BACKGROUND:Successful management of an avulsed tooth depends on preserving periodontal ligament viability during the extraoral period. Although Hank's Balanced Salt Solution (HBSS) is recommended for storage of avulsed teeth, it lacks bioactive components that actively support tissue repair. This study evaluated whether supplementation with L-ascorbic acid (L-AA) could enhance biological responses associated with periodontal healing. MATERIAL AND METHODS:Complementary in vitro and ex vivo models were used. Cultured human periodontal ligament cells were exposed to HBSS, HBSS supplemented with L-AA, or Dulbecco's Modified Eagle Medium containing fetal bovine serum. Wound closure, inflammatory cytokine expression, matrix metalloproteinase expression, and collagen type I alpha 1 chain gene and protein expression were evaluated. In the ex vivo model, 18 freshly extracted premolars were stored in the respective media for 24 h at 4°C before assessment of periodontal ligament tissue viability and gene expression. Statistical significance was set at p < 0.05. RESULTS:The optimized concentration of L-AA was 175 μg/mL. Supplementation of HBSS with L-AA resulted in significantly greater wound closure than HBSS alone. In both in vitro and ex vivo models, L-AA supplementation significantly reduced the expression of pro-inflammatory cytokines and matrix metalloproteinases while enhancing the expression of collagen type I alpha 1 chain. Although periodontal ligament tissue viability was numerically higher following supplementation, differences were not statistically significant. CONCLUSIONS:Supplementation of HBSS with L-AA favorably modulated inflammatory and extracellular matrix-related responses in cultured and ex vivo periodontal ligament tissues. Although no significant improvement in tissue viability was observed, the findings suggest potential biological benefits relevant to periodontal repair. Further studies are required to validate these findings in animal replantation models and determine their clinical relevance.

Dental trauma is common within school communities, yet access to timely care remains a challenge. Insurance coverage can reduce financial barriers and support coordinated responses. However, there are limited insights into how traumatic dental injuries (TDI) are covered and framed in Student Accident Insurance (SAI). This study applies framework-guided criteria to evaluate the content and framing of TDI in Malaysian SAI policies from 2023 to 2025. A qualitative document analysis was conducted on a purposive sample of SAI products using predefined criteria based on standard insurance policy elements and Entman’s theory of framing. Content analysis was used to classify policy elements, while frame analysis examined how TDI was conceptualized in brochures, disclosure sheets and policy wordings. Of the 48 registered insurance providers, five SAI products offering TDI coverage for full-time students aged approximately 3 to 21, mainly in kindergartens, primary or secondary schools, were identified. Plans with premiums ranging from Malaysian Ringgit (MYR) 10 to 30 were offered. Plans priced at MYR 20 and 30 typically included a TDI sublimit capped at MYR 500. Dental appliances, routine check-ups and dentures were excluded in AIA, Generali and Tokio Marine policies. TDI was uniformly framed as accident-related, with Zurich uniquely framing it as bodily injury. Coverage was for school activities, excluding high-risk sports. Responsibility was variably assigned to parents, school or both. Most providers required initial treatment within 24 h, follow-up within 14 days and claims notice within 30 days of the accident. Zurich required earlier claims notice but allowed extended reimbursement. Framework-guided criteria allow a systematic assessment of the different aspects through which SAI policies address and convey TDI coverage. Although Malaysian SAI policies offer generally affordable and standardised TDI coverage, variations in exclusions and framing highlight areas for policy improvement. Clear and consistent policy framing may contribute to strengthening community-based dental care by ensuring equitable and timely access to TDI management.

