Background <p>This study aimed to retrospectively explore the efficacy of dental general anesthesia (DGA) in treating severe early childhood caries (S-ECC) among pre-school children within 1-year longitudinal follow up.</p> Methods <p>Pre-school children, who were diagnosed as S-ECC and accepted DGA treatment, were enrolled in this study from July 2020 to July 2023 followed by at least 1-month follow-up. The general demographics and clinical indices were collected and calculated for further analyses, including the main indices of successful rate and caries recurrence rate, and the secondary indices of postoperative complications, oral health-related quality of life, and parental stratification.</p> Results <p>A total of 269 children were enrolled in this study, including166 boys (61.71%) and 103 girls (38.29%) with mean age of 3.96 ± 0.81 years. The success rate was 91.97% at 6-month and reduced to 85.93% at 12-months after DGA treatment. All the children showed no recurrent carries at 1-month, but relapsed at 6-month and 12-month with 9.71% (20/206) and 19.05% (24/126) posttreatment, respectively. Pain was the most common postoperative complication within 24&#xa0;h (55.02%) and one week (4.83%) after treatment followed by mastication problems (40.01% to 5.58%) and weariness (39.78% to 1.85%). The child impact section (CIS), family impact section (FIS), and early childhood oral health impact scale (ECOHIS) scores were significantly decreased at 1-, 6-, and 12-month posttreatment with a time dependent manner (<i>P</i> &lt; 0.001), and 91.27% of patients were overall satisfied with DGA treatment.</p> Conclusion <p>DGA seems performed safe and clinically acceptable outcomes in treating S-ECC. Pain was the main complication after DGA, and shorting procedure duration might alleviate the postoperative pain and anxiety.</p>