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Anesthesia Surgery Center

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Specializing in Comprehensive Dentistry

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The Sweet Dreams Dental Team

Michael A. Starkey, DDS And Associates​​​​




Benefits of our Sedation Dental Center
Dental Implants, bone grafting, teeth in a day, mini implants, dentures

Informed Consent for Root Canal Treatment.

This is important for the patient to understand. You may NOT want to have root canal procedure after reading this. I think root canal treatments are appropriate in the proper conditions. But new knowledge about root canal results and some holistic organic patients and dentists think they are bad for the patient.

The options to root canal treatment are: 1. Do nothing. 2. In certain circumstances a pulp treatment with new root canal medication might solve problem, sometimes just Adjust bite, maybe remove filling or crown and replace with a provisional with medicated cement. 3. But if the tooth is abscessed or has deep decay then an extraction is the only real alternative. The benefit of extraction is less expense and better chance of removing infection (however there is no guarantee. In some instances the infection will remain in bone after extraction. There will be a bone infection. And if the site does not heal some bone reduction would be required. This is rare. There are a whole new list of risks if you choose extraction.  You can choose to not replace the tooth which may be wise in some instances or you can replace tooth with implant or fixed or removable bridge. Root canals have complex nerves and blood vessel systems flowing through the root. More than dentists ever imagined in the past. See the pic on the left to get an idea of canals. Then you can appreciate RCTX complexity. Which is often more complicated than an implant procedure.


I have read the risks and benefits of root canal treatment and Dr.Starkey and his staff have answered all my questions and I choose to have Dr. Starkey provide root canal treatment on the following teeth.  If during treatment Dr. Starkey finds the tooth has a poor prognosis with root canal, that is to say that if he decides the root canal treatment will not work and I am under sedation I give him permission to extract the tooth in question.

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Patient Signature_________________________________________Date______

Witness___________________________________________

Here is an explanation of Root canal Treatment Benefits and Risks. It is informed consent. Prior to any root canal treatment it is important to understand the risks and the options, have all your questions and sign off on the root canal procedure saying you understand the controversy and that you still want to have Dr. Starkey perform root canal treatment for you.

Pros and benefits and advantages of Root canal treatment

  1. It is more conservative than surgical extraction.
  2. You get to keep your tooth.
  3. It is more convenient and easier on the patient.
  4. It can be less expensive than extraction and bridge work or implant
  5. Root canal success rate is 90 to 95 % over ten years last I learned. However with today's improved methods it may be higher.


https://articles.mercola.com/sites/articles/archive/2015/05/31/root-canal-teeth.aspx

Above is a rubber dam in place NOT by us for root canal treatment. However the patient's nose is not protected from inhaling debris and aerosols which can result in lung irritation or an infection like histoplasmosis in compromized patients. In addition the eyes are covered. A dentist needs to be able to see the patient's eyes for signs of distress.  In addition there is not a shield under the dam, The rubber dam and saliva cause irritation and discomfort for the patient and it is a long visit. Safety glasses or a see through shield is prudent. Below is a better way to protect the patient's airway and it allows me to see the patient's eyes while still protecting the eyes of the patient.  Is it overkill to place a surgical cap on the patient? Read the causes of root canal therapy in the informed consent and then you  might think it is a pretty good idea to minimize bacteria risk.

The above tooth is opposite problem of short root canal x ray. this tooth rctx was over extended but the reason for the failure probably had to do with inadequate apical seal. (the root tips were not closed off from infection.

It appears the patient swallowed an instrument. Now this does not look like an endo instrument which would have been worse if you can imagine. That is why rubber dams are so important along w/ other screens and methods to prevent such problems. But root canal treatments need to have rubber dams for patient protection and to keep saliva and blood out of tooth.

Root Canal Treatment: Is it the right choice for you?

Informed consent for root canal treatment

http://www.biggiesboxers.com/root-canals-lead-diseased-body-can/

The Cons, disadvantages, problems, and risks of root canal treatment.

