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    Informed Consent For Endodontic Procedures

    Uploaded by

    Eia Dela cruz
    This document outlines the consent for endodontic procedures. It recommends treatment to remove bacteria from the hollow space inside the tooth and seal it to prevent reinfection. It notes this has a high success rate but is not guaranteed and may require retreatment or extraction. It discusses alternative treatments and risks including instrument breakage, perforation, damage to crowns/restorations, cracking/fracturing, pain/swelling, numbness from anesthesia. The patient signs agreeing to the recommended treatment and risks.

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    Informed Consent For Endodontic Procedures

    Uploaded by

    Eia Dela cruz
    192 views2 pages
    This document outlines the consent for endodontic procedures. It recommends treatment to remove bacteria from the hollow space inside the tooth and seal it to prevent reinfection. It notes this has a high success rate but is not guaranteed and may require retreatment or extraction. It discusses alternative treatments and risks including instrument breakage, perforation, damage to crowns/restorations, cracking/fracturing, pain/swelling, numbness from anesthesia. The patient signs agreeing to the recommended treatment and risks.

    Original Title

    RCT CONSENT

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    This document outlines the consent for endodontic procedures. It recommends treatment to remove bacteria from the hollow space inside the tooth and seal it to prevent reinfection. It notes this has a high success rate but is not guaranteed and may require retreatment or extraction. It discusses alternative treatments and risks including instrument breakage, perforation, damage to crowns/restorations, cracking/fracturing, pain/swelling, numbness from anesthesia. The patient signs agreeing to the recommended treatment and risks.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    192 views2 pages

    Informed Consent For Endodontic Procedures

    Uploaded by

    Eia Dela cruz
    This document outlines the consent for endodontic procedures. It recommends treatment to remove bacteria from the hollow space inside the tooth and seal it to prevent reinfection. It notes this has a high success rate but is not guaranteed and may require retreatment or extraction. It discusses alternative treatments and risks including instrument breakage, perforation, damage to crowns/restorations, cracking/fracturing, pain/swelling, numbness from anesthesia. The patient signs agreeing to the recommended treatment and risks.

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    © All Rights Reserved
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    Consent for Endodontic Procedures

    Patient’s Name: _______________________________ Date of Birth:


    _______________

    I. Recommended Treatment

    I hereby give consent to perform Endodontic procedure(s) on me as follows:


    __________________________________________________________________________
    _and any such additional procedure(s) as may be considered necessary for my well- being
    based on findings made during the course of the recommended treatment. The nature and
    purpose have been explained to me and no guarantee has been made or implied as to result or
    cure. I have been given satisfactory answers to all of my questions and I wish to proceed
    with administration of local anesthesia during the performance of the recommended
    treatment.

    II. Discussion of Treatment

    The recommended treatment works by removing bacteria from the hollow space inside the
    tooth, and by sealing off the inside of the tooth to prevent re-infection. Although the
    recommended treatment has a very high success rate, it is a biological procedure and cannot
    be guaranteed. Occasionally, a tooth which has had root canal treatment may require
    retreatment, additional surgery, or extraction.

    III. Treatment Alternatives

    Alternative methods of treatment have been explained to me, such as extraction of the
    involved teeth, or postponement of root canal therapy.

    IV. Risks and Complications

    I understand that there are risks and complications associated with the administration of
    medications, including anesthesia, and performance of the Recommended Treatment.

    Informed Consent for Endodontic Procedures


    These potential risks and complications, include, but are not limited to, the following:

    1. Instrument breakage in the root canal.

    2. Inability to negotiate canals due to prior treatment or calcification.

    3. Perforation to the outside of the tooth.

    4. Irreparable damage to the existing crown or restoration.

    5. Cracking or fracturing of the root or crown of the tooth.

    6. Pain, infection and swelling.

    7. Difficulty opening and closing.

    8. Temporomandibular Dysfunction resulting in jaw pain.

    9. Nerve injury resulting in temporary or permanent numbness, itching, burning or


    tingling of the lip, chin, tongue or teeth.

    10.As a result of the injection or use of anesthesia, there may be swelling, jaw muscle
    tenderness or even resultant numbness of the tongue, lips, teeth, jaws and/or facial
    tissues, which is typically temporary, but in rare instances, may be permanent.

    Signature: Date:
    Patient/Parent/Guardian

    Relationship (if minor):

    Witness (signature):

    Informed Consent for Endodontic Procedures

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