Rural–Urban and Demographic Inequalities in Dental Pathology and Diagnostic Patterns in Romanian Emergency Care: A Retrospective Tertiary Clinical Cohort Study

Background/Objectives: This study investigated the independent and interactive effects of age, sex, and area of residence on dental diagnostic and anatomic patterns among emergency dental patients. Methods: Clinical data were collected from 1650 patients treated at the Arad County Emergency Clinical Hospital and analyzed using multivariate logistic regression. Dental diagnoses were grouped into carious lesions, endodontic conditions, periodontal diseases, acute infections, and other dental pathologies. Affected teeth were classified as anterior, premolar, or molar. Results: Middle-aged patients (40–59 years) showed lower odds of dental caries (OR = 0.21, p = 0.009) and endodontic conditions (OR = 0.42, p = 0.011), but higher odds of periodontal diseases (OR = 2.02, p < 0.001) compared to young adults (<40 years). Older age (≥60 years) was associated with reduced risk of endodontic emergencies (OR = 0.58, p = 0.021) but higher risk of periodontal diseases (OR = 1.92, p = 0.026). Rural residence was associated with higher odds of endodontic (OR = 1.57, p = 0.048) and periodontal pathology (OR = 1.76, p = 0.045). The endodontic effect differed by sex, with rural men showing higher odds of this outcome versus urban women (OR = 2.03, p = 0.033). Male patients were more likely to have affected anterior teeth (OR = 1.62, p = 0.045), whereas their molars were less frequently affected (OR = 0.69, p = 0.042). Conclusions: Age and rural residence were significantly associated with variations in advanced dental pathology patterns within this emergency cohort. Sex modified the association between area of residence and endodontic conditions and was independently associated with patterns of tooth involvement. Our findings identify rural men from this cohort as a high-risk subgroup and emphasize the need for targeted public health programs in rural communities.