Dental caries burden and associated factors in children with special needs undergoing dental treatment under general anesthesia: A retrospective study

Children with special needs face elevated caries risk and frequently require dental treatment under general anesthesia (GA) due to behavioral management challenges. This study aimed to characterize their dental treatment burden and identify modifiable behavioral and parental determinants. We retrospectively analyzed 52 children with special needs (mean age 6.6 ± 2.7 years; range 3–18; 71.2% male) who received comprehensive dental care under GA at a tertiary pediatric hospital between 2023 and 2025. Treatment burden was defined as the total count of restorative procedures (extractions, fillings, pulpotomies, root canal treatments, preformed metal crowns); each procedure was also modeled separately. Associations were assessed using univariate and multivariable Poisson regression (reported as incidence rate ratios, IRR, with 95% CI) and Spearman correlations. Given the small cohort, all analyses were exploratory. Mean treatment burden was 7.90 ± 2.74 restorative procedures per child (range 4–20; 411 total). Despite 80.8% brushing daily and 92.3% receiving parental assistance, only 51.9% used fluoride toothpaste and 28.8% attended annual check-ups. In univariate analysis, a higher long-term oral-habits score was associated with more fillings (IRR = 1.17 per one-point increase, 95% CI 1.07–1.28, p < 0.001) but fewer pulpotomies (IRR = 0.93, 95% CI 0.87–1.00, p = 0.045). Stable parental work schedules (IRR = 0.55, p = 0.01) and belief that primary caries requires timely treatment (IRR = 0.57, p = 0.02) were associated with fewer extractions and pulpotomies, respectively. Treatment burden in children with special needs undergoing GA is driven primarily by modifiable oral-habit and caregiver factors rather than medical comorbidities. The most critical lever is correcting the parental misconception that primary caries require treatment only when symptomatic, and establishing sustained fluoride-containing oral hygiene routines, should be prioritized over diagnosis-focused approaches.