodontitis, they went to their dentists only for routine checkups.

The trip really opened Lin’s eyes, and it also gave him a new mission in life. From then on he would do whatever he could to contribute to the dental health of Taiwan’s disabled population.

He recalled that in the same year he visited Japan, a medical malpractice lawsuit unfolded in Taiwan. A ten-year-old boy suffering from a rare and complex congenital heart defect had so many cavities that he had to undergo a whole-mouth reconstruction operation under general anesthesia. The surgery went well, and the boy was sent to a pediatric intensive care unit for observation afterwards. Nothing seemed to be out of the ordinary, but when the pediatrician removed his endotracheal intubation the next morning, the boy went into a coma, followed by pneumothorax, hemorrhagic shock, and then death. A protracted civil suit ensued, which easily gave dentists another reason to shun disabled patients.

When Lin discussed this case with Japanese doctors during his trip, one of them asked him three questions: “How could the boy’s parents have allowed his teeth to deteriorate to that extent? How could the Taiwanese government have overlooked the oral health of disabled children? Why were there no disabled groups in Taiwan lending support to dentists?

“His questions made me realize that Taiwan was absolutely still a barbarian state when it came to dental care for the disabled,” Lin said. He returned to Taiwan heavy-hearted, but also determined to address this issue.


The calling

Soon after his return, Lin happened to visit the Bali Ai-Hsin Home for Persons with Disabilities. That led to the tooth-cleaning project there.

The Bali Ai-Hsin Home for Persons with Disabilities is the only public nursing facility in New Taipei City for physically challenged people. It serves severely disabled people between two and 18 years of age who are immobile and who cannot take care of themselves. About 150 of them live in the home.

To carry out this project, Lin stepped up his efforts to learn from the experiences and knowledge of his mentors in Japan. Tokyo Dental College gave him a lot of help in this respect.

Lin was quick to admit that he was unsure whether the tooth-cleaning project at the home would succeed. For one thing, he was uncertain if the staff at the home, busy as they already were, would be eager to buy into an effort that would significantly add to their workload. “But if we didn’t do it, there would be no end to treating their bad teeth later,” Lin said of the trade-off.

To ensure that the project would be more effective, he laid down three conditions for the then superintendent of the nursing home, Guo Mei-que (郭美雀). First, since the tooth surface on the side closer to the cheek was easier to brush, that surface of the teeth of all the children had to become clean in four months. Second, the surface on the side closer to the tongue had to become clean in ten months. Third, all first-line caregivers had to diligently help the children brush their teeth. If even one person was unwilling to do that, it would be grounds for Lin to leave.

That was a tall order, but Guo agreed right away. “If we hold to those conditions, you must hold to your promise to stay with us,” she countered, and Lin concurred. Thus, the fight against bad oral hygiene in the Bali Ai-Hsin Home got underway in earnest.


Learning to brush

According to Dai Ming-qiu (戴明秋), a senior teacher at the home, they went through quite a trial-and-error process before they finally got the knack of brushing the residents’ teeth properly. When they first applied the techniques they had learned from Dr. Lin to the kids, who were often understandably frightened and uncooperative, they found out in a hurry that they still had a lot to learn. “At first, we often thought we were brushing, but we weren’t actually even making contact with the teeth. Then we learned that we needed to use our fingers to push the cheeks outward. Only when the teeth were in our direct sight could we actually brush them,” Dai said. Brushing too hard was a problem too, as it caused some of the residents’ gums to recede or develop ulcers. “We caregivers eventually put aside our dignity and brushed each other’s teeth to practice.”

Fighting against bad oral hygiene was the business of everyone at the home. Even the kitchen staff got in on the act. They developed recipes that would yield less sticky food, and they kept close tabs on the serving of snacks.

With patience and practice, the caregivers at the home eventually mastered the art of brushing teeth for the children. They are now very capable of having the children, even those more easily agitated, go through the process without struggle.

To ease the more nervous children into brushing, the adults first massage their shoulders, cheeks, and then, with gloved fingers, their gums. When the children are relaxed enough, the caregivers deftly hold the children’s heads against their chest, use the inside of their wrist to support and stabilize their faces, and begin to brush their teeth.

The caregivers have been so diligent in this undertaking partly because they have been impressed by Dr. Lin’s dedication to this project. “How can we not work hard at this when Dr. Lin, an outsider in a sense, is so committed?” Dai remarked. “He makes unannounced visits and inspections from time to time, and he pays out of his own pocket for supplies and things needed for tooth cleaning. He really treats us like family.”

To really keep the children’s teeth clean requires more than the efforts of the adults. The children have a role to play as well. It is important that they feel comfortable about having someone brush their teeth, and it is even better if they learn to do the brushing themselves. That prompted Dr. Lin to start a toothbrushing class for residents who had enough functional control over themselves that they could brush their own teeth.

