Dentistry Tripping

A trip to a foreign dentist´s office is one of those landmark moments that separate the tourists from the expats. Teeth are the very symbol of human permanence and a trip to the tooth doctor (for anything other than an emergency) is something you only do when you too are permanent. Fortunately for us Czech expats, dentistry practiced in the Czech Republic is of the same high standard as other developed countries. All the same procedures one might expect in Great Britain or the United States can be found here, and the prices are quite reasonable. Some people even take dental holidays to Prague – a bit of sightseeing combined with having some work done – because the quality-to-price ratio is so inviting. The question for many boils down to who can speak enough English to have me as a patient and where can I go for a high quality, affordable experience?

If money is no object, there are excellent private clinics in Prague that accommodate English as well as other foreign language speakers; and they can have you in and out in no time. On the other hand, once you´ve paid your mandatory medical insurance, you probably want to use it and go with a local doctor who accepts VZP and OZP, and speaks “enough” English. This article isn´t meant to cover the intricacies of various insurance schemes but I will discuss how coverage is handled.

My doctor was friendly, conscientious and had a good, steady hand. I sat through the ordeal like a good patient (tongue poised out of the way, never needing reminders to keep my mouth open, breathing deeply and trying to relax, despite the deep drilling and lots of vibrations in my jaw.) At last it was over – or so I thought. They needed to repeat the same process three more times! In fact, this “canal” had only been hollowed out and temporarily filled, the trick now was to wait for any remaining nerve in there to die completely before filling the canal with permanent composite. My co-pay after this ordeal was tiny – 350 CZK, I think. “Bargain!” I thought as I breezed out. But that´s not how payments really work.

The next visit involved filling that canal and drilling a new one. First the dentist drills right into the affected canal inside the tooth. This is where the nerve lives. Once a tube has been hollowed out, they twirl around in there with a mini bristle brush (the kind you can buy to clean between teeth) of increasing diameter. If your teeth are close to the nerve, like mine are you swear you can feel it, despite the local anesthetic. This time I was charged 2,000 or 3,000 CZK. And the next appointment wasn´t for about another two months. Each subsequent appointment that involved the composite material cost the same, so in total the procedure cost around 8,000 CZK and lasted half a year. The tooth, a rear molar, looks and feels great now, so I´m satisfied.

One of the dentists there comes highly recommended by users of this site. He has read the posts here relating to dentistry and wanted to clarify some misconceptions. He explained that VZP (and the other plans) cover certain procedures, materials and preventative care. “Certain” in this case means what the insurance company acknowledges as satisfactory. They are often not necessarily the best choice in terms of long-term stability and success, despite statistics that support this. Usually these options are also the cheapest.

So while some Expats.cz members say they paid only 400 or 500 CZK for a root canal, this only means the dentist went with the cheapest possible materials and VZP covered it fully. When performing a root canal you can fix the tooth with one of three procedures: the budget filler (with a 50/50 chance of it being sustainable), the next step up (with better odds) and finally the “top shelf” filling. VZP pays only for the cheapest material and does not cover high-end materials even partially. If you go with the state-of-the-art filler, which is recommended, you´re left paying for the whole thing.

Whether private or not, the “nicer” clinics may choose to work with only high quality materials. For one thing, they don´t want to see the same client back in the chair and have to redo the same tooth. Waiting periods at reputable local clinics are long – up to six months for new patients. Since the books are always filled, they prefer doing work that is built to last. You can opt for the low rent materials, and a low fee, at less advanced clinics, but your nice white filling may turn dark. Or you may not get a white filling at all, even for a visible tooth, because VZP doesn´t cover white fillings except for front teeth and only for minors (under 18 years of age).

Of course this is not a priority for everyone but it´s good to know the underlying principle behind the price disparity. You are not getting ripped off; you´re paying for reliable work. And across the board, prices here are still very reasonable. But be warned – if you make recommendations on Expats and provide phone numbers right in the post you are directly affecting your own wait time. The dentist in question noticed a spike in new patients after someone mentioned it was easy to get an appointment with him – which is now no longer the case. But he wanted to leave the information on the site anyway because as he put it, there is a limited number of good dentists who speak English well and accept VZP, OZP and other typical, local plans.

I learned a lot about wisdom teeth. They´re called “zuby moudrosti” in Czech, or “osmičky” because of their position as the eighth tooth. Interesting side note; not everyone has wisdom teeth – it´s a genetic thing. And for those who do have them; not everyone needs to have them removed; it depends on the size of your jaw. My jaw is tiny and the wisdom teeth – all four of them – were determined to grow anyway. According to my dentist, extraction on a face as delicate as mine (why, thank you!) is risky because the jaw is easily fractured. On top of that, my lower nerve is nestled in and amongst the roots of the teeth – which all adds up to a tricky procedure. It doesn´t have to be, and for many it´s not. And the younger you are, the faster you´ll heal.

Before doing anything, my doctor took me through the entire process, explaining the risks. He showed me my x-ray and circled the problem area where the nerve cross-sectioned the roots of the back teeth. He discussed aftercare and just generally blew me away with the level of discussion. I´ve been here eight years now and have seen all kinds of doctors, private and public. I have found each and every doctor to be qualified and professional but not all of them like to discuss things with you (as much as I´d like anyway.)  It´s understandable, with a waiting room full of desperate patients. But sometimes there´s a condescending edge of “You´re not qualified to discuss this. Don´t question me.”

My doctor informed me well about the procedure, which made me less scared. I also watched a Youtube video demonstrating the procedure. This was ill-advised. Don´t do it!

It took me over a week to recover, and pain-wise it was second only to labor. Prescription painkillers weren´t offered, so I didn´t ask. It turned out if I´d let him know I was hurting so much, he would have written a prescription, but I wanted to be brave and am currently nursing, so I suffered for about ten days. Yes, we in America go over the top with the painkillers, but the idea that Czech doctors categorically refuse to prescribe them is wrong. Just be honest with your doctor. They´re not monsters, and an experience doesn´t have to be any scarier just because it´s happening in the Czech Republic.