Rotting Teeth: An Emerging Health Issue Among Children

By Muhammad Atif Ismail

A child’s smile is often the first thing we notice, and the last thing we protect. Across Pakistan, an entire generation is growing up with decaying teeth, and hardly anyone is talking about it.

New research should have made headlines. It didn’t. A cross-sectional study published in the Pakistan Journal of Health Sciences examined 385 children between six and twelve years of age, using the World Health Organization’s DMFT index, and found that 68.9 percent of them, nearly seven in ten, had some form of dental caries. Only 31.1 percent were completely free of decay. The rest ranged from mild cases to severe and very severe ones. The World Health Organization itself now classifies dental caries as the most common non-communicable disease among children, ahead of asthma, ahead of hay fever, ahead of nearly everything else parents worry about.

Numbers like these should alarm us. They rarely do, because tooth decay does not announce itself the way a fever or a rash does. It creeps in quietly, through a habit skipped here, a sweet indulged there, until a child is in pain, unable to eat properly, missing school, falling behind. That is the real cost of this epidemic, not just cavities, but stunted nutrition, disrupted learning and a childhood dulled by discomfort that adults failed to notice in time.

What makes the picture worse is how little Pakistani families know about prevention. The same study found that almost 90 percent of children had no idea sugary foods caused tooth decay. Fewer than one in a thousand brushed twice daily with fluoride toothpaste, the single most basic defence recommended by dentists everywhere. This is not a failure of medicine. It is a failure of awareness, and awareness is something we can still fix.

Dr Maryam Bashir, a specialist in Operative Dentistry and Endodontics who heads Fazeelat Bashir Dental Clinic in Multan, put it plainly when she spoke to me. Childhood tooth decay in this country, she said, comes down to everyday habits and parental oversight: brushing routines started too late, sweeteners used too freely, feeding bottles kept in use long after they should have been retired, and a general unfamiliarity with how to choose and use toothpaste correctly. None of this, she stressed, is inevitable. Regular check-ups, informed choices about toothpaste, weaning children off feeders once teeth erupt, and cutting back on sweeteners could prevent most of what she sees in her clinic. She also had a warning for parents who reach for painkillers the moment a child complains of tooth pain: that response treats the symptom and ignores the disease. A toothache in a child is a signal, not an inconvenience, and it deserves a dentist’s attention, not a tablet.

The situation, she added, is worse in rural areas, where cheap and substandard confectionery compounds the damage and proper dental care is harder to access. Dr Armeen Tariq of Shahida Islam Medical and Dental College echoed the same concern, urging parents to take children to qualified dentists rather than unlicensed practitioners, arguing that timely treatment is what stands between a manageable cavity and years of complications.

Perhaps the most telling detail in all this is one easy to overlook: Pakistan has not conducted a national oral health survey for this age group since 2004. Two decades have passed. An entire cohort of children has grown into adulthood in that gap, and another is now repeating the same pattern, largely unmeasured and unaddressed. Researchers describe the oral health of children aged six to twelve as “unsatisfactory,” a clinical word for what is, in plain terms, a policy failure sustained by silence.

I met Malik Iftikhar, a police officer, at a private hospital where he now takes his son regularly for dental treatment. The boy needs roughly eighteen months of braces. Iftikhar admitted, without much prompting, that he had neglected his son’s dental care for years, assuming it was a minor matter that would sort itself out. It didn’t. “Now I am very much concerned about the treatment of my son,” he told me, and there was real regret in how he said it.

That regret is the real subject of this column, not the statistics, not the clinical index scores, but the quiet realisation, arriving too late for so many families, that a child’s teeth were never a small thing to begin with. If there is a lesson here, it is not complicated. Brush early. Watch the sugar. See a dentist before the pain does the talking. And perhaps, at a policy level, it is time someone in Islamabad remembered that a national oral health survey is two decades overdue, and an entire generation of children is waiting on the other side of that delay.