The aim of this retrospective study was to assess and compare the dental treatments performed under general anesthesia (GA) between healthy children and children with special health care needs (SHCN) according to age group and gender at king Fahd hospital, Dhahran, Saudi Arabia. Data was retrieved from the records of 304 healthy and SHCN children 1 18 years of age who received dental rehabilitation under GA in the period 2015-2018. The dental treatment modalities were compared in the two groups and differences according to age group and gender were reported. Compared to healthy children, children with SHCN received significantly less pulp therapy treated teeth, and restored primary teeth. While, they received significantly more extracted teeth, and restored permanent teeth (P<0.05). In both groups, younger children (? 6 years) received significantly more crowns, pulp therapy treated teeth, and restored primary teeth than older children (> 6 years) (P<0.05). While, they received significantly less fissure sealed teeth, extracted primary teeth, and restored permanent teeth (P<0.05). No gender difference was found among children with SHCN; however, healthy boys ? 6 years received significantly more extracted primary teeth than girls of same age group, while healthy boys > 6 years received significantly more pulp therapy treated teeth than girls of same age group (P<0.05). Healthy children had different approaches for treatment under GA than children with SHCN. The use of radical treatment approaches like extraction in children with SHCN and the lessened preference toward pulp therapy coupled with greater need for permanent teeth restorations when compared to healthy children were observed. Greater emphasis on oral health education and preventive strategies for children with SHCN is required. It is important to educate their parents/caregivers on the importance of establishing early dental home.