Custodial Dental Care in Federal Courts: A Systematic Review of Appellate Decisions and Implications for Public Health

ABSTRACT Objectives To examine how federal appellate courts evaluate constitutional claims concerning custodial dental care and to characterize the clinical and procedural features of these cases. Methods Decisions of the U.S. courts of appeals issued between 1980 and 2025 were identified through structured database searches. Cases substantively evaluating dental care were coded for severe pain, infection, abscess (coded separately), functional impairment, delay, custody type, representation status, defendant level, and appellate outcome. Descriptive statistics summarized case characteristics, and logistic regression evaluated associations between selected variables and appellate outcomes. Results A total of 182 appellate decisions met inclusion criteria, of which 174 evaluated adequacy of care. Severe pain was described in 86% of coded cases and functional impairment in 62%. Infection was documented in 41% of cases, with an abscess specifically identified in 16%. Delay