Objective: To explore the efficacy and safety of general anesthesia for children with severe early childhood caries (S-ECC) and its impact on postoperative caries risk. Methods: A total of 260 children with S-ECC were enrolled and divided into a general anesthesia group (n=156) and a control group (n=104) based on treatment methods. The general anesthesia group received dental treatment under general anesthesia, while the control group was treated under protective immobilization. Oral hygiene, dietary habits, oral health-related quality of life (assessed via the Chinese version of the Early Childhood Oral Health Impact Scale [ECOHIS]), and caries susceptibility (detected using the Cariostat system) were compared between the two groups before and 1 month after treatment to evaluate caries risk. Results: One month post-treatment, the proportions of children brushing teeth morning and evening, using fluoride toothpaste, and brushing for ≥2 minutes increased significantly in both groups (P<0.05), with the control group showing higher adherence than the general anesthesia group (P<0.05). No significant changes were observed in dietary habits (e.g., sweetened beverage/dessert intake >1 time/day) post-treatment (P>0.05). Both groups exhibited reduced plaque index and Cariostat scores (P<0.05), with the general anesthesia group showing lower values than the control group (P<0.05). ECOHIS scores (child impact: oral function, symptoms, psychological/social relationships; family impact: parental guilt, economic burden) decreased significantly post-treatment (P<0.05), with the general anesthesia group demonstrating lower scores than the control group (P<0.05). Conclusion: General anesthesia is safe and effective for treating S-ECC in children. It improves short-term oral conditions, reduces caries risk, and enhances quality of life. However, postoperative oral health education should be strengthened to promote long-term healthy oral hygiene habits.