Since 1998, Sonrisas strengthened its international presence.  For years, the Foundation has been helped by a number of friends both in the Dominican Republic and abroad, especially in Canada.  In 1998, the Smiles Foundation (a sister foundation to Sonrisas) was legally registered in Canada as a non-governmental charitable institution and an office was established there to support the work in the Dominican Republic.

  A number of donations, via boat and plane, have been sent from Canada to the DR -including dental materials, dental equipment, food, office materials, and more.  These shipments have been supported by businesses in Canada, like DeBoer's Furniture, the Canadian Government, ADRA Canada, CFWD, CFTC, UNICEF and the Canadian Armed Forces. 

  Only in 2004, the Foundation requested, received, and sent an equivalent to four 40-foot containers of donated equipment and materials for its clinics in the Dominican Republic.  Smiles Foundation, also, responded to the natural disaster "Hurricane Georges" that affected the Dominican Republic in late 1998 and the flooding that affected the area of Jimani in 2004.  These donations were distributed among the affected population by means of several outreach field trips carried out by the clinics in the Dominican Republic.  Donations requested and received included: office equipment, dental equipment and materials (for permanent and mobile clinics), educational equipment and materials,  and direct financial assistance.