Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Remineralisation of teeth wikipedia , lookup
Focal infection theory wikipedia , lookup
Scaling and root planing wikipedia , lookup
Periodontal disease wikipedia , lookup
Tooth whitening wikipedia , lookup
Crown (dentistry) wikipedia , lookup
Dental avulsion wikipedia , lookup
Clayton Brook Dental Practice CONSENT FOR ENDODONTIC (ROOT CANAL) TREATMENT PLEASE REVIEW THE FOLLOWING CONSENT FORM. YOU WILL BE REQUIRED TO SIGN THIS FORM PRIOR TO THE INITIATION OF TREATMENT. YOUR SIGNATURE DOES NOT COMMIT YOU TO ANY TREATMENT. NECESSARY: Root canal treatment has been recommended by your dentist as a procedure necessary to help retain your tooth in a situation that would otherwise indicate its extraction. ALTERNATIVES: These are 1. No treatment and Review; or 2. Extraction If no treatment is done, there is a risk of infection, pain, swelling, and loss of the tooth. If the tooth is extracted, then some form of an artificial replacement may be considered eg. denture, bridge, implant. RELIABILITY: Root canal treatment can be highly successful depending on the case, availability of special equipment, dentist expertise, and patient cooperation. However, success cannot be guaranteed, particularly in premolar and molar teeth. Maintaining a very good standard of oral hygeine is important to improving success. FUTURE TREATMENT: It is possible that your tooth may require additional treatment in the future such as repeat root canal treatment, surgery, or even extraction, normally at extra cost. COMPLICATIONS: These are rare. While no complications may be expected, it is possible that they may still occur. Examples include situations that may not be apparent until treatment has started, eg. cracked parts of tooth, difficult access, fine canals, difficult anatomy. RISKS: All reasonable measures are taken to minimise risks during treatment. Possible risks include, but are not limited to, the following: instrument seperation within the root canals; perforations; damage to existing restorations; missed canals or calcified canals; loss of tooth structure; fractured teeth. In some cases there is also a small risk of loss of sensation (numbness) which could be either temporary or permanent. FOLLOWING ROOT CANAL TREATMENT: Some discomfort after root canal treatment is normal. The tooth will be more brittle and more likely to fracture. Therefore a diet of softer foods is essential following treatment. A crown or onlay, with or without a post and core, is often necessary to restore the tooth. This is more likely for back teeth and your dentist will explain if this is required and the additional costs involved. CONSENT FOR TREATMENT I have read the above and I understand that no treatment is without some measure of risk and the risks of the proposed treatment have been explained to me. I prefer to undergo the endodontic (root canal) procedure in order to attempt to retain my tooth. Consequently, I hereby give my consent to Daniel Cheung to do whatever he deems necessary to perform the endodontic procedure which has been described to me. I further request and authorize Daniel Cheung to do whatever he deems advisable and necessary as a result of unforeseen circumstances. Furthermore, I give my permission for the use of any digital photos and radiographs of my procedure for purposes of case study and/or patient education or dental education. This will be kept confidential. Signed: ________________________________ Print Name: ________________________________ Date: _________________