The purpose of this clinic is to provide quality care for patients. If your root canal treatment is too difficult, you may be referred to an Endodontist.
Root canal therapy is performed to save a tooth that might otherwise need to be extracted. Usually root canal therapy is successful, but it cannot be guaranteed. At times, a tooth which has had root canal therapy may need additional treatment, such as surgery or extraction. The fee quoted is for Endodontic therapy (root canal) and not for the restoration (crown fillings) or any possible future surgery.
I understand certain risks are associated with these treatments, as in all areas of dentistry. Complications may result from the use of dental instruments, drugs, and anesthetics. These may include, but are not limited to, swelling; sensitivity; bleeding; pain; infection; and numbness which usually lasts for a few hours but may be permanent; reaction to shots; changes in biting and the way the teeth fit together; muscle cramps; joint difficulties; loosening of teeth, damages to other teeth; pain to the ear, neck, and head; nausea; vomiting; other allergic reactions; delayed healing; sinus perforations and treatment failure. During instrumentation of the tooth, a procedural error may occur. Although this occurs rarely, such an occurrence could cause the failure of the root canal, loss of the tooth, or possibly the need for a new crown or restoration.
I understand that I may have to take certain medication (drugs) while this therapy is being performed which may result in allergic reactions, drowsiness, or lack of awareness and coordination. I understand that I am not to use alcohol, tranquilizers, or sedatives while on medication for my treatment unless otherwise instructed by my doctor. I understand that I am not to drive or operate a car or other machines while taking certain medication as indicated by my doctor.
I understand that other treatment choices include no treatment or extraction of my tooth. Risks of these choices include, but are not limited to pain, infection, swelling, loss of teeth, and/or infection to other areas of the body. (Same as those listed previously).
Temporary fillings are usually placed in the tooth after root canal treatment. I understand that upon completion of the root canal therapy at KING FAMILY DENTAL CARE, it is my responsibility to have a restoration (filling, crown, etc.) placed on the Endodontically treated tooth. Future decay or fracture is possible, therefore, regular cleanings and dental checkups are advised.
Any and all of my questions have been clearly answered. I also understand that any questions that I might have during the treatment will be answered when I ask them. I, the undersigned, being the patient (parent or guardian of a minor patient) consent to endodontic therapy on the involved tooth or teeth. I have read this form.