{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T02:29:18Z","timestamp":1790994558325,"version":"4.1.0"},"reference-count":45,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T00:00:00Z","timestamp":1754524800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005739","name":"Mexican National Autonomous University (Universidad Nacional Aut\u00f3noma de M\u00e9xico)","doi-asserted-by":"publisher","award":["UNAM-PAPIIT IA202823"],"award-info":[{"award-number":["UNAM-PAPIIT IA202823"]}],"id":[{"id":"10.13039\/501100005739","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dentistry Journal"],"abstract":"<jats:p>Background\/Objectives: Dental caries is the most prevalent oral condition worldwide. Consequences of untreated dental caries (CUDC) can range from pulp damage and soft tissue ulceration due to root debris to more severe issues, such as fistulas and abscesses. Rural communities might be more vulnerable to CUDC because of lower socioeconomic status, poorer access to healthcare, and lower education levels. The objective of this study was to evaluate and compare the prevalence of CUDC in rural and urban areas in schoolchildren aged 8 to 12 years in the State of Mexico. Methods: A cross-sectional study was conducted using the PUFA index, considering the presence of pulp involvement (P), soft tissue ulcerations due to root remnants (U), fistulas (F), and abscesses (A). The independent variable was the geographic area (rural or urban), and the covariates were nutritional status, hyposalivation, having one\u2019s own toothbrush, and having received topical fluoride in the last year. Logistic regression models were fitted, calculating odds ratios (ORs) and 95% confidence intervals (CIs). Results: The prevalence of CUDC (PUFA &gt; 0) was 42.9% in rural areas and 25.9% in urban areas. Residing in a rural area (OR: 2.15, 95% CI 1.38\u20133.34, p = 0.001), hyposalivation (OR: 1.93, 95% CI 1.11\u20133.37, p = 0.020), and professional fluoride application (OR: 0.15, 95% CI 0.07\u20130.32, p &lt; 0.001) were associated with the prevalence of CUDC. Conclusions: To prevent caries and its clinical consequences due to the lack of treatment, it is important to promote timely care seeking and access to dental care services, considering the conditions of each geographic area.<\/jats:p>","DOI":"10.3390\/dj13080359","type":"journal-article","created":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T08:33:06Z","timestamp":1754555586000},"page":"359","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Consequences of Untreated Dental Caries on Schoolchildren in Mexico State\u2019s Rural and Urban Areas"],"prefix":"10.3390","volume":"13","author":[{"given":"Jos\u00e9 Cuauht\u00e9moc","family":"Jim\u00e9nez-N\u00fa\u00f1ez","sequence":"first","affiliation":[{"name":"Master and Doctoral Program in Medical-Dental and Health Sciences at the School of Dentistry, National Autonomous University of Mexico, Ciudad de M\u00e9xico 04510, Mexico"},{"name":"Faculty of Higher Studies (FES) Iztacala, National Autonomous University of Mexico, Ciudad de M\u00e9xico 54090, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0967-5616","authenticated-orcid":false,"given":"\u00c1lvaro Edgar","family":"Gonz\u00e1lez-Arag\u00f3n Pineda","sequence":"additional","affiliation":[{"name":"Faculty of Higher Studies (FES) Iztacala, National Autonomous University of Mexico, Ciudad de M\u00e9xico 54090, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda Fernanda","family":"V\u00e1zquez-Ort\u00edz","sequence":"additional","affiliation":[{"name":"Faculty of Higher Studies (FES) Iztacala, National Autonomous University of Mexico, Ciudad de M\u00e9xico 54090, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julio C\u00e9sar","family":"Flores-Preciado","sequence":"additional","affiliation":[{"name":"Faculty of Dentistry, Autonomous University of Baja California, Mexicali 21100, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3804-9761","authenticated-orcid":false,"given":"Mar\u00eda Eugenia","family":"Jim\u00e9nez-Corona","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Ignacio Ch\u00e1vez National Institute of Cardiology, Ciudad de M\u00e9xico 14080, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4924-8616","authenticated-orcid":false,"given":"Socorro