Important Information

Informed Consent Forms

Oral Surgery and Dental Extractions
Periodontal Treatment
Root Canal Treatment
Generic Form


(989) 872-3870

6240 Hill Street
Cass City, MI 48726

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James D. Thomas, DDS, PC
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Informed Consent For Root Canal Treatment

Root Canal Treatment Informed Consent
The text of the Informed Consent is below. You may download the form in Adobe Acrobat PDF format by clicking on the image to the right. You may then print, sign and bring the form to our office.
To view and print the document, you'll need Adobe Acrobat Reader on your computer. You may click on the Acrobat logo button to download the software.

  1. Success Rate. Root Canal Treatment (endodontic therapy) is about 95% successful.  Many factors affect the success of the treatment: your general health, condition of the nerve and the root canal(s), bone support around the tooth, strength of the tooth (fracture lines), etc.
  2. Completion of Treatment. Root Canals are sometimes completed in a single appointment or may take several appointments, if the treatment spans several appointments, you will have a temporary filling placed on the tooth to protect the canal.  If the filling should come out, please call the office so we can replace it.  Once treatment is begun, it is absolutely necessary that the treatment be completed, and the patient must diligently follow any and all instructions.
  3. Sensitivity. Just like with fillings, a root canal tooth can be sensitive both during and after final treatment. Usually this sensitivity disappears in several weeks. If it does not or appears to worsen, please call the office to let us know.
  4. Crown Needed. A crown is usually recommended for any tooth that has a root canal. This is because root canal teeth no longer have a blood supply to them and become more brittle than your other teeth. This is especially true of your back chewing teeth—the molars and bicuspids.  A crown goes over the root canal tooth to strengthen it and protect it from breakage.
  5. Causes of Fracture. One of the main reasons root canals fail is because of breakage or fracture of the tooth. A fractured tooth (especially a vertical fracture) can require extraction of the tooth. One of the best ways to prevent fracture of a root canal tooth is to have a crown put over the tooth to strengthen it. Other causes of fracture include grinding of teeth, improper bite, trauma, etc. These fractures can occur either before or after the root canal and often are invisible and/or hard to detect.
  6. Proper Care. Root canal teeth have no nerve, but they can still decay.  It is important to take care of root canal teeth just as you would any other tooth: good home care, proper diet, and regular dental checkups.
  7. Additional Treatment. Additional treatment may be necessary. Occasionally, root canal treatment alone does not complete the treatment. The canals of the tooth can be very narrow or curved or calcified. There may be infection around the roots of the tooth.  Instruments used to treat the tooth may become separated in the canal.  The tooth may remain or become sensitive. A surgical procedure or possibly extraction may be necessary to try to resolve the problem.
The nature and purpose of root canal treatment has been explained to me, and I have had an opportunity to have my questions answered. I understand that dentistry is not an exact science and success with root canals cannot be guaranteed. In view of the above information, I authorize the doctor and/or such associates and assistants as necessary to render any treatment necessary and/or advisable to my dental condition including any and all anesthetics and/or medications.