Consent For Root Canal Therapy - Endodontics printable pdf download

CONSENT FOR ROOT CANAL THERAPY (ENDODONTICS)

All teeth have a hollow chamber and canals within the tooth that contains the live part of the tooth including

nerves and blood vessels. Root canal treatment or endodontics is needed when this live tissue becomes sick, is

dying or dead. Endodontics involves the removal of all tissue within the tooth and filling the space with an inert

filler. This can be sometimes done in one appointment or may need two appointments. If done in two

appointments, during the first appointment as much of the tissue as possible is removed and a medication is

placed inside the tooth and the tooth is temporarily filled. At the next appointment the chamber and canals are

permanently filled. The goal is to clean and fill all canals to their end. Although this seems simple enough many

times the canals can be curved, have branches, be constricted, blocked or calcified, atypically shaped. This can

make the outcome unpredictable. Sometimes x‐rays will reveal this and other times not, as x‐rays are two

dimensional views of a three dimensional structure. You have the option of having this treatment done with a

endodontist (root canal specialist) or with us. Sometimes we will refer you to a specialist if we feel the treatment

would be better handled by the them. At other times we may start the treatment and then encounter

unforeseen challenges and give you the option of seeing the endodontist. It is possible that the specialist will

have the same outcome as a general dentist because of the nature of the challenge. There are no guarantees.

Root canal treatment is successful 90‐95% of the time.

Some of the risks and complications involved with root canal treatment are persistent pain, swelling or infection

following treatment; canal filling going past apex of canal or short of the apex, not able to negotiate the narrow,

curved or sometimes blocked canal space, breakage of instrument within the canal space, perforation of the

chamber or canal space, leakage of canal cleaning substance into tissue causing adverse reaction. Failure of

treatment may necessitate extraction of tooth, re‐treatment surgically or referral to specialist. After root canal

treatment, teeth become brittle. Back teeth that have root canals are routinely crowned otherwise they can

fracture. These teeth may not fracture for years or may fracture between the first and second appointment as

mentioned above. One must be careful to bite carefully until the crown has been placed.

We charge separately for the first and second appointment. Please check with your insurance company, many of

which will subtract the cost of the first appointment from the final treatment fee for the canal. Your are

responsible for the cost and for dealing with your insurance company and we can help you within a limited

degree.

Alternatives to having root canal treatment is to have the tooth extracted and have the tooth replaced with a

dental implant. The other alternative is to have no treatment which in some cases may lead to complications like

life‐threatening infection.

CONSENT FOR ROOT CANAL TREATMENT

Patient’s name:___________________________________________________ Age:______

I hereby give consent to perform the following procedure for myself or my dependent

______________________________________________________________________________

_______________ _____________________________________________________________

Date Signature of patient/parent/guardian

Consent For Root Canal Therapy - Endodontics