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Epidemiology and policy
P1-250 PUFA: an innovative index to measure the consequences of untreated dental decay
  1. B Monse1,
  2. H Benzian2,
  3. R Heinrich-Weltzien3,
  4. C Holmgren4,
  5. W van P Helderman4
  1. 1Fit for School Inc., Manila, The Philippines
  2. 2The Health Bureau Ltd, Haversham, UK
  3. 3WHO Collaborating Center for Prevention of Oral Disease, University Jena, Jena, Germany
  4. 4Department of Global Oral Health, Radboud University, Nijmegen, The Netherlands


Introduction Untreated dental caries is a global public health problem. Only limited data are available on the clinical consequences of untreated dental caries because there is no measure to quantify the prevalence and severity of oral conditions resulting from untreated dental caries. The new PUFA index records the presence of severely decayed teeth with visible pulpal involvement (P/p), ulceration caused by dislocated tooth fragments (U/u), fistula (F/f) and abscess (A/a); capital letters are for permanent and lower-case letters are for deciduous teeth. The PUFA/pufa score is calculated cumulatively representing the number of teeth that meet the PUFA/pufa diagnostic criteria.

Methods Three examiners were trained in PUFA use to assess reproducibility. Fifty 6-yr-old children and forty-nine 12-yr-old children were examined for PUFA/pufa and reproducibility assessed by κ calculation. Subsequent validation of the index in the 2006 Philippine National Oral Health Survey included 2030 6-yr-old and 2022 12-yr-old children using standard oral examination conditions (WHO Basic Methods 4th Edition).

Results Inter-examiner reproducibility prior to the survey had a κ value of 0.85. During the survey, intra-examiner reproducibility varied between κ values of 0.80–0.97 in both age groups. The index was easy to use under field survey conditions. The prevalence of PUFA/pufa >0 was 85%/56% (6-/12-yr-olds). The mean PUFA/pufa score was 3.5/1.2 and 40%/41% of decayed teeth had progressed to odontogenic infections (6-/12-yr-olds).

Conclusion The PUFA index complements classical caries indices with important information for epidemiologists and healthcare planners.

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