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CONSENT FOR ENDODONTIC TREATMENT

Consent for Endodontic Treatment

NAME OF PATIENT

TOOTH #

Root Canal Therapy, Anesthetics and Medications: We would like to inform you of the various procedures involved in endodontic therapy and have your consent before starting treatment. Endodontic (root canal) therapy is performed in order to save the tooth which otherwise might need to be removed. This is accomplished by conservative root canal therapy. The following discusses the possible risks that may occur from endodontic treatment or other treatment.

 

Risk: Included (but not limited to) are complications resulting from the use of dental instruments, drugs, sedation, medicine analgesics (painkillers) anesthetics and injections. These complications include swelling; sensitivity; bleeding; pain; infection; numbness and tingling sensation in the lip, tongue, chin, gums, cheeks and teeth which transient but on rare occasions, may be permanent; temporomandibular (jaw) joint difficulty; loosening of teeth; referring pain to ear, neck and head; nausea; vomiting; allergic reactions; delayed healing; and treatment failure.

 

Risks more Specific to Endodontic Therapy:  The risk includes the possibility of broken instruments within the root canals; perforation (extra opening) of the crown or root of the tooth; damaged bridges, existing fillings, crowns, or porcelain veneers; loss of tooth structure in gaining access to canals and cracked teeth. During treatment, complications may be discovered which make treatment impossible or which may require dental surgery. These complications may include blocked canals due to fillings or prior treatment, natural calcifications, broken instruments, curved roots, periodontal disease (gum disease) splits or fracture of teeth.

 

A crown is highly recommended after you have endodontic treatment as the root canal leaves your tooth weak, brittle and prone to breakage.

 

Medications: Prescribed medications and drugs mays cause drowsiness and lack of awareness and co-ordination (which may be intensified using alcohol, tranquilizers, sedatives or other drugs).  It is not advisable to operate any vehicle or machinery until recovered from the effects of the medications and drugs.

 

Other treatment choices: these include no treatment, waiting for more definite symptoms or tooth extraction. Risks involved in these choices might include pain, infection, swelling, loss of teeth and infection to other areas.

 

Consent: I, the undersigned, being the patient or guardian, consent to the performing procedure decided upon necessary or advisable in the opinion of the doctor. I understand that root canal therapy has a very high degree of clinical success; it is a biological procedure and cannot be guaranteed. Occasionally a tooth which has had root canal therapy may be require treatment, surgery or even extraction.

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