General Anesthesia - Lollipop Dental Pediatric Dentistry & Orthodontics

General Anesthesia

Checklist for Denti-cal General Anesthesia in our Office

❏ Current Medical Clearance or Physical required prior to surgery. Please have your doctor fill out the attached form and send it back to our office as soon as possible prior to the surgery date.

❏ There is a required non-refundable $100 case presentation fee that is applied prior to the General Anesthesia appointment.

❏ All Dental Treatment Plans must be signed before the date of surgery with any payment arrangements made for any non-covered Denti-cal procedures.

****If you fail to show up or cancel less than 24 hours before your appointment, a $100
cancellation fee will apply**

❏ Read over this packet for detailed information on how to prepare for your child’s surgery.

1 Day Prior to Surgery Date

Our board-certified pediatric medical or dental anesthesiologist, will give you a call to go over in detail the anesthesiology procedure and answer any questions you may have regarding the anesthesia. He will have reviewed your child’s medical history report and will take the necessary precautions to ensure a safe surgery for your child.

Our surgery coordinator will also call you the day before and confirm your estimated appointment time. We will also go over strict fasting requirements. If your child does not follow the fasting requirements, you will lose your deposit and must reschedule your child’s surgery.

Our Anesthesiologists

Our team of Board Certified Pediatric Anesthesiologists will be administering General Anesthesia to your child. They are highly experienced and have over 25 years of experience working with high risk children in dental offices and hospitals so safety is our utmost priority. Our Anesthesiologists worked in premier hospitals such as Children’s Hospital of Los Angeles and Orange County. They have also lectured in the field of Anesthesia and train new medical students on how to safely administer anesthesia to children.

Our Pediatric Dentists

Lollipop Pediatric Dentistry’s team of pediatric dentists hold themselves to the highest standards in children’s dental care. Our Pediatric Dental Specialists have years of experience and training in the care of infants, children, teens, and children with special needs. Our Pediatric Dentists are Board Eligible or Board Certified. Board Certification is a significant achievement that not all dentists attain. Board Certified pediatric dentists are the most skilled and knowledgeable in their specialty, are considered the Top 5% of meeting the highest standards, and are experts in the field of pediatric dentistry.

Preparing for Your Child’s General Anesthesia Appointment

We have recommended General Anesthesia for your child’s safety and comfort for completion of recommended dental procedures. General Anesthesia will allow your child to be asleep and comfortable. We have a Pediatric Medical Anesthesiologist who will administer medications and monitor your child while a separate Pediatric Dentist Specialist completes the dental treatment. In order to ensure the highest standards of safety, we have a team of professionals monitoring and treating your child during the procedure who have been trained specifically in pediatric dentistry and anesthesiology.

Prior to your child’s sedation appointment:

• Please notify our office of any change in your child’s health and/or medical condition. Fever, ear infection, nasal or chest congestion, or recent head trauma could place your child at increased risk for complications. Should your child become ill within 3 days prior to the appointment, contact our office to see if it is necessary to postpone the procedure. • Inform us of any prescribed, over-the-counter, or herbal medications your child is taking. The doctor will advise you if routine medications should be taken the day of the surgery. Also, report any allergies or reactions to medications that your child has experienced. • Food and liquids must be restricted in the hours prior to general anesthesia. Fasting decreases the risk of vomiting and aspirating stomach contents into the lungs, a potentially life-threatening problem. We will not proceed with the procedure if you do not comply with the following requirements.

Type of Food/Liquid

Minimum Fasting Period

Nothing allowed at all. No food, no liquids, no hard candy, no gum.

2 hours prior to appointment

YOU CAN DRINK: Clear fluids: Water, apple juice, Gatorade, Cranberry juice, Clear Jello with no fruits or bits.
DO NOT EAT/DRINK: Milk, Orange juice, chicken broth, soup with oil or fat

Between 8 to 2 hours prior to your appointment time


8 hours before appointment time

As a general rule of thumb, no food after bedtime the day before surgery.

• Dress your child in loose-fitting, comfortable clothing. This will allow us to place monitors that evaluate your child’s response to the medications and help ensure your child’s safety. These monitors measure effects on your child’s breathing, heart rate, and blood pressure. • Do not bring other children to this appointment so you can focus your attention on your child undergoing the procedure.

• We recommend having two adults accompany the patient home. On the way home, one individual should be able to observe the child’s breathing without any distractions, especially if the patient falls asleep while in the car seat.

During the sedation appointment:

• We recommend you stay within a 5 minute time distance of the office while your child is in surgery. We would like you to be present when your child begins to wake up and see their parent(s)!

• The doctor and staff will evaluate your child’s health status before he/she will be discharged home. Children recover from effects of anesthesia at different rates so be prepared to remain at our office until the doctor has determined your child is stable and the after-effects are minimal. At discharge, your child should be responsive but may be drowsy, crying, or irritable.

After the sedation appointment:

• Once home, your child will still be drowsy and must remain under adult supervision until fully recovered from the effects of the sedation. If your child wants to sleep, position your child on his/her side with the head supported and the chin up. During this period, check your child’s breathing and airway every three to five minutes. If your child is snoring, reposition the head until the snoring disappears and your child breathes normally. If breathing becomes abnormal or you are unable to arouse your child, contact emergency services (call 911) immediately. • Nausea and vomiting are occasional side effects of general anesthesia. If vomiting occurs, immediately clear the material from your child’s mouth. Once again, be sure that breathing is normal. If breathing becomes abnormal or you are unable to arouse your child, contact emergency services (call 911) immediately. If vomiting persists beyond 24 hours, contact the anesthesia at the number provided immediately.

