{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T01:09:36Z","timestamp":1785805776146,"version":"3.56.0"},"reference-count":36,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T00:00:00Z","timestamp":1773878400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: General anesthesia (GA) plays a key role in pediatric dentistry by enabling comprehensive dental treatment in children who cannot be adequately managed using conventional behavioral techniques, local anesthesia, or sedation. While previous reviews have primarily focused on safety outcomes and adverse events, less attention has been given to patterns of GA utilization and their broader clinical and public health implications. Objective: The objective was to synthesize and critically analyze contemporary evidence on utilization patterns, clinical indications, and treatment characteristics associated with GA in pediatric dentistry and to interpret variability in GA use as a clinical and health-system indicator. Methods: A systematic review with qualitative synthesis was conducted in accordance with PRISMA 2020 guidelines. Electronic searches were performed in EBSCOhost, Scopus, and the Cochrane Library to identify observational studies published between 2015 and 2025 reporting clinical data on pediatric dental treatment under GA. Results: Twenty-two observational studies met the inclusion criteria. Severe early childhood caries was the most frequently reported indication for GA, followed by behavioral management difficulties and treatment of children with special health care needs. Reported utilization rates varied widely across healthcare systems. Conclusions: GA remains an essential modality for managing complex pediatric dental cases; however, variability in utilization appears to reflect differences in preventive access, disease burden, and health-system organization. Interpreting GA use as a healthcare utilization indicator may support improved preventive strategies and policies aimed at reducing repeated GA exposure in vulnerable pediatric populations.<\/jats:p>","DOI":"10.3390\/children13030422","type":"journal-article","created":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T11:50:36Z","timestamp":1773921036000},"page":"422","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Utilization Patterns and Clinical Indications of General Anesthesia in Pediatric Dentistry: A Systematic Review"],"prefix":"10.3390","volume":"13","author":[{"given":"Mar\u00eda","family":"Carmona-Santamar\u00eda","sequence":"first","affiliation":[{"name":"Dentistry Department, Medicine and Health Science Faculty, Catholic University of Valencia, 46001 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davinia","family":"P\u00e9rez-S\u00e1nchez","sequence":"additional","affiliation":[{"name":"Dentistry Department, Medicine and Health Science Faculty, Catholic University of Valencia, 46001 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0054-1005","authenticated-orcid":false,"given":"Juan Ignacio","family":"Aura-Tormos","sequence":"additional","affiliation":[{"name":"Stomatology Department, University of Valencia, 46010 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8841-7975","authenticated-orcid":false,"given":"Clara","family":"Guinot-Barona","sequence":"additional","affiliation":[{"name":"Dentistry Department, Medicine and Health Science Faculty, Catholic University of Valencia, 46001 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5722-0547","authenticated-orcid":false,"given":"Laura","family":"Marqu\u00e9s-Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Dentistry Department, Medicine and Health Science Faculty, Catholic University of Valencia, 46001 Valencia, Spain"},{"name":"Stomatology Department, University of Valencia, 46010 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8864-3702","authenticated-orcid":false,"given":"Esther","family":"Garc\u00eda Miralles","sequence":"additional","affiliation":[{"name":"Stomatology Department, University of Valencia, 46010 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"29","DOI":"10.5005\/jp-journals-10028-1555","article-title":"General anesthesia for dental procedures in children: A comprehensive review","volume":"56","author":"Puri","year":"2022","journal-title":"J. Postgrad. Med. Educ. Res."},{"key":"ref_2","first-page":"450","article-title":"Effectiveness of a preventive recall strategy for children after dental rehabilitation with general anesthesia","volume":"39","author":"Berry","year":"2017","journal-title":"Pediatr. Dent."