Endodontic Therapy Consent and Information

Endodontic therapy (root canal) is the cleaning and removal of the nerve, blood vessels, and bacteria in the center of a tooth. Front teeth can have one or two canals and back teeth three or four canals. The cost of the treatment is dependant upon the number of nerves in a tooth and the difficulty of the case. The greater the number of nerves or more complex, the higher the cost will be. Root canal therapy is an attempt to retain a tooth that may otherwise require extraction. Although the success rate of root canal therapy is quite high, there is always a chance of failure, as such success can not be guaranteed. Occasionally a tooth that has had a root canal may require further treatment not included in the original fee such as re-treatment, surgery, or even extraction.

RISKS: Instruments broken within the root canals; perforations (extra openings) of the crown or root of the tooth; damage to fillings, crowns, veneers, bridges; cracked teeth; loss of tooth structure gaining access to canals.

During treatment, complications may be discovered which make treatment impossible. These complications may include curved roots, blocked or calcified canals, fractures of the tooth or roots, prior treatment, broken instruments, limited access due to small mouth opening. If any of these occur, the treatment will be terminated. The fee will be adjusted (usually 50% of the original estimate After treatment, risks may include: pain, swelling, infection, bruising, cramping of jaw muscles, extended freezing.

Other Treatment Choices: No treatment, having the tooth removed, or surgical endodontic treatment. Risks involved with these procedures include pain, swelling, infection, cyst formation, bad bite, chronic pain, spread of infection to other areas, loss of tooth, premature loss of adjacent teeth.

Fees are for services rendered. A successful outcome is desirable, but can not be guaranteed. Following the completion of the root canal, a permanent filling and/or crown will be required within two weeks at an additional fee. During this time, there is a high risk of the tooth fracturing, until the tooth is reinforced with a crown.

I, the undersigned, have read this form and have had the procedure, risks, alternatives, and fees explained to my satisfaction by the doctor and/or staff and consent to the treatment and risks. I have also received a copy of this consent form for my own records.

Post-Operative Instructions

It is normal to experience some discomfort for several days after a root canal appointment, especially when chewing. To control discomfort, take pain medication as directed by the dentist. If antibiotics are prescribed, continue to take them as prescribed, even if all symptoms and signs of infection are gone.

A temporary filling has been placed to protect the tooth between appointments and to allow for the tooth to heal before placing a permanent filling in its place. It is common

(and not a problem) for a small portion of your temporary filling to wear away or break off. The temporaries can last as long as a month in your mouth. Avoid eating hard or sticky foods (especially gum), and if possible, chew only on the opposite side of your mouth. It is important to continue to brush and floss normally.

It is vital that you have a permanent filling and crown to protect the tooth from fracturing as soon as possible. The tooth is currently very fragile and brittle after root

canal therapy. If you bite down on the tooth hard, you can easily fracture it.

When anesthetic has been used, your lips, teeth and tongue may be numb for several hours after the appointment. To avoid tissue damage, please refrain from chewing until the numbness has completely worn off. If you are unable to wait for this, we recommend softer foods that can be easily swallowed.