Informed Consent — Root Canal Therapy

Informed Consent — Root Canal Therapy

I realize that there is no guarantee that root canal treatment will save my tooth and that there are potential risks and complications associated with this form of treatment.

I accept that it is not unusual post-operatively to have some pain or discomfort following root canal therapy. This pain or discomfort could last for several days to several weeks as tissues surrounding the infected tooth recover and heal from the procedure. Occasionally swelling and infection can occur (or re-occur) following root canal therapy. Should this occur I acknowledge the need to contact the office or on-call dentist immediately to assess and manage this swelling or infection.

I accept that there is a risk when root canal therapy is attempted that the instruments used to perform the procedure may separate in the tooth and that this could potentially lead to the root canal failing and the tooth in question needing to be extracted, the cost of which would be my responsibility.

I accept that there is a risk that during root canal treatment the root of the tooth being worked on may crack and should this occur the tooth in question will need to be extracted, the cost of which would be my responsibility.

I accept that there is a risk when root canal therapy is done through an existing ceramic (or ceramic fused to metal) crown/cap that the ceramic from the crown may fracture and that the tooth being worked on may require a new crown, the cost of which would be my responsibility.

I understand that I may need further treatment by a specialist if complications arise during or following treatment. The cost of this consult and treatment by a specialist is my responsibility.
Following a root canal, often the tooth being worked on will be structurally weakened and as such should be restored with a full coverage restoration (crown). The cost of this procedure is not included in the initial root canal fee.

I understand that dentistry is not an exact science and that there can be no guarantees of treatment outcomes. I further acknowledge that no guarantees or assurances have been made regarding the treatment that I have consented to. I have had an opportunity to read this form and ask questions and accept that my questions have been answered to my satisfaction.

Witness:
Date:
Signed: