I am being provided with this information (verbally and written) and consent form so I may better understand the treatment recommended for me. Before beginning, I wish to be provided with enough information, in a way I can understand, to make a well-informed decision regarding my proposed treatment. I understand that I may ask any questions I wish, and that it is a better to ask them before treatment begins than to wonder about it after treatment has started. This is not a financial discussion.
Nature of Endodontic Treatment: The goal of endodontic treatment is to ultimately preserve your tooth. It is with every intention to provide the utmost care to attain this goal.
Cracks: All teeth have small craze lines or cracks due to normal chewing function. Cracks are unpredictable even if the doctor can visualize the depth of a crack with a microscope or other modalities. That means that treatment is the best option to save your tooth but if a crack propagates despite our best efforts, the tooth will eventually need extraction. Root canal therapy may extend the longevity of your tooth. You have been given the choice to try to save your tooth before treatment is rendered or extract it.
Endodontic treatment has been recommended for me:
Non-surgical root canal treatment requires removing the nerve and other tissues (pulp) or previous root canal filling materials/obstructions from inside the tooth and its root(s). It is done by first making an opening through the chewing surface of the tooth to gain access to the tooth’s pulp. The contents of the canals are removed and the canals cleaned and shaped. The canals are then filled and sealed with a biocompatible and inert material. Following root canal treatment, the tooth will need a final restoration, usually a permanent filling and crown, to return it to proper function. Failure to do this may result in RCT failure or loss of the tooth.
The final restoration is not part of this discussion and consent.
The recommendation is based on visual examination(s), on any x-rays, models, photos, any other diagnostic tests taken, and on my Doctor’s knowledge of my medical and dental history. My needs and wishes also have been taken into consideration.
The intended benefit of root canal treatment is to relieve my current symptoms and/or to permit me to continue with any additional treatment my dentist has proposed. Root canal treatment also retains the tooth root in my mouth, permitting the tooth to be restored to proper function.
The prognosis, or likelihood of success, of the endodontic treatment, was discussed with me at the time of consultation.
Alternatives to Endodontic Treatment
Depending on my diagnosis, there may or may not be alternatives to root canal treatment that involve other types of dental care. I understand the two most common alternatives to root canal treatment are:
Extraction. The extracted tooth usually requires replacement by an artificial tooth by means of a fixed bridge, dental implant, or removable denture.
No Treatment. I may decide not to have any treatment performed at all. If I decide upon not having the recommended treatment, my condition may worsen and I may risk serious personal injury, including severe pain; localized infection; loss of this tooth and possibly other teeth; severe swelling; and/or severe infection that may be potentially fatal.
*I have had an opportunity to ask questions about these alternatives and any other treatments.
Risks of Non-Surgical Therapy / Retreatment / other Endodontic Therapies:
I have been informed and fully understand that there are certain inherent and potential risks associated with root canal treatment. A small percentage of root canals performed by an endodontic specialist fail (5-10%) and may require retreatment, surgery, or extraction.
Root canal therapy is a biological procedure therefore success cannot be guaranteed. Root canal treated teeth are sometimes lost due to periodontal/gum disease, splits/fractures of the roots, or persistent infections. I understand that before, during and, after treatment, I may experience pain or discomfort, swelling, bleeding, changes in my bite, and loosening or loss of other dental restorations.
When making an access (opening) through an existing crown or placing a rubber dam clamp, possible damage can occur and a new crown may be necessary. Other teeth may be damaged during root canal treatment. Swallowing or aspiration of materials/restorations may occur.
I understand that it is possible for an infection to occur or an existing infection to worsen in the tooth being treated and/or in the area around the tooth and that I may need antibiotics and/or other procedures to treat the infection.
I understand that sterile root canal instruments sometimes separate inside the canal. This is more likely when canals are curved and narrowed. If the separated fragment cannot be retrieved, it may require sealing inside the root canal. It also may be necessary to have surgery performed on the tooth root to address the problem.
During treatment, other complications may be discovered which make treatment impossible, or which may require dental surgery.
I understand that other unintentional risks include: perforation of the tooth or tooth root by an instrument; injury to soft tissues near the tooth (lip/extraoral/intraoral lacerations, chemical/mechanical burns); sinus perforation; nerve disturbances such as temporary or permanent numbness, itching, burning, or tingling of the lip, tongue, chin, teeth, and/or mouth tissues; adverse or allergic reactions to anesthetics, irrigants, materials, or methods used during treatment. Surgical procedures may result in altered soft tissue healing (e.g. gum recession, loss of papilla, etc.)
Post-treatment healing may take up to 12 months. Successful completion of the root canal procedure does not prevent future decay or fracture or failure. Some cases may require retreatment, surgery, or extraction despite our greatest efforts to preserve your tooth.