The doctor has explained to me that the purpose of this procedure is to retain teeth that may otherwise have to be extracted. I understand that if nothing is done, any of the following could occur: abscess, pain, severe infection or extraction.The doctor has explained to me the treatment and the anticipated results of the treatment.

I understand that this is an elective procedure and that there is an alternative treatment; extraction, and the doctor has explained the risks and benefits of the alternatives. I also understand that root canal therapy has a very high success rate, but the doctor has not guaranteed or warranted a perfect result. The doctor has explained to me that there are
certain potential risks in the procedure. These include:

1. Inability to completely fill the root canal because the canal is calcified or has a unique curvature (this may require endodontic surgery or extraction of the tooth)

2. Infection that may occur and may continue, requiring further endodontic surgery or extraction

3. Fracture or breakage of the root or crown portion during or after treatment ( teeth in need of root canal treatment are in bad shape and there is always the possibility of existing fractures within the tooth which can not be detected on the x ray. These fractures will grow over time even after the completion root canal treatment and cause infection/pain/root canal failure. Fractured teeth have to be extracted and replaced with dental implants in majority of cases.)

4. Inadvertent breakage of files or instruments within the root canal system that are unable to be retrieved

5. Perforation of the tooth or root of the tooth during treatment

6. Damage to existing fillings, crowns or porcelain veneers

7. As a result of the injection or use of anesthesia, at times there may be swelling, jaw muscle tenderness or even a resultant temporary or permanent numbness of the tongue, lips, teeth, jaws and/or facial tissues

8. I understand the final restoration for this tooth should usually be completed right away or no later than in one month. The doctor recommends a crown be placed on the tooth for restoration, especially if the tooth is a posterior tooth. The treated tooth can become brittle after removing the vital blood supply (nerve therapy); the crown will help provide the support needed.

9. I understand that occasionally a tooth that has had root canal treatment may
require retreatment. In addition approximately 5-10 percent of teeth that have root canals may require additional procedure, root end surgery (apicoectomy) at a later time. Even after surgery, a small percentage of teeth (5 percent) require extraction.

Unforeseen conditions may arise that require a procedure that is different than set forth above, a repeat treatment, or I might be referred to a specialist for further treatment. I authorize the doctor and any associates to perform such procedures when, in their professional judgment, the procedures are necessary, after discussing the option with me, and obtaining my verbal consent (except in emergent circumstances where consent might not be practical to obtain).

I understand that the medications, drugs, anesthetics and prescriptions taken for this procedure may cause drowsiness and lack of awareness and coordination. I further understand that drugs and anesthetics may cause unanticipated reactions, which might require medical treatment. I also understand that I should not consume alcohol or other drugs at the same time because they can increase these effects. I have been advised not to work and not to operate any vehicle or machinery until I have fully recovered from the effects of the medications.