“We weren’t sure at first how well the children could grasp our instruction, but after a few sessions of the class, they asked if they could have a toothbrushing competition,” said Chen Yu-zhen, the head of health maintenance at the home.

That prompted the institute to hold its first ever toothbrushing competition, and it even staged skits on tooth cleaning. The children were electrified by this new wave of activities, and the interest in toothbrushing surged.

Dr. Lin added more excitement to the mix for the second competition. He announced that the reward for this competition would be a visit to Japan. Fifteen children who did well at the competition, 30 caregivers, and 13 administrators would be allowed to join a delegation of the Taiwan Dental Association on its tour to Japan to learn about the nation’s dental care system. And better yet, there would be a trip to Tokyo Disneyland too! That really got the children excited.

Now, every meal at the home is followed by a toothbrushing session; this has become a set routine. Each caregiver spends about 50 minutes after each meal to help five children brush their teeth. They are not after speed; instead they seek to do the job thoroughly.



Dr. Lin stands shoulder to shoulder with thedisabled and the underserved.


In 2008, Taiwan’s Ministry of Health and Welfare contracted with Taipei Medical University, Lin’s alma mater, to manage Shuang Ho Hospital.

Dr. Lin convinced Li Zu-de (李祖德), chairman of the board of the university, and Qiu Wen-da (邱文達), university president, to establish an oral care center for the disabled, the first such facility in the nation. Specialty treatment rooms, operating rooms, and areas dedicated to oral hygiene education serve patients in the 3,560-square-foot center. The center has one distinguishing trait: It places as much focus on patient education as on treatment. Another arguably more important distinction is its emphasis on dealing with each patient as an individual, a living person, instead of a lifeless patient number.

Ye Bi-xin (葉必信), a practicing dentist who also serves at the center, pointed out that a dentist does not need to master any particularly difficult techniques to serve disabled patients, but he or she needs to regard a patient as a human being. “You talk to them and interact with them warmly,” Ye said. “You don’t just ask them to crack their mouths open and begin to drill. You yourself need to make mental adjustments, relax, and make allowances for the children. When you treat them well, they’ll treat you well.”

Huang Mao-shuan (黃茂栓), chief of the dentistry department at Shuang Ho Hospital, appreciates the efforts Dr. Lin has put in for this oral care center. Huang specifically pointed out that Lin recruited some dentists to volunteer at the center during the first year of its operation. Their free service really helped the center take off and establish a firm footing.

“Now our center has won much praise,” Huang said. “We serve about 8,000 patient visits a year. Our program has even led the government to establish a national dental care network for people with special needs. The inexorable driving force of Dr. Lin has made this wonderful development possible.”

As a precursor of dental care for the disabled in Taiwan, Lin is always ready to learn new things, and not just about dentistry. Recently, the National Taiwan University Hospital dental clinic dedicated to serving people with special needs held a workshop for its employees. Lin attended too—not just as a speaker but also as a learner: He listened to lectures on autism and dementia.

He is also quite a perfectionist. For at least an hour each day, he reads published papers and polishes presentation materials for his next talk. “My wife said that she didn’t understand why I needed to put so much effort into revising my presentations since I’ve given similar talks hundreds of times” Lin said. “But I believe that I need to tailor my talks so they’ll be appropriate for the audience. I also need to keep up with the latest advances so I can inspire more people to join in and bring about changes in dental care.”

His next step is to expand his care to include more disadvantaged people, such as the elderly, people in vegetative states, and the mentally ill.

Since he realizes that an ounce of prevention is worth a pound of cure, he has been raising awareness for good dental hygiene. In recent years, he has noticed political candidates promising free dentures for the elderly in their election campaigns. He takes issue with that. He explains: “For one thing, subsidized dentures are necessarily low-priced and cannot be of any decent quality. But such a project could still easily cost over NT$100 million [US$3.3 million] in public funds. It would be far better to focus on oral health education, which, at NT$30 million [US$1 million] a year, produces steady and lasting results.”

He talked to government officials about it, but they simply brushed his objections aside. Lin believes that they were being bureaucratic and shirking responsibility. Implementing dental hygiene programs would take time and effort and add to their workloads, whereas giving money away for dentures would be a lot easier.

In 2010, Lin won a government award for his long-time dedication to dental care for the disabled. During the award ceremony, Lin took the opportunity to present to President Ma Ying-jeou his concept of dental care for the elderly: Providing preventive care as early as possible and keeping teeth clean will reduce the demand for dentures. However, his attempt has not yielded any meaningful changes to oral health care among the elderly, the inadequacy of which remains to be addressed.

Roadblocks notwithstanding, Lin stands firmly shoulder to shoulder with the disabled and the underserved, their families, and their caregivers. He continues to deliver warmth to them, and he continues to help keep their teeth clean. With that, they can all smile with confidence and show off their teeth—cavity-free.

Spring 2016