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Cagetti, M.G., and Campus, G. (2023). The future of pediatric dentistry is now. Children, 10.","DOI":"10.3390\/children10010097"},{"key":"ref_4","unstructured":"World Health Organization (2022). Global Oral Health Status Report: Towards Universal Health Coverage for Oral Health by 2030, WHO."},{"key":"ref_5","unstructured":"American Academy of Pediatric Dentistry (2025). Behavior guidance for the pediatric dental patient. The Reference Manual of Pediatric Dentistry, American Academy of Pediatric Dentistry."},{"key":"ref_6","first-page":"m9","article-title":"The use of general anesthesia for pediatric dentistry in Saskatchewan: A retrospective study","volume":"88","author":"Lionel","year":"2022","journal-title":"J. Can. Dent. Assoc."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1016\/S0140-6736(15)00608-X","article-title":"Neurodevelopmental outcome at 2 years of age after general anaesthesia and awake-regional anaesthesia in infancy (GAS): An international multicentre, randomised controlled trial","volume":"387","author":"Davidson","year":"2016","journal-title":"Lancet"},{"key":"ref_8","unstructured":"American Academy of Pediatric Dentistry (2023). Use of general anesthesia and deep sedation in pediatric dental patients. Reference Manual of Pediatric Dentistry, AAPD."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"He, S.-Y., Li, J.-Y., Dai, S.-S., Yang, Y.-H., Wen, Y.-F., Guo, Q.-Y., and Liu, F. (2023). Survival Analysis and Risk Factors of Pulpectomy among Children with Severe Early Childhood Caries Treated under General Anesthesia: A Retrospective Study. Int. J. Environ. Res. Public Health, 20.","DOI":"10.3390\/ijerph20021191"},{"key":"ref_10","first-page":"46","article-title":"Retrospective analysis of dental treatment under general anesthesia among children with early childhood caries in Malaysia","volume":"47","author":"Ibrahim","year":"2023","journal-title":"J. Clin. Pediatr. Dent."},{"key":"ref_11","first-page":"40","article-title":"The prevalence and factors associated with sibling-recurrent dental treatment under general anesthesia at an academic institution","volume":"41","author":"Edmonds","year":"2019","journal-title":"Pediatr. Dent."},{"key":"ref_12","first-page":"439","article-title":"Dental treatment and expenditures under general anesthesia among Medicaid-enrolled children in North Carolina","volume":"39","author":"Meyer","year":"2017","journal-title":"Pediatr. Dent."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"109","DOI":"10.4103\/1735-3327.332103","article-title":"Comparison of dental treatments performed under general anesthesia for healthy and disabled children","volume":"18","author":"Kaviani","year":"2021","journal-title":"Dent. Res. J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"155","DOI":"10.17796\/1053-4628-42.2.13","article-title":"A retrospective audit of dental treatment provided to special needs patients under general anesthesia during a ten-year period","volume":"42","author":"Mallineni","year":"2018","journal-title":"J. Clin. Pediatr. Dent."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1294","DOI":"10.1177\/10556656231164515","article-title":"Prevalence of treatment of early childhood caries among children with cleft lip and\/or cleft palate in Manitoba","volume":"61","author":"Surtie","year":"2024","journal-title":"Cleft Palate Craniofac. J."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Koberova Ivancakova, R., Suchanek, J., Kovacsova, F., Cermakova, E., and Merglova, V. (2019). The analysis of dental treatment under general anaesthesia in medically compromised and healthy children. Int. J. Environ. Res. Public Health, 16.","DOI":"10.3390\/ijerph16142528"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1134","DOI":"10.5005\/jp-journals-10005-3263","article-title":"Dental treatment in children under general anesthesia: A 24-year retrospective study","volume":"18","author":"Shayegan","year":"2025","journal-title":"Int. J. Clin. Pediatr. Dent."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Bekes, K., Steuber, A., Challakh, N., Schmidt, J., Haak, R., Hrask\u00fd, V., and Ziebolz, D. (2020). Associated factors to caries experience of children undergoing general anaesthesia and treatment needs characteristics over a 10 year period. BMC Oral Health, 20.","DOI":"10.1186\/s12903-020-01302-4"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1111\/ipd.13237","article-title":"The use of general anesthesia for dental treatment of children with special healthcare needs in Alberta, Canada","volume":"35","author":"Yazdanbakhsh","year":"2025","journal-title":"Int. J. Paediatr. Dent."