The following paragraphs are listed separately on the form and each paragraph must have the patients acknowledgement otherwise the procedure will not be administered.
Perhaps this is why you will never see this form if it gets in the way of the Almighty Sign - $$$.
Each empty root canal that can be located is filled. Occasionally, a post is also inserted into the canal to help restore the tooth. The opening in the tooth is closed with a temporary filling. At a later appointment, a crown may be placed. It is a separate dental procedure not included in this discussion.
Twisted, curved, accessory, or blocked canals may prevent removal of all inflamed or infected pulp. Since leaving any pulp in the root canal may cause your symptoms to continue or worsen, this might require an additional procedure called an apicoectomy. Through a small opening cut in the gums and surrounding bone, any infected tissue is removed and the root canal is sealed. An apicoectomy may also be required if your symptoms continue and the tooth does not heal.
Once the root canal treatment is completed, it is essential to return promptly to begin the next step in treatment. Because a temporary seal is designed to last only a short time, failing to return as directed to have the tooth sealed permanently with a crown or filling can lead to other problems such as deterioration of the seal, resulting in decay, infection, gum disease, fracture, and the possible premature loss of the tooth.
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. This treatment has been recommended to relieve the symptoms of the diagnosis described above.
I understand that following treatment I may experience bleeding, pain, swelling, and discomfort for several days, which may be treated with antibiotics. I will immediately contact the office if conditions worsen or if I experience fever, chills, sweats, or numbness.
I understand that I may receive a local anesthetic and/or other medication. In rare instances patients have a reaction to the anesthetic, which may require emergency medical attention, or find that it reduces their ability to control swallowing. This increases the chance of swallowing foreign objects during treatment. Depending on the anesthesia and medications administered, I may need a designated driver to take me home. Rarely, temporary or permanent nerve injury can result from an injection.
I understand that all medications have the potential for accompanying risks, side effects, and drug interactions. Therefore, it is critical that I tell my dentist of all medications I am currently taking, which are: (refer back to office registration form).
I understand that holding my mouth open during treatment may temporarily leave my jaw feeling stiff and sore and may make it difficult for me to open wide for several days. However, this can occasionally be an indication of a further problem. I must notify your office if this or other concerns arise.
I understand that occasionally a root canal instrument may break off in a root canal that is twisted, curved, or blocked with calcium deposits. Depending on its location, the fragment may be retrieved or it may be necessary to seal it in the root canal (these instruments are made of sterile, non-toxic surgical stainless steel, so this usually causes no harm). It may also be necessary to necessary to perform an apicoectomy, as described above, to seal the root canal.
I understand that during treatment the root canal filling material may extrude out the root canal into the surrounding bone and tissue. Occasionally, an apicoectomy mat be necessary for retrieving the filling material and sealing the root canal.
I understand teeth that receive root canal treatment may be more prone to cracking and breaking over time, which may require removal and replacement with a bridge, partial denture or implant. In some cases, root canal treatment may not relieve all symptoms. The presence of gum disease (periodontal disease) can increase the chance of losing a tooth even though root canal treatment was successful.
I understand that root canal treatment may not relieve my symptoms and I may need my tooth extracted.
I understand that if I do not have root canal treatment, my discomfort may continue and I may face the risk of a serious, potentially life-threatening infection, abscesses in the teeth and bone surrounding my teeth and eventually, the loss of my tooth and/or adjacent teeth.
I understand that depending on my diagnosis, alternatives to root canal treatment may exist, which involve other disciplines in dentistry. Extracting my tooth is the most common alternative to root canal treatment. It may require replacing the extracted tooth with a removable or fixed bridge or an artificial tooth called an implant. I have asked my dentist about the alternative and associated expenses. My questions have been answered to my satisfaction regarding the procedures, their risks, benefits, and costs.
No guarantee or assurance has been given to me by anyone that the proposed treatment or surgery will cure or improve the condition(s) listed above.
I consent to the root canal treatment as described above by Dr. -----.
I refuse to give my consent for the proposed treatment as described above.
I have been informed of and accept the consequences if no treatment is administered.
I attest that I have discussed the risks, benefits, consequences, and alternatives with __________ (patient’s name) who has had the opportunity to ask questions, and I believe my patient understands what has been explained.
Here’s the short version:
Root canals cause the tooth to rot and emit toxins. While the tooth is intact the toxins proliferate the body. If one is lucky enough to have the showing tooth break, the toxins will have the opportunity to come out of the body. A root canal is a temporary fix, eventually leading to extraction and a partial bridge if need be. So, if a tooth needs root canal work, have it pulled and explore your options. That will eliminate needless toxins in your body.
Yeah, yeah, if the tooth can be saved for a while, why not? Do you really want toxic poison circulating throughout your body until you eventually go through the extraction process?
Dental implants are metal screws, typically of titanium, that are surgically inserted into the jaw to act as an anchor for a replacement tooth (the crown). While titanium is often described as a metal that doesn’t react with tissues, there is evidence to suggest otherwise. The Bristol Wear Debris Team found that debris from joint replacements made from metals such as titanium, nickel, chrome and cobalt had worked their way into the liver, spleen, lymph nodes and bone marrow (J Bone Joint Surg, 1994; 76B: 701-12).
Dental implant surgery is very intrusive and, while surgical techniques for the procedure have improved the success rate, complications can arise. These include peri-implantitis, a bacterial inflammation that can lead to jawbone loss; nerve damage; hematoma (blood clot) in the floor of the mouth, causing possible airways obstruction; and sinusitis (Med Oral Patol Oral Cir Bucal, 2004; 9 [suppl]: 63-9; 69-74; Int J Oral Maxillofac Implants, 2004; 19: 731-4; Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2001; 92: 597-600; J Oral Maxillofac Surg, 1992; 50: 285-7).
The bottom line: find a holistic dentist opposed to fluoridation, implants and root canals. They are very rare but they are out there. Try a search for IABDM – International Academy of Biological Dentistry and Medicine and/or HAD – Holistic Dental Association.