ABSTRACT Objectives The PUFA index records the presence of pulpal involvement, ulceration, fistula, and abscess to quantify the clinical consequences of untreated dental caries. The PUFA index captures the prevalence and severity of oral conditions, making it useful for surveillance, research, and advocacy. After 15 years of global use, this systematic review synthesises how the PUFA index has been applied and reported. Methods Following PRISMA 2020 guidelines, seven databases were searched: PubMed, Embase, Scopus, Web of Science, CINAHL, Global Health, and Google Scholar. Eligible studies were published between 2010 and 2025 and reported original epidemiological data using the PUFA index. Data extraction captured study design, population, dentition type, PUFA reporting formats, examiner details, and use of complementary indices. Descriptive synthesis was performed with high inter‐rater reliability among reviewers (96.5%). Results Out of 4438 records, 260 studies from 53 countries met the inclusion criteria. PUFA was predominantly applied in low‐ and middle‐income countries across the life course, but with a focus on children and adolescents. Nearly half of the studies (48.8%) examined associations between PUFA and health outcomes, and over one‐third (37.7%) applied PUFA in population surveillance. Reporting practices varied, and examiner type was specified in about half of the studies (47.3%), with dentists being the most common (82.9%). While methodological rigour was generally good, there were inconsistencies in reporting formats and limited availability of inter‐ and intra‐examiner reliability data. Conclusions The PUFA index is a recognized oral health index that has shown steady adoption across numerous studies and diverse populations. Its global credibility has positioned it for integration into modern surveillance frameworks, including the updated WHO STEPS Oral Health Module. Future priorities include standardizing reporting, strengthening integration into surveillance systems, and exploring how the PUFA index can be used in program evaluation to better inform policy and reduce oral health inequities.
ABSTRACT Objectives Lack of regular access to dental services for children can increase disease prevalence and burden on NHS services, which is aggravated for the most vulnerable. Non‐clinical community hubs could be a feasible alternative for dental checks and oral health education. The aim of this study was to assess the oral health of children attending a non‐clinical community hub, and the feasibility/acceptability of these settings to children. Method This study adopted an parallel mixed‐methods approach. Dental screening of children (0–16 years old) was undertaken in a non‐clinical community hub by a trained and calibrated dentist in April 2024. Basic demographics, global quality of life and clinical data were collected. All children were given oral health education using tooth models and dietary advice. A sub‐sample of children were recruited for qualitative inquiry, using a purposive sampling strategy. Three focus groups were facilitated with a pre‐determined topic guide and creative arts‐based techniques to facilitate discussion. These were audio‐recorded, transcribed verbatim and inductively coded following thematic analysis. Results Over the 5‐day period, 141 children were screened with a mean age of 6.4 years (SD 3.8). Mean d 3 mft was 1.7 (SD 2.9; 0–15), D 3 MFT was 0.3 (SD 0.9; 0–4), and combined d 3 mft/D 3 MFT was 2.0 (SD 3.1; 0–19). Fifteen patients had silver diamine fluoride, 125 had fluoride varnish and one refused. Forty‐one children were signposted for future care. Three focus groups involving 11 children identified three themes that were constructed from the data were: ‘space’ requirements; promoting positive engagement; familiarity with the environment. Children were generally accepting of foodbanks as settings for oral health screening and preventive care. They emphasised the importance of child‐friendly, non‐threatening spaces and highlighted how familiar environments and trusted staff fostered feelings of safety and engagement. Conclusion Non‐clinical community hubs are feasible and acceptable spaces to children to screen for oral health, providing a unique opportunity to reduce barriers to access and to target underserved groups with following on screening activities.
