Dental Treatment Needs and Management in Medically Compromised Children at a Tertiary Pediatric Dental Center—A Retrospective Observational Study

Background: Medically compromised pediatric patients often present with extensive dental treatment needs and may require treatment under general anesthesia due to behavioral limitations or systemic health conditions. The aim of this study was to evaluate dental treatment needs, clinical status, and indications for general anesthesia among medically compromised children referred for dental consultation from a tertiary children’s hospital. Methods: This retrospective study included 215 medically compromised children referred from a tertiary children’s hospital to the Department of Pediatric Dentistry between 2020 and 2024. Data extracted included age, sex, type of dentition, systemic diagnosis, dmft/DMFT and pufa/PUFA (the clinical consequences of untreated dental caries, including pulpal involvement, ulceration, fistula, and abscess formation), treatment type, and reasons for the use of general anesthesia. Group comparisons were performed using the Mann–Whitney U test for continuous variables and the chi-square or Fisher’s exact test for categorical variables. Results: A total of 62 patients (28.8%) required treatment under general anaesthesia, whereas 153 patients (71.2%) were treated in the outpatient setting. Children treated under general anaesthesia were significantly younger (6.13 vs. 10.60 years; p < 0.001) and generally presented with a greater burden of untreated dental disease, with the most pronounced differences observed in primary and mixed dentition. They underwent more extractions and restorative procedures than outpatients. The most common reasons for general anaesthesia were lack of cooperation and extensive dental treatment needs, often co-occurring with systemic comorbidities. Conclusions: Among medically compromised children in this tertiary referral cohort, those treated under general anaesthesia generally presented with a greater burden of untreated dental disease, particularly in the primary and mixed dentition groups. These findings support the importance of timely dental assessment and interdisciplinary care in this population.