Tooth/teeth number(s) :

The goal of root canal treatment is to save a tooth that might otherwise require extraction. Although root canal treatment has a very high success rate, as with all the medical and dental procedures, It is a procedure whose results cannot be guaranteed. Root canal treatment is performed to correct an apparent problem. This procedure will not prevent future tooth decay, tooth fracture, or gum disease. Occasionally, a tooth that has had a root canal treatment may require treatment, endodontic surgery, or tooth extraction.

I understand that non treatment may result in, but it's not limited to:

Increased risk of complications if delayed
infection and/ or abscess
Pain and/ or swelling
Need for immediate emergency treatment if symptoms worsen

I understand that there are risks associated with any dental, surgical, and anesthetic procedure. These risks include, but are not limited to:

instrument separation in the canal
perforations (extra openings) of the canal with instruments
Blocked root canals that cannot be ideally completed
incomplete healing
Post-operative infection requiring additional treatment or the use of antibiotics
Tooth and/ or root fracture that may require extraction
Fracture, chipping, or loosening of existing tooth or crown
Post-treatment discomfort
Temporary or permanent numbness
Change in the bite or Jaw joint difficulty
Medical problems may occur, If I do not have the root canal completed
Reactions to anesthetics, chemicals or medication

By signing, I understand the recommended treatment, the fee involved, and the risks of such treatment, any alternatives and risks of the alternatives. I understand the information discussed and have had the opportunity to ask any questions.

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Informed Consent for Endodontic Treatment