Background: The COVID-19 pandemic disrupted healthcare delivery worldwide, including dental services. In Japan, the burden and age-specific patterns of dental anesthesia use have not been quantified. We aimed to describe national trends in dental sedation and general anesthesia (GA) in Japan from fiscal year (FY) 2019 (pre-pandemic baseline) through FY 2023 using aggregated claim-level data from the National Database Open Data Japan and interpret these trends in the context of COVID-19-related healthcare constraints. We compared the age distributions of patients who underwent GA in dentistry and medicine. Methods: This analysis used aggregated claim counts from the National Database Open Data (FY 2019–FY 2023). Sedation and GA categories were defined using reimbursement codes: inhalation sedation (K002), intravenous sedation interpreted as conscious or moderate sedation (K003), intravenous anesthesia interpreted as deep sedation (L001–2), and GA (L008). Outcomes were annual claim counts, relative indices standardized to FY 2019 (=100), and age-stratified distributions in 5-year groups (0–4 years to ≥90 years). Age distributions for GA were visualized as mirrored pyramids in dentistry and medicine. No inferential tests were performed. Results: Inhalation sedation increased by approximately 7% in FY 2023. Intravenous sedation increased substantially by 68%. Intravenous anesthesia declined sharply in FY 2020, the first pandemic year, and then plateaued. Dental GA decreased in FY 2020, recovered, and expanded to 110,000 claims by FY 2023 (relative index: 122.3).Dental GA showed a bimodal age distribution (peaking at 5–9 years and 15–29 years), whereas medical GA were concentrated at 70–85 years, indicating distinct modality- and sector-specific demand structures. Conclusion Using claims tabulations spanning the pre-pandemic, pandemic, and “with-COVID” phases, we found heterogeneous trajectories in dental sedation and GA in Japan, characterized by robust growth in conscious or moderate sedation and recovery and expansion of dental GA after an initial 2020 decline. The divergent GA age distributions between dentistry and medicine underscore fundamentally different demand profiles.Interpreted within the context of COVID-19, these modality- and age-specific patterns highlight the adaptive and resilient responses of Japan’s dental anesthesia services under pandemic-related constraints and provide a foundation for future policy and workforce planning.