Decellularized tissue scaffolds mimic the native pulp-dentin microenvironment and support the odontogenic development of stem cells. This study investigated the dentinogenic effect of Wharton's Jelly Mesenchymal Stem Cells (WJMSCs) in decellularized human dental pulp (DHDP) with bone morphogenic protein-7 (BMP-7) at three concentrations: 0 ng/mL (control), 25 ng/mL, and 50 ng/mL. The effects of BMP-7 were evaluated by histological examination, WJMSC viability using AlamarBlue, dentinogenic gene expression by qPCR, and dentinogenic protein expression by ELISA. By day 21, all three groups exhibited cell distribution along the pore surfaces of DHDP, followed by the presence of a collagen matrix in the tissue. WJMSC viability treated with 25 ng/mL and 50 ng/mL showed a statistically significant increase on days 7, 14, and 21 compared to the control group (p < 0.05). Gene expression analysis of dentin sialophosphoprotein (DSPP) and dentin matrix protein-1 (DMP-1), and odontogenic marker (Runx2) revealed 25 ng/mL BMP-7 resulted in significantly higher expression levels for DMP-1 and Runx2 on day 21 compared to control and 50 ng/mL BMP-7 group (p < 0.05). DSPP and DMP-1 protein expressions also showed trends similar to those of gene expressions. BMP-7 (25 ng/mL) can maintain cell viability and promote dentinogenic effects of WJMSC in the DHDP scaffold.

BACKGROUND/AIM:The optimal storage medium for an avulsed tooth should preserve the viability of periodontal fibroblasts (PDLF) to the highest degree, facilitating the re-attachment of periodontal fibers and improving the prognosis of replantation. This study compared the effect of the PDLF viability in Hank's balanced salt solution (HBSS), supplemented culture medium, that is, Dulbecco's Modified Eagle Medium (DMEM), and four modified HBSS mixtures. MATERIAL AND METHODS:Periodontal tissues were obtained from extracted human teeth and processed for PDLF culture. The cells were then exposed to six experimental media: (i) HBSS, (ii) HBSS and ascorbic acid (HBSS + Vit C), (iii) HBSS and platelet-derived growth factor (HBSS + PDGF), (iv) a mixture of HBSS, PDGF, and Vit C (HBSS + PDGF + Vit C), (v) HBSS and platelet lysate (HBSS + PL), and (vi) DMEM for 3, 6, 12, and 24 h. A MTT assay was performed to determine the cell viability. RESULTS:Vitamin C-containing media maintained PDLF viability significantly better than HBSS + PDGF and HBSS + PL at 3, 6, 12, and 24 h (p < 0.05). The percentages of viable PDLF at 3, 6, 12, and 24 h were significantly higher than 0 h for HBSS + Vit C, HBSS + PDGF + Vit C, HBSS + PL, and DMEM (p < 0.05). CONCLUSION:All experimental media were able to maintain PDLF viability (DMEM>HBSS+Vit C; HBSS+PDGF+Vit C>HBSS+PL>HBSS+PDGF; HBSS). Although DMEM had the highest cell proliferative effect, it is impractical to be used as a transport medium due to its cost, storage, and availability. The supplementation of Vit C yielded significant cell proliferative effects; hence, HBSS + Vit C can be a better alternative as a storage medium than HBSS.

Adaptations to the teaching and learning during the pandemic affected dental students’ ability to achieve clinical competency. This study aimed to: (1) assess the self-reported competencies of dental students affected by the pandemic; (2) describe the enablers and barriers to achieving clinical competency among these students; and (3) to elucidate factors related to the resilience of the teaching and learning system during the pandemic for future adaptations and implementations. A questionnaire consisting of eight domains with 43 questions was sent to Universiti Kebangsaan Malaysia’s (UKM) recent dental graduates from the 2021 cohort. Eight students from the cohort were also interviewed. The semi-structured, in-depth interviews were recorded and transcribed. A total of 56 questionnaires were returned, resulting in a 100% response rate. Seven out of the eight studied domains had a high self-perceived competency score, while only six of the 43 skills had a self-perceived competency score of less than 80%. Eight participants were interviewed for the second part of the study. Multiple enablers and barriers were identified and categorised into five themes, which were clinical time, student mental health, clinical teaching, cross-infection protocols, and communication and other faculty policies. Dental graduates affected by the COVID-19 pandemic had a good level of self-perceived clinical competency. The multiple factors identified as enablers and barriers to achieving clinical competency can be utilised as references in curriculum development, planning and policymaking, especially with regards to adaptations made to the undergraduate dental curricula worldwide.

