Root Canal Treatment Consent Form

Please enable JavaScript in your browser to complete this form.

ROOT CANAL TREATMENT CONSENT FORM

Patient Name
Date Of Birth
Address

Purpose of Treatment :

The aim of root canal treatment (RCT) is to save a tooth that has been badly damaged due to decay, disease or injury. Most people prefer to save their tooth because it will generally function better than an artificial tooth. Problems with biting, chewing and oral health are associated with losing a tooth. Losing a tooth can also lead to problems with speaking and possibly a change in appearance. Root canal treatment may take between 1 and 4 visits to complete, depending on the difficulty of the tooth and how quickly infection is relieved. Success of RCT also relies upon a person’s immune system functioning well. Endodontic surgery may also be required when conventional RCT will not or has not completely eliminated infection. This involves a small exposure of the tip of the root of the tooth and both removal of residual infection around the tip and the sealing off directly of the root tip.

Root canal treated teeth typically require crowns later to provide additional strength. This is usually done 2-3 months after the root canal to allow for proper healing. The cost of the crown is separate and will be discussed at the time of the crown procedure.

Alternatives to RCT:

No treatment of the infected tooth may result in continued or worsening infection and/or pain which can lead to destruction of bone around the tooth or spreading of infection through the bone. The only alternative to RCT which relieves pain and/or infection is removal of the entire tooth (extraction). Antibiotics only help the body to control the size of infection but will not cure an infected tooth.

Risks:

As with all dental treatments, root canal treatment has some risks and possible complications. Such risks and complications include, but are not limited to:

• Difficulty locating and working in all suspected canals due to curves or calcifications. Sometimes there are extra canals which may be undetected.

• Incomplete filling of all canals.

• Perforation or penetration of the surrounding bone or tissue with RCT instruments. This usually reduces the long-term prognosis of the tooth.

• Separation of RCT instruments within the root canals during treatment may require referral to specialist (endodontist) for removal.

• Bad response of the patient’s body to some materials used during cleaning, disinfection and filling of roots.

• Reinfection of the canal system which will prolong treatment by requiring extra appointments.

• Fracture of the remaining tooth may occur before a final restoration can be placed. If the fracture is at root level, the tooth may need to be extracted.

Whilst root canal treatment can save most teeth, the dentist cannot guarantee that it will be successful in every case. If any of the above occur, treatment may continue with the knowledge that a lesser prognosis is expected, or the tooth may be removed right away or you may require referral to an endodontic specialist. A return of problems in the future may require re-treatment or endodontic surgery. Teeth that have received RCT are somewhat weakened because of the loss of tooth substance and therefore normally require a crown afterwards ; this needs to be factored into the overall treatment costs.

CONSENT

I understand and agree to the recommended treatment, the fees involved, the risks of treatment, any alternatives including the consequences of doing nothing. I have had all of my questions answered, and have not been offered any guarantees.

Print full name

Dr Amtul Saba
94 Moore St, Liverpool NSW 2170
Ph: 02 8124 8953
E: [email protected]
https://liverpooldentalcare.com.au/