Root Canal Treatment Consent

Root Canal Treatment Consent

Background Information for Patients Considering
Root Canal Treatment:

Before treatment is commenced I would like you to read the following important information. If after reading this information you have any questions in relation to any aspect of your treatment please ask.

What is Root Canal Treatment?
When a tooth has been subjected to extensive dental decay, trauma or disease the nerve or pulp in the tooth may become irreversibly inflamed/infected and die. In such cases root canal treatment is indicated to save the tooth.
The pulp lies within the crown of the tooth and travels down the root of each tooth in a fine canal (hence the term root canal). Molar teeth usually have 3-4 root canals, premolar teeth 1-2 root canals and front teeth usually only have 1 root canal.

Root canal treatment involves the removal of the infected pulp form the tooth, disinfection of the root canal(s) and then filling of the root canal(s). This is usually completed in 2-3 visits. Please note that an additional appointment and cost is required to restore the tooth.
At the initial visit an x-ray will be taken to determine the number and shape of the root/root canal(s) the tooth to be treated has. After numbing the tooth the infected pulp tissue is then removed fromm each of the canal(s) with a series of specialised files. The root canals are then cleaned and shaped further and cleaned out with a special antiseptic rinse. Finally an accurate measurement of each canal is made and another x-ray is taken to confirm this measurement. A special dressing is then placed and sealed in the tooth. Normally the tooth is then left for two to three weeks before the next visit.


Dependant on your individual response to treatment and the tooth being treated. You may require an additional visit for irrigation and short-term dressing where evidence of infection or infection persists following the previous appointment.


At the second or third appointment the dressing is removed from the tooth and again the canals are cleaned with a special antiseptic rinse. The tooth is then thoroughly dried and the root filling material can be placed into each root canal. A final x-ray is then taken to ensure that each canal is filled completely.

Sometimes it is necessary to re-dress the tooth at the second or third appointment and even prescribe antibiotics if there are still signs of infection present. In these cases the tooth is left for another couple of weeks before placing the root filling.

The cost of root canal treatment depends on the number of root canals that a tooth has and the number of appointments necessary to definitively treat the cause of the tooth infection. The quote presented may or may not include the crown which needs to placed on the tooth after the root canal has been completed . 

What are the alternatives to Root Canal Treatment?
Extraction is the only alternative for a tooth with an infected, dead or dying pulp. Although removal of the tooth is quicker and less costly than saving the tooth with root canal treatment it is important that you are aware that removing the tooth may result in some of the following problems
• May cause cosmetic concerns.
• May cause chewing/biting difficulties.
• Tooth movement may occur with nearby teeth drifting into the space that is left. This can potentially make other teeth more prone to dental decay and gum disease, as maligned teeth are more difficult to clean. This tooth movement may also cause interferences to your normal bite, which can result in jaw problems.
• The above problems are not a complete list of complications and should you wish to have the tooth/teeth extracted a separate consultation and/or treatment plan/estimate may need to be formulated.

It is true that extracted teeth can be replaced by various artificial means such as dentures, bridge and implants. Some important points to be aware of in relation to artificial replacements are that:
• The cost of replacing a tooth is usually always more than that of saving it with root canal therapy in the first place.
• However good the replacement is it will always only be a substitute for your own tooth and hence may have limited function and appearance.

Possible Problem's/Complications with Root Canal Therapy:
Like all dental treatment and biological tissue no guarantee's can be given in relation to the long-term success of treatment. Unforeseen circumstances may arise during treatment that may compromise successful root canal treatment. It is important to note that root canal therapy will not be suggested
if it is unlikely to succeed.

Important points to be aware of are:
• It is important to note that some discomfort following each stage of root canal treatment may be experienced for 2 to 3 days. This is considered to be normal and is usually resolved with over the
counter pain medications. If you experience more severe pain you should contact us immediately.
• After a tooth has had root canal therapy all teeth are weakened after root canal therapy and may need restoration with a crown to strengthen the tooth.
• Root fillings can and do sometimes fail, with re-infection of the root canal occurring. This can usually be treated by re-doing the root canal treatment, this may need to be done by a specialist referral, to an endodontist (a dentist who is specialised in root canal treatment), or by endodontic surgery.
• After treatment the tooth may become discoloured, this can treated with a bleaching treatment or masked with crowning/veneering the tooth.
• Although unlikely, it is possible for the very fine files and rotary instruments used to clean the root canals may fracture during treatment. If any unforeseen difficulties/complications such as this arise during treatment it may be necessary to refer you to an endodontist to complete the treatment.

Health Funds:
Any quotation includes the Australian Dental Associations scheduled item numbers and tooth identification if applicable. These numbers are recognised by the health funds. I answer to you for the services that I provide and the fees that I charge. That is your right and my responsibility. Your insurer answers to you for the rebates they give. That is your right and their responsibility. It is neither my responsibility nor my right to be involved in that relationship.

Finally if you should have any further queries please do not hesitate to ask.


Consent for Treatment:
Root Canal Treatment

This is my consent to provide the dental treatment as indicated in this form:

  • I have read any provided ADA handout for this course of treatment.
  • I have received a written or verbal quotation and I am clear on the costs involved in this course of treatment.
  • I have given the practice a full, complete and up to date medical and medications history.
  • I am aware that a specialist referral is available for this procedure
  • I fully understand the entire document and the what the treatment entails including advantages, disadvantages, limitations, risks.
  • The treating dental practitioner has explained the known possible complications of and alternative treatments.
  • The treating dental practitioner has answered all of my questions to my full satisfaction.
  • I understand that the results of the treatment can not be guaranteed.
  • I give my permission and consent for the root canal treatment to be performed.


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