Evaluation of Pulpal Involvement,Ulceration, Fistula,and Abscess Index and Periapical Index in Screening for Endodontic Disease: Reliability and Accuracy |
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| Affiliation: | 1. Department of Restorative Dentistry, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia;2. Department of Family Oral Health, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia;1. Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Bern, Switzerland;2. Department of Periodontology and Operative Dentistry, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany;3. Department of Prosthetic Dentistry, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany;4. Department of BioMedical Research, University of Bern, Bern, Switzerland;1. Department of Restorative Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil;2. Department of Biological Sciences, Dental School of Bauru, University of São Paulo, Bauru, Brazil;1. Department of Endodontics, University of Washington, Seattle, Washington;2. Department of Restorative Dentistry, University of Washington, Seattle, Washington;1. Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Bern, Switzerland;2. Department of Periodontology and Operative Dentistry, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany;3. Department for BioMedical Research, University of Bern, Bern, Switzerland;4. Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland;6. Division of Preventive Dentistry, Periodontology, and Cariology, University of Zürich Center of Dental Medicine Zürich, Zurich, Switzerland;1. Endodontic Unit, Restorative Department, National Dental Centre Singapore, Singapore;2. Private Practice, Cetraro, Italy |
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| Abstract: | IntroductionThe pulpal involvement, ulceration, fistula, and abscess (PUFA) index was developed to screen for the clinical consequences of untreated dental caries. The aim of this study was to compare the diagnostic accuracy of the PUFA index and the periapical index (PAI) in identifying pulpal and periapical diseases.MethodsA cross-sectional study was conducted using consecutive sampling. Each participant went through screening using the PUFA index, orthopantomography assessment using PAI, and comprehensive clinical examination to derive pulpal and apical diagnoses. The outcomes were dichotomized. Reliability was estimated using the Cohen kappa coefficient. Sensitivity, specificity, and predictive values were calculated. The area under the receiver operating characteristic curve was compared using the chi-square test.ResultsA total of 165 participants were examined, 98.2% of whom had a decayed, missing, or filled tooth index >0. Of 4115 teeth assessed, 16.2% (n = 666) were diagnosed with pulpal disease and 7.9% (n = 325) with periapical disease. Interexaminer reliability for the PUFA index and PAI was 0.87 and 0.80, respectively. Intraexaminer reliability was 0.83 and 0.76 for the PUFA index and 0.75 and 0.72 for PAI. For pulpal diagnosis, the sensitivity of the PUFA index and PAI was 67.6% and 41.7%, respectively; the specificity of the PUFA index and PAI was 99.8% and 99.2%, respectively. For apical diagnosis, the sensitivity of the PUFA index and PAI was 87.7% and 75.4%, respectively; the specificity of the PUFA index and PAI was 95.4% and 98.4%, respectively. The PUFA index is statistically more accurate than PAI for pulpal diagnosis and apical diagnosis (P < .05).ConclusionsThe PUFA index can be used in screening for pulpal and periapical diseases with some limitations. |
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| Keywords: | Orthopantomograph periapical index prevalence sensitivity specificity |
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