Utilization Patterns and Clinical Indications of General Anesthesia in Pediatric Dentistry: A Systematic Review.

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.