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Background: Data on dental decay using the Decayed, Missing, Filled teeth (DMFT/dmft) index provides information on caries and treatment experiences only, but fails to give information on clinical consequences of untreated dental caries. Aim: The aim of the study was to determine the prevalence and clinical consequences of untreated dental caries using Pulp, Ulceration, Fistula, Abscess (PUFA) index among schoolchildren. Materials and Methods: A cross-sectional survey of 957 schoolchildren, aged 6–15 years in Udupi taluk was conducted. Caries experience was evaluated according to World Health Organization (WHO) criteria, 1997 (DMFT/dmft index) and clinical consequences of untreated dental caries by PUFA/pufa index. Results: The results showed that 77.3% of 6–10 years old children had caries (mean dmft score: 3.30 ± 2.9, mean DMFT score: 0.26 ± 0.7), 47.3% showed clinical consequences of untreated caries (mean pufa score: 1.30 ± 1.9, mean PUFA score: 0.03 ± 0.2) and 26.8% reported pain. In 11–15 years old children, 55.6% had caries (mean dmft score: 0.36 ± 0.9, mean DMFT score: 1.04 ± 1.4), 18% showed prevalence of pulpal involvement (mean pufa score: 0.15 ± 0.5, mean PUFA score: 0.14 ± 0.4) and 11.6% reported pain. Statistical analysis revealed a strong relation between DMFT/dmft and PUFA/pufa in both age groups. Conclusion: The present study revealed negligence in the dental treatment of children resulting in pulpal involvement. This index is a valuable measurement tool to record clinical consequences of untreated dental caries.