Root Canal Consent

I have been informed of the reasoning for root canal, the root canal procedure, risks, treatment alternatives and the maintenance of these teeth.

Root Canal Procedure

The aim of root canal (endodontic treatment) is to maintain teeth that have been badly damaged due to decay, disease, injury, or trauma. This causes either infection or inflammation of the pulp and symptoms may include pain, sensitivity to hot and cold, soreness, swellings, or discoloured teeth. Having your own teeth is usually stronger and more efficient in biting and chewing and easier to clean and maintain than artificial teeth.

Root canal treatment can involve one to three appointments depending on the severity of the infection and difficulty of the root canal and it is important to attend all the appointments to complete the root canal. The initial preparation and shaping of the root canal involves opening the tooth to access the inner nerve and pupal tissues and cleaning them using fine file instruments. Different teeth have different numbers of root canals and during root canal treatment; each root canal is cleaned, enlarged, and shaped in the initial appointments.

An anti-inflammatory and an anti-bacterial medication may be put inside the root canal to help stop the inflammation and infection. This dressing may be left for 3-4 weeks depending on the severity of the infection and is sealed with a temporary filling.

Pain or discomfort usually last within the first couple of days and will not be experienced by every patient. It is recommended to take some paracetamol, ibuprofen or other pain-relief medications as indicated by the dentist to help with the discomfort following root canal therapy.

Once the tooth has settled, the root canals are filled, and the pulpal chamber is sealed in order to protect the inside of the tooth. The jawbone surrounding the root canal may take some time to heal completely and follow-up visits may be needed to see whether healing has been satisfactory. Root canal treated teeth have an increased risk of fracture without protection of an artificial crown made of ceramics, metal, or gold. For most teeth, it is highly recommended to have a crown fitted in order to improve the long-term success of root canal treatment.

Root canal treatment is successful in most cases, if you take good care of the treated tooth and attend regular appointments, it may last for many years and possibly the rest of your life.

To improve the chance of success, root canal treatment is best to start earlier rather than later. If the pulp of the tooth is not treated, severe pain, swelling and abscesses can occur. If the infection is left, this can damage the surrounding bone around the root of the tooth which, may result in early loss of the tooth.

In some cases, root canal treatment may not be appropriate, and extraction may be the best, or only, option. This results in a gap in that area and problems with biting, chewing and oral health are associated with losing a tooth. For example, nearby teeth can move out of their normal positions and tilt into the space of the missing tooth. This can make chewing and biting difficult and can lead to further decay and gum disease around tilted teeth. The options to replace the missing teeth will be given in the likelihood the tooth has to be removed.

Risks

As with every dental procedure, root canal treatment may not be successful in every case as each individual and their conditions are unique and long-term success may not occur. All of which, we will discuss with you.

Complications that may result from root canal therapy include but are not limited to: (the ones which are marked are applicable to your treatment).

• Tenderness and discomfort
• Transient or on rare occasion permanent numbness of the lip, tongue, chin, or gum
• Jaw joint tenderness or restricted ability to open for a few days/weeks
• Tooth sensitivity/injury/fracture or gum sensitivity/tenderness
• Loss of the tooth/weakened tooth
• Difficulty to access the root canals or locate them
• Fracture instruments perforation delayed healing
• Accidental swallowing of foreign matter
• May need retreatment/ removal of the root end
• Specialist referral

Procedural Risks

Adverse reactions to the anaesthetic, drugs, medications:

On some rare occasions, patients may have an adverse reaction to the anaesthetic or medications that are used or prescribed. These reactions usually take place within the first two hours and can include pallor, palpitations, diaphoresis, dizziness, nausea, and a more serious anaphylactic reaction can occur. It is important to disclose all medical history including list of allergies, medications, natural remedies, herbal, or any non-prescription medications to avoid and prevent these adverse outcomes and appropriately manage the procedure.

Accidental Swallowing of foreign matter:

Root canal treatment requires fine and small componentry and is all performed carefully under appropriate clinical isolation. As mentioned, the upmost care will be taken to prevent complications such as this however, there is always a risk that the fine componentry can be accidently swallowed during the procedure. If this occurs, there is a requirement to have appropriate x-rays and surgical treatment to have it removed.

Root/Crown Fracture:

During root canal therapy there is a risk that the root or that the tooth may fracture, this can be attributed to previous cracks within the tooth or during the process of cleaning the infection. There is no complete accurate way of determining how extensive or how severe a crack is until the tooth has been checked or fillings removed. On some occasions, if the crack or damage to the tooth is too extensive, the tooth is not advantageous to keep and hence the tooth will need to be removed.

Instrument Perforation:

During the process of root canal treatment, there lies the possibility of the fine instruments to perforate the side of the tooth. This tends to occur in more complex cases including calcified canals, thin canals, abnormal tooth root morphology, obstructions and/or previous root canal entry paths. Minor perforations often do not cause a problem and require a dressing to be placed to let the area heal before continuing.

Extensive perforations, depending on the area the instruments perforate may result in removal of the tooth or to be seen by a specialist to seal the tooth under surgical conditions.

Post Procedural Risks

Post-Surgical Care (bleeding, swellings, pain, bruising, joint pain, prolonged numbness):

After root canal treatment, patients may feel quite sore and tender over the next couple of days and may notice minor bruising and swelling. The swelling, tenderness, pain, bruising, and prolonged numbness from the anaesthetic should settle over the next couple of days and weeks but the exact duration of these complications may not be determinable. There is a slight chance they may become permanent and irreversible. It is important to attend follow-up appointments to provide and manage the healing and to let the dentist know if the pain, tenderness, or prolonged numbness is still present or has increased over time.