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1111\/ipd.12484","article-title":"Early childhood caries epidemiology, aetiology, risk assessment, societal burden, management, education, and policy: Global perspective","volume":"29","author":"Tinanoff","year":"2019","journal-title":"Int. J. Paediatr. Dent."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Karl, V., Scholz, K.J., Hiller, K.A., Tabenski, I., Schenke, F., Buchalla, W., Kirschneck, C., Bekes, K., and Cieplik, F. (2022). Retrospective cohort study on potential risk factors for repeated need of dental rehabilitation under general anesthesia in a private pediatric dental practice. Children, 9.","DOI":"10.3390\/children9060855"},{"key":"ref_22","first-page":"24","article-title":"Preferential use of stainless steel crowns as a strategy to minimize retreatment of primary molars under general anesthesia","volume":"43","author":"Patel","year":"2021","journal-title":"Pediatr. Dent."},{"key":"ref_23","unstructured":"Aromataris, E., and Munn, Z. (2020). JBI Manual for Evidence Synthesis, Joanna Briggs Institute. Available online: https:\/\/synthesismanual.jbi.global."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"29","DOI":"10.4103\/0976-9668.107257","article-title":"Early childhood caries update: A review of causes, diagnoses, and treatments","volume":"4","author":"Colak","year":"2013","journal-title":"J. Nat. Sci. Biol. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1111\/ipd.13186","article-title":"Dental treatment of children with special healthcare needs: A retrospective study of 10 years of treatment","volume":"34","author":"Hieronymus","year":"2024","journal-title":"Int. J. Paediatr. Dent."},{"key":"ref_27","first-page":"16","article-title":"Tratamientos dentales realizados bajo anestesia general en el servicio de odontopediatr\u00eda de un centro dental docente. Estudio retrospectivo","volume":"23","author":"Condori","year":"2023","journal-title":"Odontol. Pediatr."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Weninger, A., Seebach, E., Broz, J., Nagle, C., Lieffers, J., Papagerakis, P., and Da Silva, K. (2022). Risk indicators and treatment needs of children 2\u20135 years of age receiving dental treatment under general anesthesia in Saskatchewan. Dent. J., 10.","DOI":"10.3390\/dj10010008"},{"key":"ref_29","first-page":"75","article-title":"Patterns of paediatric dental treatment under general anaesthesia: A retrospective study","volume":"17","author":"Shukry","year":"2022","journal-title":"Arch. Orofac. Sci."},{"key":"ref_30","first-page":"3","article-title":"Oral rehabilitation under general anesthesia for pediatric patients at Bahrain Defense Force Hospital: A retrospective study","volume":"33","author":"Najib","year":"2021","journal-title":"J. Bahrain Med. Soc."},{"key":"ref_31","first-page":"313","article-title":"Reasons of repeat dental treatment under general anaesthesia: A retrospective study","volume":"18","author":"Guidry","year":"2017","journal-title":"Eur. J. Paediatr. Dent."},{"key":"ref_32","first-page":"61","article-title":"Pain-related complaints of paediatric patients after dental treatment under general anaesthesia","volume":"24","author":"Radacsi","year":"2023","journal-title":"Eur. J. Paediatr. Dent."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"303","DOI":"10.17796\/1053-4628-42.4.12","article-title":"Trends and characteristics of pediatric dentistry patients treated under general anesthesia","volume":"42","author":"Rudie","year":"2018","journal-title":"J. Clin. Pediatr. Dent."},{"key":"ref_34","unstructured":"European Academy of Paediatric Dentistry (2019). Best clinical practice guidance for restorative treatment of primary teeth. Eur. J. Paediatr. Dent., 20, 659\u2013666."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1007\/s40368-018-0368-2","article-title":"Procedural pain in routine dental care for children: A part of the Swedish BITA study","volume":"19","author":"Ghanei","year":"2018","journal-title":"Eur. Arch. Paediatr. Dent."},{"key":"ref_36","first-page":"e303","article-title":"General anesthesia for oral and dental care in paediatric patients with special needs: A systematic review","volume":"13","author":"Silvestre","year":"2021","journal-title":"J. Clin. Exp. Dent."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/3\/422\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T12:22:45Z","timestamp":1773922965000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/3\/422"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,19]]},"references-count":36,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["children13030422"],"URL":"https:\/\/doi.org\/10.3390\/children13030422","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,19]]}}}