Clinical consequences of untreated dental caries in youth population using pulpal involvement, ulceration, fistula, and abscess index

Supplementary Files



Decayed, missing, and filled teeth index;
Dental fistula;
Pulpal involvement, fistula, and abscess index;

How to Cite

Kharel, S., Dixit, P. B., Shrestha, D. ., Ghimire, S., Dahal, S., & Dhakal, S. (2023). Clinical consequences of untreated dental caries in youth population using pulpal involvement, ulceration, fistula, and abscess index. Journal of Kathmandu Medical College, 12(3), 168–73. Retrieved from


Background: Dental caries is a major health problem worldwide despite improvements in oral health.  It is one of the leading causes for extraction of teeth. Untreated caries may lead to pain and infection causing negative impact on a patient's personal well-being. Implementation of preventive strategies is the most cost-effective measure to prevent dental caries and its consequences.

Objectives: To find out the consequences of untreated dental caries in the youth population using pulpal involvement, ulceration, fistula, abscess index.

Methods:  A descriptive cross-sectional study was carried out in 295 patients aged 15 to 24 years visiting the Department of Conservative Dentistry and Endodontics at Kathmandu Medical College with a complaint of dental caries from October 2021 to February 2023 after obtaining ethical approval. The data obtained were entered and analysed using Statistical Package for Social Sciences. Mean, median, standard deviation, frequency and percentage were calculated depending upon the nature of data.

Results: Among various consequences of untreated dental caries, pulpal involvement was the most common consequences followed by abscess. Pupal involvement was found in 57 (19.32%) individuals and abscess in two (0.68%) individuals. None of the participants presented with ulceration and fistula. There was no significant association seen between age and sex with presence of pulpal involvement, ulceration, fistula and abscess among the individuals examined.

Conclusion: Dental caries is a global issue that affects many people. It is possible to reduce the prevalence of caries and mitigate its associated consequences by increasing awareness and implementing preventive strategies on a national level.


Petersen PE, Bourgeois D, Ogawa H, Estupinan-Day S, Ndiaye C. The global burden of oral diseases and risks to oral health. Bull World Health Organ. 2005 Sep;83(9):661-9. [PubMed | Full Text]

Petersen PE. The World Oral Health Report 2003: Continuous improvement of oral health in the 21st century–the approach of the WHO global oral health programme. Community Dent Oral Epidemiol. 2003 Dec;31(Suppl 1):3-24. [PubMed | Full Text | DOI]

Klein H, Palmer CE, Knutson JW. Studies on dental caries: I. Dental status and dental needs of elementary school children. Pub Health Rep. 1938 May 13:751-65. [Full Text]

Broadbent JM, Thomson WM. For debate: Problems with the DMF index pertinent to dental caries data analysis. Community Dent Oral Epidemiol. 2005 Dec;33(6):400-9. [PubMed | Full Text | DOI]

Monse B, Heinrich?Weltzien R, Benzian H, Holmgren C, van Palenstein Helderman W. PUFA – An index of clinical consequences of untreated dental caries. Community Dent Oral Epidemiol. 2010 Feb;38(1):77-82. [PubMed | Full Text | DOI]

Yani RW, Alvarado AE, Polnok S, Devassy D, Prayitno H, Arna YD, et al. Distribution of caries based on PUFA index on college students of student study service (KKN) participants. Proceedings of Health Sci. [Internet]. 2017 April 22. [Full Text]

Khanal S, Shah P, Khapung A. Assessment of sequelae of untreated dental caries using PUFA index in children visiting a tertiary center in Kathmandu. J Coll Med Sci Nepal. 2022 Nov 4;18(3):206-14. [Full Text | DOI]

Tukys HS. Clinical assessment of effects of untreated dental caries in school going children using PUFA index. Chettinad Health City Med J. 2014 3(3):105-8. [Full Text]

PUFA index among schoolchildren in Udupi Taluk, India. J Orofac Sci. 2018 Jan 1;10(1):19. [Full Text]

Lee Y. Diagnosis and prevention strategies for dental caries. J Lifestyle Med. 2013 Sep;3(2):107-9. [PubMed | Full Text]

Kamran R, Farooq W, Faisal MR, Jahangir F. Clinical consequences of untreated dental caries assessed using PUFA index and its covariates in children residing in orphanages of Pakistan. BMC Oral Health. 2017 Dec;17(1):1-7. [PubMed | Full Text]

Reisine ST. The impact of dental conditions on social functioning and the quality of life. Annu Rev Public Health. 1988 May;9(1):1-9. [PubMed | Full Text | DOI]

Karki S, Päkkilä J, Laitala ML, Humagain M, Anttonen V. Influence of dental caries on oral health?related quality of life, school absenteeism and school performance among Nepalese schoolchildren. Community Dent Oral Epidemiol. 2019 Dec;47(6):461-9. [PubMed | Full Text | DOI]

Kumar YS, Acharya S, Pentapati KC. Prevalence of dental pain and its relationship to caries experience in school children of udupi district. Eur J Paediatr Dent. 2014 Dec;15:371-5. [PubMed | Full Text | DOI]

Acharya S, Tandon S. The effect of early childhood caries on the quality of life of children and their parents. Contemp Clin Dent. 2011 Apr;2(2):98. [PubMed | Full Text | DOI]

Manivannan S, Mani G. Assessment of untreated dental caries using pufa index in children of Chennai - A cross-sectional observational study. PalArch's Journal of Archaeology of Egypt/ Egyptology. 2020 Nov 28;17(7):1246-56. [Full Text]

Sudan J, Sogi GM, Veeresha LK. Assessing clinical sequelae of untreated caries among 5-, 12-, and 15-year-old school children in ambala district: A cross-sectional study. J Indian Soc Paedod Prev Dent. 2018 Jan 1;36(1):15-20. [PubMed | Full Text | DOI]

Figueiredo MJ, De Amorim RG, Leal SC, Mulder J, Frencken JE. Prevalence and severity of clinical consequences of untreated dentine carious lesions in children from a deprived area of Brazil. Caries Res. 2011;45(5):435-42. [PubMed | Full Text | DOI]

Baginska J, Stokowska W. Pulpal involvement-roots-sepsis index: A new method for describing the clinical consequences of untreated dental caries. Med Princ Pract. 2013;22(6):555-60. [PubMed | Full Text | DOI]

Praveen BH, Prathibha B, Reddy PP, Monica M, Samba A, Rajesh R. Co relation between PUFA index and oral health related quality of life of a rural population in India: A cross-sectional study. J Clin Diagn Res. 2015 Jan;9(1):ZC39-42. [PubMed | Full Text | DOI]

Upadhyay S, Shrestha R, Shrestha D, Poudyal S. Permanent teeth emergence time and sequence in children of Kavre District, Nepal. Kathmandu Univ Med J. 2016 Jul 1;55(3):269-73. [PubMed | Full Text]

Vithanaarachchi N, Nawarathna L, Wijeyeweera L. Standards for permanent tooth emergence in sri lankan children. Ceylon Med J. 2021 Jul 30;66(1):44-9. [PubMed | Full Text | DOI]

Dixit LP, Gurung CK, Gurung N, Joshi N. Reasons underlying the extraction of permanent teeth in patients attending peoples dental college and hospital. Nepal Med Col J. 2010 Dec 1;12(4):203-6. [PubMed | Full Text]

Ramazani N, Rezaei S. Evaluation of the prevalence of clinical consequences of untreated dental caries using PUFA/pufa index in a group of Iranian children. Iran J Paediatr. 2017 Feb 28;27(1):e5016. [Full Text | DOI]