Informed Consent

At Endodontics of Malden, we believe that an informed patient is our best patient.

After we inform you about what is involved with the procedure, we would like to have your consent before proceeding with the root canal treatment.

The informative process is comprised of three parts:

  1. We show you an informative, albeit humorous, video about root canal therapy, while you are seated in our reception area.
  2. We also ask you to read our Informed Consent Form which is detailed below.
  3. Last, and most important, we will diagnose the problem with your tooth and suggest appropriate treatment options.

  
Our Informed Consent Form

I understand that root canal therapy is the treatment performed to retain a tooth that might otherwise require extraction. During root canal therapy, certain procedural complications can occur, including but not limited to: separated instruments, blocked canals, root perforations and damage to restorations.

A patient may experience post-operative discomfort and/or swelling and may require medications for several days. Although root canal therapy has a high degree of success, it is still a biological procedure, and as such, cannot be guaranteed. Some teeth that have had root canal therapy may require re-treatment, surgery, or even extraction.

I also understand that only root canal therapy is to be performed in this office and I will need to return to my dentist for a post or core-build-up and a full crown. All teeth that have had a root canal treatment need to be protected by placement of a core and a full crown.

When you return to your dentist after the root canal therapy, he or she will remove the cotton that we place over the root canal filling and replace it with a solid core. This core-build-up needs to be done within 7 to 10 days after completion of the root canal, even if you have to wait to get the full crown.

Sometimes patients take a risk (of breaking the tooth or of coronal leakage that contaminates the root canal filling) by not placing the crown immediately because they choose to wait for financial or insurance reasons. Much as we urge you to place the crown immediately, if you have to wait, please do go back to your dentist and remove the cotton that we place over the root canal filling and build up the core. This reduces (but does not eliminate) the chances of breakage and coronal leakage.

I have read and understand the above paragraph that explains why I have to return to my dentist for a post or core-build-up and a full crown.
 
 
__________________________         ___________              ______________
Patient's Signature                     Tooth #                           Date
 
 
__________________________________________
 Treating Dentist: Dr. Fernandes / Dr. Sharma / Dr. Singh