A\u00edda","family":"Borges-Y\u00e1\u00f1ez","sequence":"additional","affiliation":[{"name":"Dental Public Health Department, Graduate and Research Division at the School of Dentistry, National Autonomous University of Mexico, Ciudad de M\u00e9xico 04510, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1159\/000503309","article-title":"Terminology of Dental Caries and Dental Caries Management: Consensus Report of a Workshop Organized by ORCA and Cariology Research Group of IADR","volume":"54","author":"Machiulskiene","year":"2020","journal-title":"Caries Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"592","DOI":"10.1177\/0022034513490168","article-title":"Global burden of oral conditions in 1990\u20132010: A systematic analysis","volume":"92","author":"Marcenes","year":"2013","journal-title":"J. Dent. Res."},{"key":"ref_3","unstructured":"World Health Organization (WHO) (2025, May 07). Highlights Oral Health Neglect Affecting Nearly Half of the World\u2019s Population. Available online: https:\/\/www.who.int\/news\/item\/18-11-2022-who-highlights-oral-health-neglect-affecting-nearly-half-of-the-world-s-population."},{"key":"ref_4","unstructured":"World Health Organization (2022). Global Oral Health Status Report: Towards Universal Health Coverage for Oral Health by 2030, World Health Organization."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1111\/j.1600-0528.2005.00235.x","article-title":"Sociobehavioural risk factors in dental caries\u2014International perspectives","volume":"33","author":"Petersen","year":"2005","journal-title":"Community Dent. Oral Epidemiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1111\/ipd.12484","article-title":"Early childhood caries epidemiology, aetiology, risk assessment, societal burden, management, education, and policy: Global perspective","volume":"29","author":"Tinanoff","year":"2019","journal-title":"Int. J. Paediatr. Dent."},{"key":"ref_7","first-page":"5954","article-title":"Rural-urban disparities in the distribution of dental caries among children in south-eastern Louisiana: A cross-sectional study","volume":"20","author":"Afaneh","year":"2020","journal-title":"Rural Remote Health"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1111\/idj.12074","article-title":"The primary and mixed dentition, post-eruptive enamel maturation and dental caries: A review","volume":"63","author":"Lynch","year":"2013","journal-title":"Int. Dent. J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1186\/s12903-021-01396-4","article-title":"Impact of dental caries on oral health related quality of life among preschool children: Perceptions of parents","volume":"21","author":"Pakkhesal","year":"2021","journal-title":"BMC Oral Health"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1111\/cdoe.12174","article-title":"Trends in income-related inequality in untreated caries among children in the United States: Findings from NHANES I, NHANES III, and NHANES 1999\u20132004","volume":"43","author":"Capurro","year":"2015","journal-title":"Community Dent. Oral Epidemiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1111\/j.1600-0757.2011.00427.x","article-title":"Oral health care systems in developing and developed countries","volume":"60","author":"Kandelman","year":"2012","journal-title":"Periodontol. 2000"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"866","DOI":"10.1590\/S0102-311X2004000300024","article-title":"Paul\u00ednia, S\u00e3o Paulo, Brasil: Situa\u00e7\u00e3o da c\u00e1rie dent\u00e1ria com rela\u00e7\u00e3o \u00e0s metas OMS 2000 e 2010","volume":"20","author":"Gomes","year":"2004","journal-title":"Cad. Sa\u00fade P\u00fablica"},{"key":"ref_13","first-page":"193","article-title":"\u201cICDAS\u201d\u2014An international system for caries detection and assessment being developed to facilitate caries epidemiology, research and appropriate clinical management","volume":"21","author":"Pitts","year":"2004","journal-title":"Community Dent. Health"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1111\/j.1600-0528.2009.00514.x","article-title":"PUFA\u2014An index of clinical consequences of untreated dental caries","volume":"38","author":"Monse","year":"2010","journal-title":"Community Dent. Oral Epidemiol."