{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T04:54:09Z","timestamp":1790916849088,"version":"4.1.0"},"reference-count":36,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Paediatrics Child Health"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To identify systemic factors associated with paediatric dental general anaesthesia (DGA) utilisation among children aged 0\u201313\u2009years in Aotearoa New Zealand (NZ), using a multilevel conceptual framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A scoping review was conducted in accordance with PRISMA\u2010ScR guidelines. Peer\u2010reviewed literature published between 2000 and 2025 was identified through searches of PubMed and Google Scholar. Eligible studies examined paediatric DGA, dental hospitalisation or contributing factors in NZ. Data were extracted and synthesised across four domains: disease burden, service access, treatment pathways and structural and social determinants. Study quality was assessed using the Mixed Methods Appraisal Tool.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Sixteen studies were included. Persistent severe early childhood caries was consistently associated with DGA utilisation, particularly among M\u0101ori, Pacific and socioeconomically disadvantaged children. Health system factors\u2014including delayed access to community oral health services, missed appointments, workforce constraints and variation in referral practices\u2014were also associated with increased hospitalisation. Treatment\u2010related factors, including restoration failure and repeat DGA, contributed to service demand, although evidence was primarily observational. Structural and social determinants, including socioeconomic deprivation and access barriers, influenced both disease burden and service engagement. Evidence regarding migration was limited and inconclusive.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Increasing paediatric DGA utilisation in NZ is associated with interacting clinical, health system and structural factors. As the current evidence base is largely observational, causal inference is limited. Reducing demand will likely require coordinated prevention\u2010focused strategies, improved service access and continuity and attention to structural and social inequities, supported by further research.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jpc.70611","type":"journal-article","created":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T04:11:16Z","timestamp":1790914276000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Systemic Factors Associated With Paediatric Dental General Anaesthesia Utilisation in Aotearoa New Zealand: A Scoping Review"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1427-9594","authenticated-orcid":false,"given":"Sathananthan","family":"Kanagaratnam","sequence":"first","affiliation":[{"name":"Dental Public Health Specialist (Retired) T\u0101maki Makaurau Auckland  Auckland Aotearoa New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6799-6779","authenticated-orcid":false,"given":"Philip J.","family":"Schl\u00fcter","sequence":"additional","affiliation":[{"name":"Te Kaupeka Oranga Faculty of Health Te Whare Wananga o Waitaha University of Canterbury  \u014ctautah Christchurch Aotearoa New Zealand"},{"name":"General Practice Clinical Unit, Faculty of Medicine The University of Queensland  Brisbane Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,1]]},"reference":[{"issue":"5","key":"e_1_2_12_2_1","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1177\/0022034515573272","article-title":"Global Burden of Untreated Caries: A Systematic Review and Metaregression","volume":"94","author":"Kassebaum N. 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