Regenerative endodontics aims to restore pulp tissues, thus preserving the vitality of the tooth. One promising approach involves the utilization of decellularized human dental pulp (DHDP) as a scaffold repopulated with Wharton’s Jelly mesenchymal stem cells (WJMSCs). This study aimed to regenerate pulp tissues using DHDP and WJMSCs following pulpectomy in mature canine teeth of a feline animal model and to investigate the histological features of the regenerated pulp.A 12-month-old male domestic shorthaired felines were used as subjects. Teeth were categorized into untreated (Group 1), pulpectomy with mineral trioxide aggregate (MTA) (Group 2), and pulpectomy with DHDP-repopulated scaffold and MTA (Group 3). The animals were sacrificed six weeks post-intervention. H&E and immunohistochemistry using anti-collagen type 1 and laminin antibodies were used to stain the tissue sections.Histological examinations presented pulp-like tissues in Group 3, with tissue components similar to the structures found in Group 1. Immunohistochemical analysis demonstrated the presence of collagen type I and laminin within the regenerated tissues. The root canals of teeth in Group 2 were devoid of pulpal tissue.DHDP with WJMSCs can potentially be used for pulp regeneration, supporting the modality for developing new clinical protocols in stem cell therapy.

BACKGROUND/AIM:Mouthguards are crucial for protecting athletes against orofacial injuries, yet concerns persist regarding their potential impact on oral functions. This study aimed to investigate the effects of sports mouthguards on oral functions and speech over time. MATERIAL AND METHODS:Thirty national rugby players received custom-fitted mouthguards. Questionnaire responses and speech recordings were collected before mouthguard use and at various intervals after using mouthguards: immediately, 1 week, 2 month, and 6 months. Spectrographic analysis was performed to measure voice onset time (VOT) for /p, b, t, d/ phonemes. Questionnaire responses were assessed with Friedman's test, while VOT changes were examined using one-way repeated measure analysis of variance. RESULTS:Compliance with mouthguard use improved during training and competitions, with consistent wear reported during matches. Over time, speaking difficulties and lisping decreased significantly (p < .001). The perception of nausea improved (p < .001), stabilizing after 1 month (p = .414). Sensations of bulkiness declined (p < .001). Mouth dryness reduced steadily, with no occurrences reported by all players by the end of the study. None of the participants reported bad breath, ulcers, or redness in the mouth. VOT changed immediately after wearing mouthguards (p < .001), gradually regressing toward the baseline, although not completely reaching it. Players held a favorable view of mouthguard use, with comfort and support for mandatory use increasing over time. CONCLUSIONS:Custom-fitted mouthguards do not lead to significant long-term disruptions in oral functions. Athletes generally adapt to mouthguard use, reporting improved comfort and greater support for their use.

A fractured instrument is an undesirable endodontic mishap that can prevent complete root canal disinfection, thereby affecting the root canal treatment outcome. The present case discussed the surgical management of an extruded fractured barbed broach at the apical third of maxillary right first premolar. A 28-year-old female presented with an endodontic failure on tooth 14 and was diagnosed as previously root canal treated with symptomatic apical periodontitis. Radiographic examination revealed a straightline radiopacity structure that was 2 mm in length extruded from the apical root-end, suggesting a fractured instrument. The case was successfully managed through endodontic microsurgery. The present case emphasises the significance of cone-beam computed tomography as a valuable tool for diagnosis and investigation, while also offering supplementary information for the planning of surgical treatment.

