Czechia, the "nation of ruined teeth": swapping amalgam for white fillings won't fix the real problem

As of July 1, Czech dentists will, with rare exceptions, no longer be allowed to use amalgam fillings — the temporary exemption granted to Czechia and Slovenia by the European Union has expired, while the ban has already been in force in the rest of the EU since last year. At the same time, it's becoming clear that even the switch to white fillings won't solve the bigger issue — the dismal state of children's teeth in Czechia.

According to the Czech Dental Chamber, many patients deliberately put off their dentist visits late last year, even when they already had cavities — they were waiting for January 1, when insurance companies began partially reimbursing the cost of white fillings for the first time. "November and December were disastrous, because patients were waiting for the new year to get 900 crowns from their insurer toward a white filling. January and February, on the other hand, turned out to be extremely busy for dentists," says Roman Šmucler, president of the Chamber.

According to the country's largest insurer, the General Health Insurance Company (VZP), which covers nearly 60% of the Czech population, 731 million crowns were spent on white fillings for adult patients in the first four months of the year alone: 212 million went toward non-layered photocomposite fillings and 519 million toward plastic ones. Starting January 1, 2026, insurers will reimburse such treatment up to 900 crowns, with patients covering the rest themselves.

If spending continues at this pace, the annual total could reach 2.2 billion crowns — even though the explanatory note accompanying the law that introduced this benefit originally projected up to 2.8 billion. According to dentist and healthcare analytics expert Bára Jurčíková, a member of VZP's board of directors, an accurate forecast was difficult to make from the start, since quality photocomposite fillings for adults had never before been reimbursed by the state.

The number of patients is expected to rise noticeably as the start of the summer holidays approaches — the point at which amalgam use will be banned outright. According to VZP spokesperson Viktorie Plívová, the insurer's projected main fund balance for 2026 stands at 16 billion crowns — about 2 billion lower than the forecast made earlier in the year. The reason is more successful premium collection combined with lower-than-expected activity in certain segments, including dentistry: so far, dentists have placed fewer fillings than anticipated.

A separate problem is the lack of up-to-date data on the state of Czechs' teeth. The last comprehensive study of this kind was conducted almost twenty years ago, around 2008. The Dental Chamber has proposed a new study using comparable methodology, so the results could be tracked over time and benchmarked against other countries. The issue was recently discussed by the Health Ministry's advisory group on primary care reform.

As Health Ministry spokesperson Hana Plačková explains, a new study should provide an up-to-date picture of the prevalence of tooth decay and other oral health issues among children and adults, reveal regional disparities and gaps in access to dental care, and serve as a basis for planning the clinic network, treatment tariffs and targeted prevention programs. However, no specific start date or research team has yet been determined.

According to Jurčíková, Czechia still lacks a comprehensive system for preventing tooth decay in children: "In that case, it hardly matters what color the filling is — white or black — or how much the insurer pays toward it," she says.

The situation is especially worrying when it comes to children's teeth. "We're something of an outlier in the EU: everywhere else, demand for dental treatment — extractions, fillings, root canals — is dropping sharply, but among children here it's barely declining at all. Parents don't pay enough attention to their child's first teeth, which is why there's a huge amount of tooth decay among four-year-olds in this country," explains Roman Šmucler.

Yet tooth decay is easily prevented through proper hygiene and diet. The international benchmark is for 80% of six-year-olds to have no cavities at all. The latest figures show Czechia barely reaching 50%. And decayed baby teeth can cause problems for permanent teeth down the line.

"Several billion crowns have gone into reimbursing white fillings — yet a full-scale cavity and gum disease prevention program, say in schools and kindergartens, could have been built for far less money. But that requires the agreement of all the insurance companies, the Health Ministry and the Education Ministry — and that, I think, is where the real problem lies. It calls for serious coordination," Jurčíková concludes.

Around Prague, based on reporting by seznamzpravy.cz