It used to be that about all Czech dentistry could offer was a black filling or a gold crown — and that stereotypical Soviet-bloc smile. Things have improved a lot since then, but a major hitch looms on the horizon: Dentists here are a vanishing breed.

A third of Czech dentists are older than 50 and will retire in the next five to 10 years, while factors like high university costs and poor pay are conspiring to keep the number of potential replacements low, says Jiří Pekárek, president of the Czech Chamber of Dentists.

"In South and some of Central Bohemia, thousands of people are unable to find a dentist willing to take new patients," Pekárek says. "The situation will only get worse. We believe that within a decade, our current number of 7,000 dentists will be reduced by half."

But things are already critical, as The Prague Post discovered during visits to several dental offices in Prague.

"People keep coming one after another and we cannot accept a single one," said a dentist at the Jabloňová medical center in Prague 10, who asked not to be named. The man said none of the center's nine dentists could take a new patient.

A similar situation was found in the nearby Malešice medical center.

"The lack of dentists that has started to show up was predicted long ago," Pekárek says, adding that he and others have sought to warn successive health ministers about the crisis. "But no one has done anything."

The Health Ministry could not be reached for comment.

Money matters

There are many factors driving the shortage of dentists.

For one, there's the generation gap. Dentists were poorly paid under communism, and the profession promised neither prestige nor profit. Students wanting to enter a medical profession chose another field.

"Being a dentist did not have much social distinction," says Petr Kolář, a young dentist working in Prague.

Jiří Mazánek, another dentist and a member of the Scientific Council of Charles University, says the root of the problem lies in the educational system. The country's five dental schools graduate just 120 dentists a year — and that's not enough.

"To make up for the dwindling numbers, we would need to double that," he says.

But there's no money to do that: Universities don't have enough to accept more dental students, even if interest in the profession, especially in recent years, has been growing. This year, for example, Charles University was able to admit only 94 dental students out of 840 applicants.

A five-year program for one student costs 200,000 Kč ($9,149), but only about half of that is subsidized by the government. There aren't enough teachers, either.

"Even if we had money to be able to accept more students," says Mazánek, "we still would not have enough professors to teach them. The career of a university professor is not very attractive anymore. People would rather practice privately where they can make more money than be a professor at a university."

No coverage

Insurance companies are not helping matters. Most don't provide much dental coverage, often leaving patients to pick up big parts of the bill themselves, or go without advanced care.

"I know dentists, mostly specialists, who only work three, four days a week because the insurance companies would not pay them more money anyway," Kolář says.

Dental specialists, like orthodontists, are the most needed.

In the Plzeň region of west Bohemia, for example, people often have to wait up to a year to get braces. Why? There's one orthodontist per 28,000 people. It's a specialization that virtually disappeared during communism; most Czech orthodontists are over the age of 60. And their replacements are arriving slowly.

Bargain hunters

Part of the dental crunch is also due to the fact that Czechs themselves are taking better and better care of their teeth. Yet, many are still reluctant to pick up the tab; the culture of socialized medicine, and expectations that the state should pay for everything, remains alive and well.

"Some dentists buy the newest equipment and materials in order to be able to offer it to their patients," says Kolář, who works mainly with foreigners at the European Dental Center on Wenceslas Square. "But they are a sort of good Samaritans because they can never get back what they invest in it," he says.

The result, despite high demand for a low supply of dentists, is still low prices. For example, a porcelain crown costs as little as 2,500 Kč, while it could cost as much as 15,000 Kč abroad.

Border regions in particular are benefiting from so-called "dental tourism," in which Czech dentists often cater to wealthy Westerners glad to pay cash up front for what they see as bargain rates.

The result is still fewer seats for Czech patients.