• Your child may be drowsy for some time after the sedation appointment. Restrict activities for the remainder of the day. Prohibit potentially harmful activities such as bike riding, swimming, using playground equipment, or any activity where balance is important.

• In addition to the general anesthesia medications, we often use local anesthetic to numb the mouth during dental treatment. The numbness usually lasts two to four hours. Watch to see that your child does not bite, scratch, or injure the cheek, lips, or tongue during this time. • Children may be irritable after treatment. If this occurs, stay with your child and provide a calm environment. During the procedure, the anesthesiologist may give a pain reliever, called Toradol® through an IV that will last about 5 hours. If you believe the irritability is caused by discomfort, you may give your child acetaminophen (Tylenol®) or ibuprofen (Motrin®, Advil®) after 5 hours of being discharged from our office. Follow the instructions on the bottle for dosing

based upon your child’s age/weight.

• Once your child is alert, you may give him/her sips of clear liquids to prevent nausea and dehydration. Small drinks taken repeatedly are preferable to large amounts. The first meal should be something light and easily digestible (e.g., soup, Jell-O®, apple sauce). Do not give fatty or spicy foods (e.g., French fries, tacos, salsa, milk, cheese, yogurt). • A slight fever (temperature to 100.5°F) is not uncommon after general anesthesia. You may give your child acetaminophen (Tylenol®) or ibuprofen (Motrin®, Advil®). Follow the instructions on the bottle for dosing based upon your child’s age/weight. Because dehydration may cause a slight increase in temperature, clear fluids may help correct this condition. If a higher fever develops or the fever persists, call (714) 485-6211

• Please feel free to call the office for any questions or concerns that you might have.

Lollipop Pediatric Dentistry – Placentia 

1041 E Yorba Linda Blvd Suite 206 Placentia, CA 92870

(714) 528-8252, ext 1


Lollipop Pediatric Dentistry – Garden Grove 

12777 Valley View St Suite 222
Garden Grove, CA 92870
(714) 893-7539, ext 1


Lollipop Pediatric Dentistry – Costa Mesa 

2750 Harbor Blvd. Suite B6
Costa Mesa, CA 92626
(714) 592-0039, ext 1


Lollipop Pediatric Dentistry – Cerritos 

13047 Artesia Blvd Suite C100 Cerritos, CA 90703

(562) 542-2526, ext 1


Lollipop Pediatric Dentistry – Tustin 

13931 Carroll Way Suite C
Tustin, Orange County, CA 92780 (714) 598-1036. ext 1


Lollipop Pediatric Dentistry – Long Beach 

4251 Long Beach Boulevard, Suite A Long Beach, CA 90807
(562) 270-9719 ext 1


Lollipop Pediatric Dentistry – Lake Forest 

21751 Lake Forest Drive #21
Lake Forest, CA 92630
(949) 250-1100


Dr. Brian Huang – Anesthesiologist (213) 590-8053
Dr. Scott Gillin – Anesthesiologist (858) 254-0512
Dr. Christopher Snell – Anesthesiologist (619) 861-8887 Dr. Albert Kang – Anesthesiologist (626) 269-4070
Dr. Charles Lee – Anesthesiologist (949) 424-2309
Dr. Andrew Elmasri – Anesthesiologist (949) 288-3401 Dr. Drew Preston – Anesthesiologist (310) 694-4286

After Hours Questions for Dental Assistant on Call – (714) 485-6211


Medical Clearance for General Anesthesia

Patient Name: ________________________________ 

Patient Date Of Birth ______________________ 

Dear Doctor, the patient named above presented to Lollipop Pediatric Dentistry for comprehensive dental care. He/she will require complete oral rehabilitation under general anesthesia and nasal intubation with possible dental extractions. Please evaluate the patient and provide a current H & P and clearance for dental surgery under general anesthesia.

Please list any medical conditions:________________________________________________________

1. Does the patient have any medical conditions or diagnoses that contraindicate the use of general anesthesia? Yes or No
*If yes, please explain: _________________________________________________________________

2. Is the patient taking any medications that should be stopped prior to general anesthesiaYes or No *If yes, please explain: _________________________________________________________________

3. Are there any contraindications to proposed dental treatment including dental extractions that may induce moderate gingival bleeding? Yes or No

*If yes, please explain: _________________________________________________________________

4. Is there any premedication recommended prior to dental treatment? Yes or No *if yes, please provide medication and instructions: ___________________________________________

5. Will your office call in the Rx for the patient (if necessary)? Yes or No 6. Any specific pain medication recommended? Yes or No

**If yes, please explain:_________________________________________________________________

Physician Name: _____________________________________________ Date: ______________ 

Physician Signature: __________________________________________

Please fax reply immediately to (714) 542-8933. Feel free to contact me at (714) 528-8252, ext 1 with any questions or concerns. Thank you for your time and assistance.


Dr. Mary Regina Pham DDS, MS Diplomate American Board of Pediatric Dentistry Lollipop Pediatric Dentistry

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