Informed Consent (for Root Canal Therapy)

Endodontic (Root Canal) Therapy Procedures

Root canal treatment involves making an access opening through the biting surface of the tooth to allow removal of the soft tissue (pulp) located in the small canals in each root. If any unexpected difficulties occur during treatment, you may be referred to an endodontist, who is a specialist in root canal treatment.

Benefits: Root canal treatment is intended to allow you to keep your tooth for a longer time, which will help to maintain your natural bite and the healthy functioning of your jaws.

Risks: Bleeding, pain, swelling, infection, or discomfort after completion may require further treatment or medication. You will receive a local anesthetic and/or other medications that carry risks, side effects, and drug interactions.

Holding your mouth open during treatment may temporarily leave your jaw feeling stiff and sore and may make it difficult for you to open wide for several days.

Curved, hidden, or blocked canals may prevent removal of all pulp tissue and may require additional treatment.

A root canal instrument may break off in a root canal. The fragment may be retrieved or it may be sealed in the root canal. This usually causes no harm. Material may extrude out the root canal into the surrounding bone and tissue, which may necessitate further treatment.

The opening in the tooth will be closed with a temporary filling. At a later appointment, a crown or other definitive restoration may be placed. It   is a separate dental procedure not included in this discussion. Failing to return as directed to have the tooth sealed permanently with a crown or filling can lead to decay, infection, gum disease, fracture, or premature loss of the tooth.

Root canal treatment may not relieve your symptoms, and your tooth may need to be extracted.

Consequences If No Treatment: If you do not have root canal treatment, you may be exposed to increased risk of pain, swelling, infection, tooth loss, and medical risk.

Alternative Treatments: Depending on your tooth, alternatives to root canal treatment may exist. Extracting your tooth is the most common alternative to root canal treatment. It may require replacing the extracted tooth with a prosthetic.


Every reasonable effort will be made to ensure that your root canal treatment is completed properly, although it is not possible to guarantee perfect results. By signing below, you acknowledge that you have received adequate information about the proposed endodontic procedures, that you understand this information, and that all of your questions have been answered fully. You also give permission for information gained from your examination to be used in clinical and economic research, practice marketing, and patient education activities and materials, provided that your identity is not reasonably discernible.