Delayed Healing:

The ability to heal after treatment varies between individuals so do not be alarmed if the area is healing quickly or slower than expected. During the follow-up visits, the healing of the root canal will be assessed and managed appropriately if the healing process is not going as expected.

Fracture of the Tooth:

After root canal therapy, the tooth is significantly weakened due to previous cracks, infections, decay and shaping and cleaning out the infected pulpal tissues within the root canal. There lies a potential for the tooth to fracture overtime, especially if a final filling or crown has not been placed on a root treated tooth.

Re-Infection of the Root Canal:

Re-infection of the root canal can occur overtime if you do not have an adequate filling or crown to protect after root canal treatment. It can also occur due to decay, cracks, failing root canal seal, resistant bacteria/infection in the tooth and lack of maintenance. If re-infection of the root canal occurs, it is often difficult to diagnose, and the tooth is usually symptomless. It is important to attend follow up appointments to assess the healing of the root canal.

Wear of the Ceramics:

If a crown has been proposed to be placed it is important to be aware that overtime, the ceramic may become worn, chipped, fracture or break from functional forces of eating, grinding, and clenching. If the fracture is small then it may be repairable, but on most occasions, this will need to be replaced and a new ceramic crown/bridge will be constructed.

Loss of the Tooth:

Endodontically treated teeth are often weaker than a natural healthy tooth and most will require a crown to maintain it for long term. The same risk factors resulting in loss of teeth are the same factors that can cause loss of teeth that are treated with root canal. This can include periodontal issues, cracks, decay, or trauma.

Maintenance

To improve the chances of success, there is a requirement to attend follow-up appointments so that healing can be monitored and assessed. Following treatment, there is need for ongoing and lifelong maintenance daily at home and with regular check-ups every 3-6 months which is not included in the costs of the root canal treatment. This ensures the optimum care for teeth, implants, prosthesis, and gums.

In essence, for long term success of your root canal treatment you have the following responsibilities:

1. Follow all instructions from your dentist
2. Clean all teeth carefully and thoroughly, as instructed
3. Appear for periodic examinations and cleans every 3-6months as advised by your dentist. There is an additional fee for these services.
4. Exercise care in not abusing the prosthesis and advice your dentist immediately if any problems are noticed.

If you fail to maintain the work that has been done and do not attend regular appointments, complications can arise and become untreatable, difficult, and costly to manage. You will be liable to incur the total costs for treatment to correct implications or failures if you do no attend follow up appointments and maintain regular appointments.

Acknowledgement and Consent

1. I certify that I have been fully informed by my dentist and have carefully read all the information provided on this form and the proposed treatment and the alternatives have been explained to me by the dentist to my satisfaction. I understand the purpose and nature of root canal therapy treatment. I understand what is necessary to accomplish the procedure. I understand the implications and consent to the proposed treatment. I agree to the fees and accept the general and special conditions.
2. The dentist has carefully examined my mouth. Alternatives to this treatment have been explained. I have tried or considered these methods, but I desire to complete root canal treatment to maintain the tooth.
3. I have further been informed of the possible risks and complications involved. I understand that such complications include pain, swelling, infection, discolouration, and acute or chronic pain or dysfunction associated with my jaw joint/s or muscles. Numbness of the lip, tongue, chin, cheek, or teeth may occur. The exact duration of these complications may not be determinable, and I am aware that there is a slight chance they may become permanent or irreversible. Also, possible inflammation of the vein, injury to existing or surrounding teeth, bone fractures, sinus penetration, delayed healing, allergic reactions to drugs or medications used.
4. I understand that if I do not proceed with the proposed treatment, any of the following could occur: bone disease, loss of bone, gum tissue inflammation, infection, sensitivity, abscesses, pain, looseness of teeth, and necessity of extraction. Also possible is temporomandibular joint (jaw) problems, headaches, referred pains in the back of the neck and facial muscles, and tired muscles when chewing.
5. The dentist has explained that there is no method to accurately predict the healing of a root canal in each individual.
6. It has been explained that in some instances root canal treatment can fail. If this occurs, first line is to re-treat the root canal and/or removal of the root tip under surgical procedures with a possible specialist referral followed by extraction if treatment fails. Alternatively, the option still exists to have the tooth removed at an earlier stage. I have been informed and understand that the practice of dentistry is not an exact science; no guarantees or assurance as to the outcome of results of treatment or surgery can be made.
7. I agree to follow the home care instructions. I agree to report to the dentist for regular examinations and cleans as instructed.
8. I agree to the type of anaesthesia, depending on the choice of the dentist and follow the instructions that are given to me by the dentist.
9. To my knowledge I have given an accurate report of my physical, mental health and medical history. I have also reported any prior allergic or unusual reactions to drugs, food, insect bites, anaesthetics, pollens, dust, blood, body disease, gum or skin reactions, abnormal bleeding or any other conditions related to my health.
10. I consent to photography, filming, recording and x-rays of the procedure to be performed for the advancement of dentistry, provided my identity is not revealed.
11. I request and authorise medical/dental services for me. I fully understand that during and following the contemplated procedure, surgery, treatment, conditions may become apparent which warrant, in the judgement of the dentist, additional or alternative treatment pertinent to the success of comprehensive treatment. I also approve any modifications in design, material, or care, if it is felt this is in my best interest. I understand that regardless of what had been explained to me or my expectations, results and experiences may vary from patient to patient.

No Warranty or Guarantee?

I hereby acknowledge that that no guarantee, warranty, or assurance has been given to me. That the proposed treatment will be completely successful to my complete satisfaction or appearance. Each individual and their conditions are unique, thereby it is anticipated that the long-term success cannot be promised.

Disclaimer: The practice of dentistry is not an exact science and therefore, reputable practitioners cannot guarantee results. Please understand that no one can promise that any treatment or dental procedure will be successful of that any risk, complication or injury will occur.