ROOT CANAL TREATMENT, INFORMED CONSENT - PDF Document

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  1. ROOT CANAL TREATMENT, INFORMED CONSENT While serious complications associated with root canal therapy are very rare, we would like to inform you about the various procedures involved in endodontic therapy and have your consent before starting treatment. Endodontic (root canal) therapy is usually performed because the pulp (nerve) tissue of a tooth is unhealthy. The following discusses benefits and risks involved in endodontic treatment. Risks associated with dental treatment in general include (but are not limited to) complications resulting from the use of dental instruments, drugs, sedation, medicines, analgesics (pain killers), 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 is transient but, on infrequent occasions, may be permanent; reaction to injections; changes in occlusion (biting); jaw muscle cramps and spasms; temporomandibular (jaw) joint difficulty; loosening of teeth; pain referred to ear, neck, and head; nausea; vomiting; allergic reactions; delayed healing; sinus perforations; and treatment failure. Risks more specific to root canal treatment include the possibility of a small piece of an instrument broken within a root canal; perforations (extra opening) of the crown or root of the tooth; damage to existing bridges, 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 by a specialist. These complications may include blocked canals due to fillings, prior treatment or natural calcifications; broken instruments; severely curved roots; periodontal disease (gum disease); and splits or fractures of the teeth or roots. A pulpal debridement fee will be charged if root canal treatment is started, but unable to be completed. ************************* A little “history:” Dentists were taught in dental school that root canal treatment has, on average, a very high success rate. This implied that success meant for the remainder of the patient’s life. It was assumed that, because the bone appeared to heal when viewed on an x-ray some time after the root canal treatment was done, and the patient had no symptoms, that the bacteria in the bone (due to the infected nerve tissue of the tooth) had died, thus allowing the bone to heal. Because of recent research regarding the bone surrounding previously-infected teeth, it has been realized that bacteria may remain in the bone for many years following root canal treatment. Please be aware, that due to this research, we have learned that we may expect to either sometimes need a secondary treatment of the root canal system or surgery, by an endodontist (root canal specialist), at any time in the future after root canal treatment has been first done. The risk of need for additional procedures applies to all treated teeth, but the more canals the tooth has (i.e., molars) and/or the larger the infection, the higher the risk of need for additional root canal procedures in the future. Patient’s intials: __________________

  2. Medications: Prescribed medications may cause drowsiness and lack of awareness and coordination (which may be influenced by the use of alcohol, tranquilizers, sedatives, or other drugs). It is not advisable to operate any vehicle or hazardous device until recovered from their effects. Birth control pills might not be as effective when taking antibiotics. Other Treatment Choices include: no treatment, tooth extraction, or less often, waiting for more definite development of symptoms. Risks involved in these choices might include pain, infection, swelling, loss of teeth, and infection of other areas. I, the undersigned, consent to the procedure(s) recommended. I also understand that, upon completion of root canal treatment, a permanent restoration (usually a buildup and crown) is required within a short amount of time (no more than 3 weeks is recommended, based on research) in order to prevent leakage of bacteria into the tooth, resulting in increased infection or fracture (and therefore loss) of the tooth. I understand that root canal treatment is an attempt to save a tooth that may otherwise require extraction. Although root canal therapy has a high degree of success, it cannot be guaranteed. _____________________________________________________ Patient’s Printed Name Date ____________________________________________ ____________________________ Patient / Parent or Guardian if Minor Witness Rev. 9/14/16 wmm __________________________________