After examination and/or x-rays, and other testing procedures, it has come to my attention that in the opinion of my dentist, my tooth will require/s root canal treatment.

The goal of root canal treatment is to save a tooth that might otherwise require extraction. Although root canal treatment has a very high success rate, as with all medical and dental procedures, it is a procedure whose results cannot be guaranteed. This procedure will not prevent future tooth decay, fracture, or gum disease, and occasionally a tooth that has had root canal treatment may require re-treatment, endodontic surgery, or tooth extraction.

Risks and Complication: Are unlikely but may occur. They might include, but are not limited to:
a) Instrument separation in the canal.
b) Perforations (extra openings) of the canal with instruments.
c) Blocked root canals that cannot be ideally completed.
d) Incomplete healing.
e) Post-operative infection requiring additional treatment or the use antibiotics.
f) Tooth and/or root fracture that may require extraction.
g) Fracture, chipping, or loosening of existing tooth or crown.
h) Post-treatment discomfort.
i) Temporary or permanent numbness.
j) Change in the bite or jaw joint difficulty (TMJ problems or TMD).
k) Medical problems may occur if I do not have the root canal completed.
l) Reactions to anesthetics, chemicals, or medications.

The following other treatment options might be possible:
a) No treatment at all.
b) Waiting for more definitive development of symptoms.
c) Extraction: To be replaced with either nothing, a denture, a bridge, or an implant

After the completion of the root canal procedure, the tooth may require further restorative treatment (i.e post, core build-up, crown). Failure to have the tooth properly restored in a timely manner significantly increases the possibility of failure of the root canal procedure or tooth fracture. The reasons for needing root canal treatment have been explained to my satisfaction, and I understand that in spite of my dentist's efforts, this tooth may still require further root canal surgery, re-treatment, or perhaps extraction at a future date. My dentist has given me the option of seeking treatment from an endodontist (root canal specialist), which I have refused. However, I understand that in the event of complications within my tooth structure, a referral to an endodontist may be necessary.

I have had the opportunity to ask questions and am satisfied with the answers I have received. Having read and considered all the above, I hereby give my informed consent for root canal treatment.