Informed Consent for Endodontic Treatment

Informed consent for Endodontic Treatment


Precautions
Precautions must be taken for Endodontic Treatment in certain circumstances. You MUST inform the dentist prior to treatment if you have any of the following medical conditions:
• heart condition;
• history of rheumatic heart disease;
• artificial heart valves;
• known allergies to antibiotics.

Potential Complications
As with all dental and medical procedures, Endodontic Treatment is not without risk. Some of the potential complications of this treatment include, but are not limited to:
• Post-operative discomfort – There may be a slight discomfort experienced after each stage of the Endodontic, and may last for several days. This usually subsides and can be alleviated with painkillers.
• Instrument separation in the canal – It may be possible for the instruments used to perform the Endodontic Treatment to separate in the tooth, particularly if the canals are very tight or blocked. The separated portion of the instrument may either be left in place and the remaining treatment completed as per normal; or it may be bypassed and the area around the instrument cleaned prior to completing the rest of the treatment; or it may be removed altogether.
• Perforations/ledging of the canal – It may be possible for the instruments to deviate from the path of the canal within the tooth, particularly if the canals are very curved. This can cause ledges in the middle of the canal that prevent access to the end of the canal, and in some cases, can even create extra openings in the side of root. If a ledge is created, this can often still be bypassed and the remaining treatment completed as per normal; if the ledge cannot be bypassed and the tooth is not symptomatic, the tooth may be filled up to the level of the ledge. If there is a perforation, an external approach may be required to repair the perforation.
• Re-infection – If the seal of the tooth is compromised, either by: not having a permanent restoration (in the form of a filling or crown on the tooth); or having the tooth fracture or split; re-infection of the tooth may occur. If there is enough tooth structure remaining, the Endodontic treatment may need to be redone to resolve the re-infection.
• Blocked Endodontics – Very deep decay can cause the canals of teeth to become closed and even blocked in some cases. This can make cleaning of the canals difficult, or even impossible.
• Incomplete healing – Even if the Endodontic Treatment is fully completed, the tooth may heal with a small scar around the base of the root, or in some circumstances, not even heal properly at all.
• Tooth and/or root fracture – Endodontic treatment requires removal of considerable portions of tooth and filling material, which may weaken the tooth and potentially cause the tooth to fracture. Any fillings within the tooth may also be weakened, and could potentially fracture or fall out.
After the completion of the Endodontic Treatment, a permanent restoration (in the form of a filling or crown) will be required to seal and protect the Endodontic Treated tooth. Failure to properly restore the tooth in a timely manner (generally within 30 days) significantly increases the possibility of re-infection of the tooth or tooth fracture.

Alternative Treatment Options
The following are other treatment options which might be possible:
• no treatment at all;
• waiting for more definitive development of symptoms;
• extraction of tooth and then replaced with nothing, a denture, a bridge or an implant.

Cost
The cost of endodontic treatment is as outlined in the attached treatment plan. Full payment of each stage of treatment is required on the day of the appointment.

Teeth requiring Endodontic Treatment

• I have read and understand the conditions and information in this Consent Form.
• I have discussed the information contained in the Consent Form concerning Endodontic Treatment with my dentist, and am satisfied with the answers that I have received.
• I have had explained to me the cost of the treatment and I accept responsibility for that cost.
• I understand the dentist has a special interest in endodontics, but is not a endodontist.
• I authorise my dentist to provide me with Endodontic Treatment.