Dental Practicality Index (DPI) and American Association of Endodontists Endodontic Case Difficulty Assessment (AAECDA) form potentially can guide clinicians in making clinical decisions and triaging in large practices and academic settings. Nonetheless, the reliability and validity should be evaluated before institution-wide implementation. This study aimed to evaluate the inter-rater reliability of the DPI and AAECDA forms. Ten randomly selected, trained students rated 25 cases with both forms. The itemby-item inter-rater and overall reliability were estimated with Gwet’s agreement coefficient (AC2) and intraclass correlation coefficient (ICC), respectively. The association between clinical decisions and the scores was analysed with the Generalised Estimating Equation. The inter-rater reliability of DPI was generally very good (AC2 = 0.81–1.00), except context (good; AC2 = 0.718; 95% confidence interval [CI] = 0.575–0.861). The inter-rater reliability of AAECDA was generally very good (AC2 = 0.81–1.00) and good (AC2 = 0.61–0.80), except the radiographic appearance of the canal(s) (fair; AC2 = 0.424, 95% CI = 0.263–0.585). Moderate overall inter-rater reliability of AAECDA (ICC = 0.53, 95% CI = 0.38–0.70) and DPI (ICC = 0.62, 95% CI = 0.48–0.77) was observed. Referral to an endodontist was positively associated with AAECDA score (odds ratio [OR] = 1.323, 95% CI = 1.145–1.52, p < 0.001). The decision of tooth extraction was positively associated with the DPI score (OR = 1.983, 95% CI = 1.539–2.555; p < 0.001). In conclusion, DPI and AAECDA are methods with moderate inter-rater reliability when used among dental students.

The aims of this in vitro study were to investigate metal contamination and short-term stability of two types of household bleach and a specially-formulated sodium hypochlorite (NaOCl) for endodontic use. The first part of the study was to compare traces of metal elements (Cu, Fe and Ni) between the two types of household bleach (Clorox and Milton) and a specially-formulated NaOCl (CanalProTM 3% NaOCl, Coltene, Whaledent)) using UV spectrophotometer. The second part of the study was to compare the available chlorine and pH of these different NaOCl formulations at different temperatures. Chemical stability of the NaOCl was assessed by measuring the amount of free available chlorine (FAC) using the iodometric titration assay at the temperature of 15, 30, 45, and 60 °C. The pH of the solutions was measured using calibrated pH meter. The results showed that Milton contained significantly higher concentration of Cu, Fe and Ni compared with the other formulations (P < 0.001). Concentrations of Fe detected in Clorox and CanalPro were higher than in the control, distilled water (P < 0.05). In all NaOCl samples, the concentration of available chlorine increased with temperature. Concomitantly, there was a significant decrease in pH with increasing temperature (P < 0.001) with all the NaOCl formulations. In conclusion, traces of metal remnants could be observed in all the NaOCl formulations, especially in Milton. Heating the NaOCl increases the FAC and decreases its pH.

Australian Endodontic JournalEarly View LETTER TO THE EDITOR Response to the commentary on the article ‘pulpal and periapical disease in crowned vital teeth: A prospective matched cohort study’ Sobrina Mohamed Khazin DDS, DClinDent, Sobrina Mohamed Khazin DDS, DClinDent orcid.org/0000-0003-2448-9341 Department of Restorative Dentistry, Kulliyyah of Dentistry, International Islamic University Malaysia, Selangor, MalaysiaSearch for more papers by this authorDalia Abdullah BDS, MClinDent, Corresponding Author Dalia Abdullah BDS, MClinDent daliaabdullah@ukm.edu.my orcid.org/0000-0003-1112-6859 Department of Restorative Dentistry, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia Correspondence Dalia Abdullah, Department of Restorative Dentistry, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia. Email: daliaabdullah@ukm.edu.mySearch for more papers by this authorAmy Liew Kia Cheen DDS, MPH, Amy Liew Kia Cheen DDS, MPH orcid.org/0000-0001-6008-5331 Department of Family Oral Health, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Kuala Lumpur, MalaysiaSearch for more papers by this author Sobrina Mohamed Khazin DDS, DClinDent, Sobrina Mohamed Khazin DDS, DClinDent orcid.org/0000-0003-2448-9341 Department of Restorative Dentistry, Kulliyyah of Dentistry, International Islamic University Malaysia, Selangor, MalaysiaSearch for more papers by this authorDalia Abdullah BDS, MClinDent, Corresponding Author Dalia Abdullah BDS, MClinDent daliaabdullah@ukm.edu.my orcid.org/0000-0003-1112-6859 Department of Restorative Dentistry, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia Correspondence Dalia Abdullah, Department of Restorative Dentistry, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia. Email: daliaabdullah@ukm.edu.mySearch for more papers by this authorAmy Liew Kia Cheen DDS, MPH, Amy Liew Kia Cheen DDS, MPH orcid.org/0000-0001-6008-5331 Department of Family Oral Health, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Kuala Lumpur, MalaysiaSearch for more papers by this author First published: 29 July 2022 https://doi.org/10.1111/aej.12659Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Early ViewOnline Version of Record before inclusion in an issue RelatedInformation