},{"key":"ref_15","first-page":"4312","article-title":"Oral health disparities among adolescents from urban and rural communities of central Chile","volume":"18","author":"Giacaman","year":"2018","journal-title":"Rural Remote Health"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"V\u00e9lez-Le\u00f3n, E.M., Albaladejo-Mart\u00ednez, A., Cuenca-Le\u00f3n, K., Encalada-Verdugo, L., Armas-Vega, A., and Melo, M. (2022). Caries Experience and Treatment Needs in Urban and Rural Environments in School-Age Children from Three Provinces of Ecuador: A Cross-Sectional Study. Dent. J., 10.","DOI":"10.3390\/dj10100185"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"195","DOI":"10.3389\/fpubh.2019.00195","article-title":"A Comparison of Dental Caries in Urban and Rural Children of the Riyadh Region of Saudi Arabia","volume":"7","author":"AlShammery","year":"2019","journal-title":"Front. Public Health"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"182","DOI":"10.5005\/jp-journals-10005-1936","article-title":"Status of Dental Caries and Its Association with Oral Hygiene Practices among School-going Children of Rural and Urban Areas in Kamrup District of Assam","volume":"15","author":"Doley","year":"2022","journal-title":"Int. J. Clin. Pediatr. Dent."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Peters, A., Brandt, K., Wienke, A., and Schaller, H.G. (2022). Regional Disparities in Caries Experience and Associating Factors of Ghanaian Children Aged 3 to 13 Years in Urban Accra and Rural Kpando. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19095771"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e060","DOI":"10.1590\/1807-3107bor-2020.vol34.0060","article-title":"Oral health status of schoolchildren living in rural and urban areas in southern Brazil","volume":"34","author":"Dalmolin","year":"2020","journal-title":"Braz. Oral Res."},{"key":"ref_21","unstructured":"Beaglehole, R. (2009). The Oral Health Atlas: Mapping a Neglected Global Health Issue, FDI World Dental Federation."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1111\/j.1601-5037.2004.00096.x","article-title":"Knowledge on gingivitis and oral hygiene practices among secondary school adolescents in rural and urban Morogoro, Tanzania","volume":"2","author":"Masanja","year":"2004","journal-title":"Int. J. Dent. Hyg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1111\/j.1875-595X.2006.tb00075.x","article-title":"Oral health behaviour of children and adults in urban and rural areas of Burkina Faso, Africa","volume":"56","author":"Varenne","year":"2006","journal-title":"Int. Dent. J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"132","DOI":"10.4103\/jisppd.jisppd_342_21","article-title":"Assessing consequences of untreated dental caries using pufa\/PUFA index among 6\u201312 years old schoolchildren in a rural population of Kerala","volume":"40","author":"Vasavan","year":"2022","journal-title":"J. Indian Soc. Pedod. Prev. Dent."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"442","DOI":"10.2478\/v10039-012-0075-x","article-title":"Index of clinical consequences of untreated dental caries (pufa) in primary dentition of children from north-east Poland","volume":"58","author":"Rodakowska","year":"2013","journal-title":"Adv. Med. Sci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1186\/1471-2458-11-558","article-title":"Untreated severe dental decay: A neglected determinant of low Body Mass Index in 12-year-old Filipino children","volume":"11","author":"Benzian","year":"2011","journal-title":"BMC Public Health"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1111\/idj.12393","article-title":"Oral health status associated with sociodemographic factors of Nepalese schoolchildren: A population-based study","volume":"68","author":"Karki","year":"2018","journal-title":"Int. Dent. J."},{"key":"ref_28","unstructured":"(2025, May 07). Instituto Nacional Estad\u00edstica y Geograf\u00eda (INEGI). Available online: https:\/\/www.inegi.org.mx\/default.html."},{"key":"ref_29","unstructured":"Consejo Nacional de Poblaci\u00f3n (CONAPO) (2025, May 07). Indices de Marginaci\u00f3n por Entidad Federativa y Municipio. Available online: https:\/\/www.gob.mx\/conapo\/documentos\/indices-de-marginacion-2020-284372."