The medical Consent Law requires doctors to advise patients of the general nature of treatment procedures, the acceptable treatment alternatives, and the risks inherent in the proposed procedures.

I voluntarily consent to endodontic (root canal) treatment that has been recommended. I understand that the goal of root canal treatment is to save a tooth that might otherwise require extraction. Although root canal treatment has a very high success rate, it is a dental-biological procedure, whose results cannot be guaranteed. Further, root canal treatment is performed to correct an apparent problem and occasionally undiagnosed or hidden problems arise. I understand that this procedure will not prevent future tooth decay or a possible fracture, and that occasionally a tooth that had root canal treatment may require re-treatment, surgery or tooth extraction.

The procedure is fully explained to me including the risks involved. I have been informed that complications might include, but are not limited to:

1. Perforation of the canal with instruments, which could result in the need for root canal surgery or the loss of the tooth.
2. Instrument breakage in the canal, which may require re-treatment, root canal surgery or extraction.
3. Post-operative infection, which may require additional treatment and/or the use of antibiotics.
4. Tooth fracture, that may require additional treatment or tooth extraction.
5. Incomplete healing, which may require re-treatment and/or root canal surgery or extraction.
6. Referral to a specialist if any unexpected difficulties occur during the treatment.
7. Post- treatment discomfort altered feeling of the soft tissues of the mouth.