Emergency Dental Care in the ACA Era: Rural-Urban Disparities and Their Association With State Medicaid Policy.

OBJECTIVES: Rural US populations face greater barriers to dental care than urban residents. This study examines emergency department (ED) visits for nontraumatic dental conditions (NTDCs) among adults, comparing rural and urban areas. It also explores how Medicaid expansion and varying state Medicaid dental policies influence the likelihood of NTDC-related ED visits. METHODS: We conducted a cross-sectional analysis using 2019 ED data from eight states. Descriptive statistics characterized NTDC-related ED visits by patient, visit, and county-level variables across four Medicaid policy groups. Chi-squared tests and T-tests assessed rural-urban differences in visit characteristics and payer mix. Logistic regression models estimated the likelihood of NTDC ED visits by rurality and payer type, adjusting for sociodemographic factors and stratified by Medicaid expansion and adult dental benefit status. RESULTS: Rural NTDC ED visits were shorter (2.5 h) and less costly ($1602) than urban visits (over 3 h,$2532). Analysis of rurality and payer mix revealed three key patterns: (i) rural residents consistently had higher visit rates than urban residents in three of the four groups; (ii) uninsured patients-both rural and urban-had the highest probability of NTDC ED visits in three of the four groups; and (iii) among Medicaid-covered visits, rural enrollees in non-expansion states without adult dental benefits had the highest likelihood of NTDC ED visits. CONCLUSIONS: This study highlights continued ED reliance for NTDCs 5 years post-ACA, driven by Medicaid policy and access gaps. Expanding rural oral healthcare remains vital for improving access, especially for the uninsured

Metronidazole-Induced Encephalopathy in a Patient With Metastatic Cancer.

Metronidazole-induced encephalopathy (MIE) is a rare adverse effect from long-term metronidazole use. We describe a patient with metastatic cancer and complicated abscesses on long-term antibiotics who presented to the emergency department with acute encephalopathic features including reported weakness and confusion. Physical examination was remarkable for chronic right-sided weakness from a previous stroke and reported abnormal right-sided finger-to-nose testing, which may have been due to weakness from his prior stroke. Head CT was non-contributory, and brain MRI showed bilateral edema in cerebellar dentate nuclei, suggestive of MIE. We recommend having a low threshold for brain MRI in patients on long-term metronidazole to rule out other diagnoses and, in patients with lasting neurologic deficits, early neurology and palliative care involvement to improve quality of life

Computed tomography in pediatric blunt abdominal trauma: current evidence, challenges, and future directions - a systematic review and meta-analysis.

INTRODUCTION: Assessment of intra-abdominal injuries (IAIs) in children is challenging due to unreliable physical examination, communication barriers, and the serious consequences of missed injuries. Computed tomography (CT) is widely used for its high sensitivity, but concerns persist regarding radiation exposure and resource utilization. This systematic review and meta-analysis aimed to quantify IAI prevalence, describe organ-specific injury patterns, and evaluate intervention and mortality outcomes in children with blunt abdominal trauma assessed using CT. METHODS: We searched PubMed, Web of Science, Cochrane Library, and Scopus through August 2025 for studies evaluating pediatric blunt abdominal trauma, CT-based assessment, and CT-detected IAIs. Bayesian random-effects meta-analyses were used to estimate pooled prevalence and outcomes, with additional hierarchical and meta-regression models for organ-specific injuries and study-level covariates. Certainty of evidence was assessed using the GRADE framework. RESULTS: Fifteen studies including 7,430 children were analyzed. The pooled posterior median prevalence of IAI was 84.5% (95% credible interval [CrI]: 62-94%), while the probability of intervention was 7.7% and mortality was 1.4%. Solid organ injuries predominated, with liver (13.1%, 95% CrI: 4.9-45.5%), bowel (11.2%, 4.2-40.9%), spleen (11.1%, 4.1-40.4%), and kidney (8.7%, 3.2-34.3%) injuries most common; adrenal (3.4%) and pancreatic (1.4%) injuries were rare. Meta-regression showed higher injury probabilities with increasing age and male predominance. Injury Severity Score-based subgroup analyses yielded substantially lower IAI probabilities (11-12%), reflecting broader trauma populations. Certainty of evidence was moderate for overall IAI prevalence and low for other outcomes due to heterogeneity and sparse events. CONCLUSION: Although CT is highly sensitive for detecting IAIs in pediatric blunt abdominal trauma, low rates of intervention and mortality support selective CT use guided by validated decision rules and observation rather than routine imaging. Future research should prioritize multicenter prospective studies, pragmatic implementation of decision tools, and development of non-ionizing imaging alternatives to optimize CT use and minimize long-term risks in children

Effect of an Eight-Week Breathing Exercise Program on the Respiratory Function and Craniovertebral Angle in Dental Students: A Pre-test and Post-test Quasi-experimental Study.

Introduction Dental training requires prolonged static and forward-leaning working positions that may contribute to forward head posture. Forward head posture can be quantified using the craniovertebral angle (CVA) and may be associated with reduced respiratory performance. This study investigated whether an eight-week breathing exercise program improves respiratory function and neck posture in senior dental students. Methods A prospective pre-test/post-test quasi-experimental study was conducted among senior dental students (20-25 years) at the University of Sharjah. Forty-five participants completed baseline testing; 40 completed post-intervention testing and were included in paired analyses. Respiratory function was assessed using spirometry (forced vital capacity (FVC), forced expiratory volume in 1 second (FEV₁), peak expiratory flow (PEF)). Neck posture was assessed using CVA from standardized lateral photographs. The intervention consisted of daily diaphragmatic breathing, alternate-nostril breathing, and dynamic breathing exercises for eight weeks. Pre-post changes were analyzed using paired-sample t-tests. Results Respiratory function improved significantly after the intervention. Mean FVC increased from 2.99 ± 0.90 L to 3.32 ± 0.87 L (p \u3c 0.001), mean FEV₁ increased from 2.81 ± 0.89 L to 3.17 ± 0.84 L (p \u3c 0.001), and mean PEF increased from 6.50 ± 2.31 L/s to 7.42 ± 2.08 L/s (p \u3c 0.001). CVA did not change significantly (42.95 ± 8.11° pre-intervention vs 43.35 ± 8.23° post-intervention; p = 0.83). Mean spirometry values remained below device-generated predicted/reference values despite improvement. Conclusion An eight-week breathing exercise program significantly improved spirometric measures in dental students but did not significantly change CVA. These findings suggest that breathing exercises can enhance respiratory function, while meaningful correction of forward head posture may require additional posture-specific interventions