Systemic Factors Associated With Paediatric Dental General Anaesthesia Utilisation in Aotearoa New Zealand: A Scoping Review

To identify systemic factors associated with paediatric dental general anaesthesia (DGA) utilisation among children aged 0-13 years in Aotearoa New Zealand (NZ), using a multilevel conceptual framework. A scoping review was conducted in accordance with PRISMA-ScR guidelines. Peer-reviewed 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. Sixteen studies were included. Persistent severe early childhood caries was consistently associated with DGA utilisation, particularly among Māori, Pacific and socioeconomically disadvantaged children. Health system factors-including delayed access to community oral health services, missed appointments, workforce constraints and variation in referral practices-were also associated with increased hospitalisation. Treatment-related 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. 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-focused strategies, improved service access and continuity and attention to structural and social inequities, supported by further research.