For Root Canal Therapy

Patient Consent Information

The doctor has explained to me that the purpose of this procedure is to retain teeth that may otherwise have to be extracted. The doctor has explained to me the treatment and the anticipated results of the treatment. I understand that this is an elective procedure and that there are alternative treatments, and the doctor has explained the risks and benefits of the alternatives. I also understand that root canal therapy has a very high success rate, but the doctor has not guaranteed or warranted a perfect result. The doctor has explained to me that there are certain potential risks in the procedure. These include:

1. Inability to completely fill the root canal because the canal is calcified or has a unique curvature (this may require endodontic surgery or
extraction of the tooth)
2. Infection that may occur and may continue, requiring further endodontic surgery or extraction
3. Fracture or breakage of the root or crown portion during or after treatment
4. Inadvertent breakage of files or instruments within the root canal system that are unable to be retrieved
5. Perforation of the tooth or root of the tooth during treatment
6. Damage to existing fillings, crowns or porcelain veneers
7. As a result of the injection or use of anesthesia, at times there may be swelling, jaw muscle tenderness or even a resultant temporary or
permanent numbness of the tongue, lips, teeth, jaws and/or facial tissues

Unforeseen conditions may arise that require a procedure that is different than set forth above, a repeat treatment, or I might be referred to a specialist for further treatment. I authorize the doctor and any associates to perform such procedures when, in their professional judgment, the procedures are necessary, after discussing the option with me, and obtaining my verbal consent (except in emergent circumstances where consent might not be practical to obtain).

I understand that the medications, drugs, anesthetics and prescriptions taken for this procedure may cause drowsiness and lack of awareness and coordination. I further understand that drugs and anesthetics may cause unanticipated reactions, which might require medical treatment. I also understand that I should not consume alcohol or other drugs at the same time because they can increase these effects. I have been advised not to work and not to operate any vehicle or machinery until I have fully recovered from the effects of the medications.

Please do not hesitate to ask the doctor or the staff if you have any questions.

Post-Operative Instructions


After Treatment

Your endodontic (root canal) treatment is now complete. Taking an analgesic before the numbness wears off may help maintain an acceptable comfort level. Please wait to eat or drink on the affected side until after the numbness has worn away. Please do not chew or attempt to eat on the affected side while you are still numb.


Discomfort or soreness in the area is normal for a few days (or even weeks) and range from mild to severe. This occurs because of existing infection and inflammation of the gum and tooth ligaments as well as the manipulation of the tooth during treatment. The gums may be sore and the tooth is often tender to biting or chewing. Over the counter analgesics such as Ibuprofen, Advil, Aleve, Aspirin, Motrin, Excedrin, and Tylenol should relieve most of the discomfort. Rinsing with warm salt water (1 teaspoon of salt per glass of warm water) will help. Discomfort in the area in no way affects the successful outcome of treatment.

If antibiotics and/or pain medications were prescribed, please take them as directed. If you were given a prescription for pain, it is meant to help you with more serious discomfort only for a couple of days. In the unlikely event that swelling, fever, or severe pain should occur, please call the office promptly.

Temporary Filling

A temporary filling has been placed in the entry made into your tooth. It is normal for a thin layer of the temporary filling to be chewed away between appointments. An unusual taste can be expected. Should all of the temporary filling come out, please call our office. It’s important that your temporary filling stays intact until the placement of a permanent restoration.

Final Restorations


Endodontically treated teeth have been weakened by previous decay and fillings. It is necessary for these teeth to receive additional protection in the form of a cast restoration (onlay or crown). This will protect these teeth against future fracture and decay, and protect the root canal filling from possible contamination. Delay in obtaining a final restoration may result in fracture and/or possible loss of the tooth or require a retreatment or a root canal.