Patient consent form for Root Canal Treatment


Prior to commencing Root canal Treatment it is important to understand what is involved in the procedure and clarify any questions you may have, regarding your treatment.


Principal Risks and Complications

  1. The success of root canal therapy is influenced by many factors.  Your general health, adequate gum attachment and bone support, shape and condition of the roots and nerve canals, quality of previous dental care, the force of your bite  and pre-existing root fractures can affect the success and the individual healing of the root canal therapy.

  2. Teeth treated with root canal therapy can still decay, however, as the nerve is gone, there will be no pain.  Other possible complications include infection, bleeding, loss of sensation in the area and tooth loss. Effective oral hygiene and periodic examinations  are necessary for ensuring the success of your treatment.

  3. The treated teeth may remain sensitive following your appointment.  If sensitivity persists and does not seem to be decreasing, it is advised that you phone the practice to make an appointment.  It is, however, normal for a treated tooth to be sensitive for approximately one to two weeks following the final appointment and to feel different than the surrounding teeth for up to approximately one month.

  4. In some teeth, regular root canal therapy may not be sufficient.  If the canals are severely curved or calcified, there can be substantial infection in the bone around the roots.

  5. Root fracture is one of the main reasons why root canal treatment fails.  Unfortunately, some cracks that extend from the crown down into the roots are invisible and undetectable.  They can occur in uncrowned teeth from injury, biting on hard objects, and habitual clenching and grinding.  Whether the fracture occurs before or after a root canal, the tooth may still require an extraction. In some cases root canal therapy may not be possible or may need further referral to a specialist.

  6. Treated teeth may become more brittle that other teeth.  After root canal treatment, it is highly advisable to have a crown to provide further support, strength and prevent further damage in the future, to strengthen the tooth, improve function and fix any discoloration or aesthetic aspects.   


Alternatives to root canal therapy and necessary follow up care

Alternatives to root canal therapy, if applicable, have been explained to me.  I have tried or considered these options, but I choose to proceed with root canal therapy. Upon completion of root canal treatment, it is very important for each patient to return to his or her dentist for a permanent restoration of the tooth and long term crown.  I agree to comply with the post operative care instructions provided and understand the importance of six monthly maintenance appointments.



I have read this consent form and discussed its contents and the specific information provided to my satisfaction.  I certify that I have been given an opportunity to read fully and understand the terms and conditions of the above consent.  I hereby give my consent to be examined and treated as necessary.

Thanks for submitting!