},{"key":"ref_30","first-page":"20","article-title":"Simplified oral hygiene index for ages 4 to 6 and 7 to 10 (deciduous and mixed dentition)","volume":"4","author":"Rodrigues","year":"1990","journal-title":"Rev. Odontol. Univ. Sao Paulo"},{"key":"ref_31","first-page":"31","article-title":"Caries experience in adolescents 13\u201314 years with and without erosive tooth wear: A case-control study","volume":"46","year":"2022","journal-title":"J. Clin. Pediatr. Dent."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1093\/rheumatology\/41.4.381","article-title":"The wafer test: A semi-quantitative test to screen for xerostomia","volume":"41","author":"Kraus","year":"2002","journal-title":"Rheumatology"},{"key":"ref_33","unstructured":"Sullivan, K.M., and Gorstein, J. (1999). ANTHRO: Software for Calculating Pediatric Anthropometry, WHO."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"19","DOI":"10.4103\/jofs.jofs_62_17","article-title":"Severity and Clinical Consequences of Untreated Dental Caries Using PUFA Index Among Schoolchildren in Udupi Taluk, India","volume":"10","author":"Singhal","year":"2018","journal-title":"J. Orofac. Sci."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1177\/23202068221075964","article-title":"Assessing the Clinical Consequences of Untreated Caries in 8- to 10-Year-Old Children with Pufa Index","volume":"13","year":"2022","journal-title":"J. Adv. Oral Res."},{"key":"ref_36","first-page":"6694259","article-title":"Food Insecurity and Dental Caries in Rural Mexican Populations","volume":"2023","year":"2023","journal-title":"Int. J. Dent."},{"key":"ref_37","first-page":"27","article-title":"Socioeconomic inequalities in oral health service utilization any time in their lives for Mexican schoolchildren from 6 to 12 years old","volume":"151","year":"2015","journal-title":"Gac. Med. Mex."},{"key":"ref_38","first-page":"69","article-title":"Benefits of Health and Wellness Education in the Adult Population in M\u00e9xico, 2006","volume":"15","year":"2013","journal-title":"Rev. Electr\u00f3nica Investig. Educ."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"135","DOI":"10.17796\/1053-4628-42.2.9","article-title":"Estimation of Trace Elements in Mixed Saliva of Caries Free and Caries Active Children","volume":"42","author":"Sekhri","year":"2018","journal-title":"J. Clin. Pediatr. Dent."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Gonz\u00e1lez-Arag\u00f3n Pineda, A.E., Garc\u00eda P\u00e9rez, A., and Garc\u00eda-Godoy, F. (2020). Salivary parameters and oral health status amongst adolescents in Mexico. BMC Oral Health, 20.","DOI":"10.1186\/s12903-020-01182-8"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Spatafora, G., Li, Y., He, X., Cowan, A., and Tanner, A.C.R. (2024). The Evolving Microbiome of Dental Caries. Microorganisms, 12.","DOI":"10.3390\/microorganisms12010121"},{"key":"ref_42","first-page":"3","article-title":"Ciencias Cl\u00ednicas","volume":"14","year":"2013","journal-title":"Cienc. Cl\u00ednicas"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1159\/000325151","article-title":"Mechanisms of action of fluoride for caries control","volume":"22","author":"Buzalaf","year":"2011","journal-title":"Monogr. Oral Sci."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"243","DOI":"10.3390\/pediatric16020021","article-title":"Control of Dental Caries in Children and Adolescents Using Fluoride: An Overview of Community-Level Fluoridation Methods","volume":"16","author":"Manton","year":"2024","journal-title":"Pediatr. Rep."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"134","DOI":"10.4103\/jispcd.JISPCD_406_19","article-title":"How Fluoride Protects Dental Enamel from Demineralization","volume":"10","author":"Simmer","year":"2020","journal-title":"J. Int. Soc. Prev. Community Dent."}],"container-title":["Dentistry Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2304-6767\/13\/8\/359\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:25:12Z","timestamp":1760034312000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2304-6767\/13\/8\/359"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,7]]},"references-count":45,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2025,8]]}},"alternative-id":["dj13080359"],"URL":"https:\/\/doi.org\/10.3390\/dj13080359","relation":{},"ISSN":["2304-6767"],"issn-type":[{"value":"2304-6767","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,7]]}}}