Family Dentistry & Orthodontics endodontic treatment consent form

Download 5.78 Kb.
Date conversion05.01.2017
Size5.78 Kb.
Andrew Dao, D.D.S.

Family Dentistry & Orthodontics


The doctor has recommended that one or more of your teeth needs endodontic therapy (root canal treatment). Endodontic therapy is the treatment of the canal or pulp chamber that lies in the middle of the tooth and its root. When completed, root canaled teeth generally act and feel just like your other teeth and have an excellent chance of remaining in your mouth for as long as your other teeth.

Root canal therapy is accomplished by using local anesthetic. Access is gained to the pulp chamber in the middle of your tooth by drilling a small hole through the tooth or crown. Small instruments are then used to remove the blood and nerve supply inside the tooth. Delicate files are then used to smooth and shape the canals to make sure no tissue remains which could later become infected. The canals will be sterilized with medications and the canals completely filled with an inert material to prevent bacteria and fluids from getting inside the tooth. This therapy is very safe and effective, nonetheless, there are risks and consequences of having a root canal.
Your treatment may take several visits over a few weeks to complete. During that time you may experience some soreness and discomfort in and around the tooth being treated. These problems will go away, however, in rare cases the discomfort may linger for a few days.
Despite the very high success rate this procedure enjoys there is a small chance (less than 5%) that the root canal treatment may not be successful. In such instances other procedures such as retreatment, root tip surgery, or extraction may be necessary.
Once a tooth has been root canaled it tends to be more brittle than a live tooth. For this reason, the doctor will recommend that you have a crown or cap placed on the tooth for its protection. Without this protection, there is significant chance of the tooth fracturing which may require its extraction.
On rare occasions, your canal(s) may be extremely curved, hooked, or clogged that one of the delicate instruments used to remove the internal nerve and blood supply may separate inside these irregular canals. The doctor will try to remove the broken piece of instrument if at all possible, but may elect to leave it in and fill the canals. Calcified (clogged) canals may not allow full penetration of the instruments which may lead to a shortened fill. If an adequate seal has been made the treatment will likely be a success. If, however, this is not an option or if it has been attempted without success you may require an apicoectomy (root tip amputation) or other treatment.

Signature: ___________________________ Date: _____________________

The database is protected by copyright © 2016
send message

    Main page