INTRODUCTION:COVID-19 pandemic has disrupted the clinical training of dental programmes worldwide. This study aimed to assess the self-reported competencies of dental graduates directly affected by the COVID-19 pandemic, as compared to the cohort before the year 2020.MATERIALS AND METHODS:A questionnaire consisting of eight domains with 43 questions was sent to all the Universiti Kebangsaan Malaysia's (UKM) dental graduates of 2019 and 2020 cohorts. The domains were as follows: (A) gathering information at chairside, (B) diagnosis, (C) treatment planning, (D) treatment and prevention, (E) community-based, (F) management and administrative, (G) communication and (H) personal management and professional development. Three additional questions were included to assess satisfaction on clinical teaching and supervision, requirements and assessment and cross-infection control.RESULTS:A total of 54 (91.5%) and 45 (100%) questionnaires were returned by the 2019 and 2020 cohorts, respectively. The 2019 cohort consistently perceived their competencies to be high across all the eight domains, and these responses were significantly higher than the 2020 cohort for seven out of the eight domains (p < .005). The 2019 cohort also consistently perceived their competencies higher compared to the 2020 cohort for 40 out of 43 skills. Eleven skills were deemed to have "poor ratings," and seven of these skills were rated significantly lower by the 2020 cohort than the other cohort (p < .005).CONCLUSIONS:The findings of this study highlight the impact of the COVID-19 pandemic on the self-perceived competencies of dental graduates. The 2020 graduates reported lower percentages of competent responses, mainly for community-based skills and management and administrative skills, even though they were deemed competent and graduated. The loss of clinical time and the suspension of certain face-to-face activities significantly affected their perceived competencies.

Introduction Measuring the effectiveness of a dental curriculum as reflected by the competencies of the graduates is paramount in ensuring the curriculum remains relevant in the rapidly evolving field of dentistry. We aimed to assess the competencies of dental graduates of Faculty of Dentistry, Universiti Kebangsaan Malaysia (UKM) as perceived by the graduates and their employers, based on the core competencies listed in the UKM undergraduate dental curriculum. Methods A self-administered questionnaire consisting of 43 questions based on eight domains of competencies were sent to all UKM dental graduates of years 2012 to 2015 as well as senior dental officers who represented their employers. Findings 132 out of 177 graduates (75%) and 18 out of 33 employers (55%) responded. Most graduates felt competent in gathering information and all employers agreed that the graduates were competent with this skill. Out of the eight domains, only community based domain was collectively rated ‘poor’ by the employers while the rest of the domains had an ‘excellent’ rating by both the graduates and their employers. However, based on the individual skill, basic life support skill was rated very low for both groups (38.6% graduates and 23.5% employers). The employers underrated the graduates in the domain of treatment and prevention, community-based, management and administrative, and communication. Significance The findings of this study allow an evaluation of the curriculum in a myriad of angles. Although the graduates reported a good level of competency in most domains, the employers were reserved on the community-based skills. This needs to be addressed in order to improve the undergraduate program.

Objectives: This study aimed to evaluate the efficacy of various local anesthesia (LA) in vital asymptomatic teeth. Materials and Methods: Randomized controlled trials comparing pulpal anesthesia of various LA on vital asymptomatic teeth were included in this review. Searches were conducted in the Cochrane CENTRAL, MEDLINE (via PubMed), EMBASE, ClinicalTrials.gov, Google Scholar and 3 field-specific journals from inception to May 3, 2019. Study selection, data extraction, and risk of bias assessment using Cochrane Risk of Bias Tool were done by 2 independent reviewers in duplicate. Network meta-analysis (NMA) was performed within the frequentist setting using STATA 15.0. The LA was ranked, and the surface under the cumulative ranking (SUCRA) line was plotted. The confidence of the NMA estimates was assessed using the CINeMA web application. Results: The literature search yielded 1,678 potentially eligible reports, but only 42 were included in this review. For maxillary buccal infiltration, articaine 4% with epinephrine 1:100,000 was more efficacious than lidocaine 2% with epinephrine 1:100,000 (odds ratio, 2.11; 95% confidence interval, 1.14-3.89). For mandibular buccal infiltration, articaine 4% with epinephrine 1:100,000 was more efficacious than various lidocaine solutions. The SUCRA ranking was highest for articaine 4% with epinephrine when used as maxillary and mandibular buccal infiltrations, and lidocaine 2% with epinephrine 1:80,000 when used as inferior alveolar nerve block. Inconsistency and imprecision were detected in some of the NMA estimates. Conclusions: Articaine 4% with epinephrine is superior when maxillary or mandibular infiltration is required in vital asymptomatic teeth.

This study aimed to determine the incidence and contributing factors to pulpal and periapical disease in crowned vital teeth. Seventy-three pairs of healthy teeth were included and divided into two groups; 'crowned' and 'untreated' groups. The crowned group was prepared for full coverage crown and no treatment was carried out on the untreated group. Both groups were subjected to clinical and radiographic examination to detect endodontic signs and symptoms pre-operatively and one-week after crown cementation. Electric pulp test was also subjected to both groups, pre-operatively, after tooth preparation and before crown cementation. The incidence of pulpal and periapical disease was 6.8% and 1.4%, respectively, after tooth preparation. Factors associated with pulpal and periapical disease were exposed pulp during tooth preparation and pre-operative bone level <35%. Despite the low incidence, the occurrence of pulpal and periapical disease within a short period is noteworthy.

Crown re-attachment is the most conservative treatment that can be used to restore fractured tooth, even in an emergency situation. The re-attachment maintains original contour and incisal translucency of the tooth, and reduces the chair time and cost. In case of crown fracture with pin-point pulp exposure, irritation to the pulp should be minimised and consideration must be taken for pre-treatment pulpal status, choice of pulp capping material, choice of bonding system and treatment sequence during crown re-attachment procedures. This article reported a crown fracture case with pin-point pulp exposure that was treated using crown re-attachment with direct pulp capping. At two-year follow-up, the tooth was asymptomatic, remained functional, vital, and the appearance of restoration was acceptable with no colour change to the crown.

Introduction: The aim of this study was to compare the effect between different levels of ultrasonic tip activation on the depth of epoxy resin-based sealer (AH plus) dentinal tubules penetration. Materials and Methods: Extracted single-rooted premolars (n = 60) were randomly allocated into three groups and instrumented following the same protocol. Group 1 (control), the sealer was mixed with 0.1% Rhodamine B dye and placed using size 20 K-file. In Group 2, the sealer was passively activated using ultrasonic tip (ISO 25) 10 s mesiodistally and buccolingually at 2 mm from the apex. In Group 3, the sealer was activated in a similar manner at 4 mm from the apex. Samples were sectioned horizontally at 2 mm, 4 mm, and 6 mm from the apex and analyzed using a stereomicroscope for tubular dentine sealer penetration. The cross-sectional area (μm2) was measured with software to get the percentage of sealer penetration, and presences of voids were recorded. Results: Significant lesser percentage of sealer penetration into the dentinal tubules was observed between the control group and both the experimental groups (P = 0.00) at 2 mm, 4 mm, and 6 mm from the apex. There was no significant difference in the percentage of sealer penetration into the dentinal tubules between both the experimental groups (P > 0.05). The presence of voids between all groups was not statistically significant (P > 0.05). Conclusion: Passive ultrasonic activation of sealer placement resulted in deeper sealer penetration into the dentinal tubules even at a higher level of tip activation (4 mm).

INTRODUCTION:The 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.METHODS:A 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.RESULTS:A 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).CONCLUSIONS:The PUFA index can be used in screening for pulpal and periapical diseases with some limitations.