People, especially children, are usually afraid of dentists. How do you communicate with them in order to build trust and eliminate their fear?

The most important thing is for parents not to scare their children before visiting the dentist. Parents themselves are often scared and they tell their children that if they eat a lot of sweets, they will have toothaches and the dentist will have to pull their teeth, which is terribly painful. This is a very bad way to go about it. If I don’t want my children to have cavities, I don’t give them sweets and I brush their teeth at least twice a day. Communicating with toddlers is always difficult because we are strangers to them in a strange environment. What can work in this case is just sufficient time for a check-up and speaking with them calmly and quietly. For older children, we offer, for example, the possibility to watch cartoons on the ceiling in the examination room and, of course, to choose a gift when the procedure is finished. If we adults don’t show fear, there is no reason for children to be afraid.

When should parents bring their children in for their first check-up?

According to the Czech Dental Chamber, we should visit the dentist every six months, while a child’s first visit should happen at one year of age. As a rule, we start cleaning a child’s teeth when the first ones appear, which is usually at around the sixth to eighth month. Of course, sometimes parents have no idea how to clean an infant’s teeth. In that case, I recommend coming for a check-up as soon as the first tooth appears, when we will explain how to care for the child’s teeth, what to use and what not to use.

Are parents conscientious in this respect?

Most of them, yes. When parents first bring their children to the dentist, they think that the initial check-up serves primarily as an examination. But that’s really not what it’s about. Of course, we look into the child’s mouth, but the initial preventive check-up is rather a matter of giving instructions on how to take care of the child’s teeth so that they remain healthy.

Some people might say that these are just “baby teeth” that are going to fall out anyway. Why is prevention important?  

I believe that prevention is the most important thing that can help us avoid potential problems, such as time spent sitting in the dental chair, unpleasant feelings during procedures and financial costs. Every tooth has its own importance and should remain in the mouth until it is replaced by a permanent tooth. For example, the second molars often grow when a child is between ten and twelve years old. Tooth decay left untreated at an early age leads to inflammation of the tooth pulp, toothaches and extraction that would otherwise be unnecessary. If a tooth is removed prematurely, that can lead to orthodontic problems, such as misalignment of the permanent teeth.

What is the correct way to clean children’s teeth and for how long is parental supervision required?

Prevention of cavities is very closely associated with effective cleaning. Parents often tell me that they brush their children’s teeth, but the kids still have cavities. When we discuss it more in-depth, they tell me that their children are uncooperative and only let the parents clean their front teeth since cleaning the back teeth causes nausea or the kids just chew on the toothbrush and so on.

In my opinion, there are no toddlers that would let their teeth be brushed without tears. But it’s necessary. We try to brush their teeth any way we can – with circles or with horizontal movements – and we help them for as long as they tolerate it. At least until they are eight to ten years old. Even at that age, there is no shame in checking your kids’ teeth and finishing the brushing for them. Of course, it’s also necessary to visit a dental hygienist, again twice a year.

Generally speaking, in what condition are the teeth of the children that you have in your care?

The parents of the children who come to our clinic care about oral health. I definitely can’t complain. Of course, there are exceptions, when parents come with a child who has at least a dozen cavities and ask us to save as many teeth as possible. I stand by the fact that if they receive preventive care as they should and if their parents listen to us, children simply will not get so many cavities. However, we live in a country where people have different opinions on raising children, on their nutrition and on preventive care.

You perform dental procedures under general anaesthetic also in the case of paediatric patients. What kind of procedures does that typically involve?

We usually use general anaesthesia when treating uncooperative children or younger children with numerous cavities. It is then up to us whether we can repair the tooth by, for example, treating the root canals and cementing a zirconia crown in place, or whether it is already in such bad condition that we have to extract it. We also use general anaesthesia when we perform dental procedures such as extraction of supernumerary permanent teeth or, conversely, tunnelling. These procedures help orthodontists to set the placement of teeth whose original position would not have allowed spontaneous eruption and the tooth would have remained in the jawbone forever.

There is strong demand for anaesthesiologists. Do you have someone of your own at the clinic or do you collaborate with external specialists?

We have been providing general anaesthesia for many years and demand is still rising. We currently collaborate with an incredibly skilful paediatric anaesthesiologist and her two assistants. They are so well coordinated that it’s a joy to watch them work.

How do you prepare a paediatric patient for such a procedure?

In order for us to perform a procedure under anaesthesia, we need the paediatrician’s consent, which consists of an examination of the child and an agreement that the child can undergo the procedure without any risks to his or her health. At the same time, we need to provide the parents with detailed information on how the whole procedure will be carried out. If both parties agree, they sign an informed-consent form, which everyone is already familiar with. On the day of the procedure, it is necessary for the child to have an empty stomach and to limit his or her fluid intake sufficiently in advance.

It is currently quite difficult to find a dentist who is accepting new patients. According to the Czech Dental Chamber, the number of dentists is continuously rising. What’s the problem?

That is a very complex and much-discussed issue. The number of dentists is actually growing. However, not all of them intend to return to the regions that they’re originally from in the Czech Republic. And it’s true that big cities like Prague, Brno and Plzeň offer young doctors greater comfort. At the same time, foreigners study here and then return to their home countries.

It’s important to look at the numbers, i.e. how many dentists arrange cooperation with health insurance companies. Many patients who can’t find a doctor look for a dentist who has agreements with insurers because they can’t afford to pay for care out of pocket. Others are convinced that all care should be covered by their insurance and they’ll use the money that they save for other things.

People also prefer doctors within walking distance or within very short driving distance, which isn’t entirely possible. There has always been a higher concentration of specialists, including dentists, in big cities, and we just have to accept that.

MDDr. Zdeněk William Pelc, MBA, dentist at Canadian Medical