Dental Education Lecture: Consent for Root Canal Treatment

DENTIST: Xin Wei,DDS,PhD,MS          PATIENT:                                                               

Diagnosis: 1. Pulpitis (nerve infection)           2. Apical infection (root tip infection)   3. Recurrent pulpal infection (nerve re-infection)

About the Proposed Treatment

Root canal treatment, also called endodontic treatment, involves relieving pain and discomfort by removing the nerve tissue (called pulp) located in the center of the tooth and its root or roots (called the root canal). The treatment involves drilling through the biting surface of the tooth and exposing the pulp, which is removed with very fine metal files. Medications may be used to sterilize the interior of the tooth to prevent further infection.

Each empty root canal is filled with a rubber-like material and medicated cement. Occasionally a metal pin (called a post) is also inserted into the canal to help restore the tooth. The opening in the tooth is closed with a temporary filling. At a later appointment, a cap (also called a crown) may be placed.

Twisted, curved or blocked root canals may prevent removal of all inflamed or infected pulp.  Since leaving any pulp in the root canal may cause your symptoms to continue or worsen, this might require an additional procedure called an apicoectomy. Through a small opening cut in the gums and surrounding bone, any remaining pulp is removed and the root canal is sealed.  Sometimes the tooth with failed root canal treatment may need to be extracted. Success rate for root canal treatment is 90-95%.  If your case turns out to be difficult, you may be referred to a specialist (endodontist) for consultation and/or treatment.

Once the root canal treatment is completed, it is essential to return promptly to have treatment completed. Because a temporary seal is designed to last only a short time, failing to return as directed to have the tooth sealed permanently with a crown could lead to the deterioration of the seal, resulting in decay, infection, gum disease, tooth fracture, and the possible premature loss of the tooth.

Benefits and Alternatives

Root canal treatment is intended to allow you to keep your tooth for a longer period of time, which will help to maintain your natural bite and the healthy functioning of your jaws. Extracting your tooth is the most common alternative to root canal treatment. This alternative may require replacing the extracted tooth with a removable partial denture, a fixed bridge or an artificial tooth called an implant.

Common Risks

1. Bleeding, pain, soreness, and infection: During and after treatment, you may experience bleeding, pain, swelling or discomfort for several days, which may be treated with pain medication. You may also experience an infection, which would be treated with antibiotics.  The antibiotics can interfere with effectiveness of oral contraceptives.  Use other contraceptive measures if applicable.

2. Reaction to anesthesia and/ or sedation: To keep you comfortable during treatment you will receive a local anesthetic and possibly a sedative (tranquilizer). In rare instances patients have an allergic reaction to the anesthetic, which may require emergency medical attention.  The anesthetic may reduce your ability to control swallowing, which increases the chance of swallowing foreign objects during treatment. Sedatives may temporarily make you drowsy or reduce your coordination.

3. Stiff or sore jaw joint: Holding your mouth open during treatment may temporarily leave your jaw feeling stiff and sore and may make it difficult for you to open your mouth wide for several days or longer afterwards, in spite of the fact that you do not have obvious discomfort beforehand. Heat pack on your sore area may help.  In severe situation, you need to see a TMJ specialist.  Treatment also may leave the corners of your mouth red or cracked for several days.

4. Broken instruments: Occasionally a root canal instrument will break off in a root canal that is twisted, curved or blocked with calcium deposits. Depending on its location, the fragment can be retrieved or it may be necessary to seal it in the root canal (these instruments are made of sterile, non-toxic surgical stainless steel, so this causes no harm). It may also be necessary to perform an apicoectomy to seal the root canal.

5. Overfill: As a result of filling the root canal, the incomplete formation of your tooth or an abscess at the end of the tooth (called an apex), an opening may exist between the root canal and the bone or tissue surrounding the tooth. This opening can allow filling materials to be forced out of the root canal into the surrounding bone and tissue. An apicoectomy may be necessary for retrieving the filling material and sealing the root canal.

6. Need for further treatment: Teeth that receive root canal treatment may be more prone to cracking and breaking over years, which may ultimately require a bridge, implant, or partial denture. In some cases, root canal treatment may not relieve all symptoms. If you suffer from gum disease (also called periodontal disease), this can increase the chance of losing a tooth even though root canal treatment was successful.

Consequences of not performing treatment

This course of treatment will help to relieve your symptoms. If you do not have root canal treatment, your discomfort could continue and you could face the risk of a serious, potentially life-threatening infection, abscesses in the tissue and bone surrounding your teeth and eventually, the loss of the tooth.

Tooth/teeth to have root canal treatment: #               

Additional information:                                                                                                                                                

Every reasonable effort will be made to ensure that your condition is treated properly, although it is not possible to guarantee perfect results. You understand that the tooth may be lost in spite of all efforts to save it.  By signing below, you acknowledge that you have received adequate information about the proposed treatment, that you understand this information and that all of your questions have been answered fully. You have also received postoperative instruction (oral and written).

1.          I give my consent for the proposed treatment as described above

2.          I refuse to give my consent for the proposed treatment as described above. I have been informed of the potential consequences of my decision to refuse treatment

Patient Signature                                                                                 Date                     /       /201       

                           

Dentist Signature                                                                                 Date                   /       /201              

                                                             

Witness Signature                                                                                 Date                   /       /201        

Xin Wei, DDS, PhD, MS 1st edition 05/30/2010, last revision 05/30/2010