  1. There are some who think that root canal treatment is ill advised because leaving a dead tooth in the mouth is unhealthy. You can see and read their opinions I posted their web sites to the left.                                                                                               
  2. If the infection of the tooth is severe it may not be possible to save the tooth with rctx. 
  3. If there is a lack of tooth structure then the root canal treatment may leak from the restoration failing or the crown can come off the root.
  4. The use of 3 D scans show more marginally successful root canal treatments. There is concern about an asymptomatic root canal but low grade infection at the root tip that may affect overall health of patient. Usually the Dental Radiology Specialist will say the tooth has "apical pathology."
  5. Sometimes root canal treatment is more complicated than just extracting the tooth and placing an implant. For example multiple canals, curved roots, large cysts at the root tip.
  6. If the patient is decay prone then a root canal well done with an excellent restoration will probably fail anyway over time due to re decay. So if a patient is cavity prone it may be smarter to remove the tooth.
  7. Root canal treatments do NOT always work even when done by the best endodontist. 
  8. Root canal teeth tend to get dry and brittle and will crack or split if they are a back tooth unless the cusps are covered with an expensive crown.
  9. When there is no nerve in the tooth after root canal treatment a patient can bite harder on this tooth and that is another reason for breakage.
  10. The average life of a root canal molar is about ten years. The average life of an implant is decades.
  11. Excellent home care and healthy diet is advised. A night time appliance if the patient is a tooth grinder or clencher.
  12. The roots of teeth can split and cause failure.Split roots are hard to diagnose.
  13. It is possible that a root canal treatment is performed on the wrong tooth and it does not solve the problem.
  14. It is possible that root canal tx is performed on the right tooth but there happens to be another tooth that begins to hurt or was not felt when the first tooth was over riding it with pain.
  15. Difficult root canal treatments can result in the dentist stripping or perforating or ledging the root canal. Sometimes that can be repaired but not always.
  16. Broken files. A root canal treatment can result in a file separating in one of the canals. This usually is not a problem. In fact it may help seal the root canal.
  17. Root canal treatment can result in overfilling of root canal material. That means the cement or gutta percha has gone outside the root tip. A small amount like a "puff of cement" is okay and actually a good sign.  If it is a large amount surgery may be required to remove the excess cement. This happens sometimes when there is a cyst. But can happen anytime. And most of the time nothing needs to be done.
  18. Abscessed teeth may require a decompression procedure prior to root canal treatment or simultaneously. That is like an open and drain to release pressure and toxins from around the root tip. An incision is made in the gum and the bone around the root tip may be curetted to open up the drainage.
  19. Success is possible with root canal of some infected teeth but it will take two or more visits.
  20. The rctx is more successful if the treatment can be done before their is an abscess.
  21. Some teeth need to have a post and or pins after root canal treatment to help hold on to crown.
  22. It sometimes happens that the dentist fills root canal short of the apex. A little short may be okay but a lot short will result in infection at root tip. The reasons for filling short are various, unable to assess x ray at time of tx or the root is longer than normal, or the doctor ledge off the canal that is to say blocked off the canal and cannot get to the root tip.
  23. Root canal treatment in teeth with gum disease may result in failure of root canal tooth.
  24. Sometimes a patient may need a root canal because of gum disease. The infection entered the tooth by way of infected bone and gum tissue. Gum disease needs to be managed well.
  25. Hidden root canals that the doctor could not find or were too small to treat or see.
  26. Numbness in the jaw or lip due to root canal over filed or over filled and putting pressure on a nerve
  27. Communication into sinus from over filing.
  28. Injection of sodium hypochlorite into canals that goes out into bone can cause pain and bruising. See photo. Black and white image.
  29. Root canal teeth tend to turn color  a darker shade. If it is a front tooth that can be disappointing to patient.
  30. Rubber dam is mandatory for root canal treatment. I know many patients do not like having them in their mouth. Not only that they are in their mouth for 1 to 2 hours. It is not comfortable. Again sedation can help make the visit pleasant and seem short. The patient needs to be protected from swallowing tiny instruments and bad tasting chemicals that kill germs. At the same time the dentist needs a dry field to operate. The dry field makes it easier to see and keeps saliva and other contaminants from getting into the canals which will result in an infected root canal sometime in the future. Still there is the risk of contamination in spite of a dentist's best efforts.
  31. Post operative complications. Most common is a high bite. The tooth will give you serious pain. Contact the office if you are experiencing biting pain. It will not go away until we adjust the bite. Infection can occur. Pain can last 24 hours to 3 days. You may want narcotic pain meds but that is rare. And in our Brave New World narcotic prescriptions are frowned upon by certain government agencies. 

What is a root canal treatment?  It is when a dentist or endodontist removes the pulp and bacteria from a tooth and seals it to prevent infection.

We are able to perform root canal treatment on  most teeth including molars. We often treat under IV sedation because root canal treatment on molars can take a couple of hours. Molar root canal treatments can be complex because of extra canals and difficulty diagnosing with regular imaging x rays. While we can treat most molars the very difficult RCTX are prudent to refer to the specialist. IV Sedation allows the patient to be comfortable for a two hour root canal and reconstruction of the tooth visit.

We are able to provide the restorative work at the same time  we do the root canal treatment and that saves the patient time. Most root canal treatments are done in one setting unless there is an unusual problem or infection.

But root canal treatments have become controversial. Some dentists or others think they are bad for you. Be informed  so you can make the optimum choice for you.


The Omaha Dental

 


              

 

This is an interesting problem above. The dentist is removing infected tissue at the root tip but if you look close you will see two vertical lines though small indicating the root is split. The Dr.'s attempt to treat this tooth is questionable due to the cracks.

The problem w/ the rctx above is it was finished too short. The result is infected root; one reason it was filled short is because it was a difficult rctx the roots were longer than average

https://www.healthstartsinthekitchen.com/2014/04/27/say-unnecessary-root-canal-procedure/

Dentists have learned more about roots of teeth since 3 D scanning of the jaw has improved. More accurate diagnosis of a suspect tooth because the dentist can see the roots in all dimensions. But at the same time 3 D scans reveal that the root tips of finished root canals can still contain bacteria and be a low grade infection. And for this reason some professionals insist that root canal treatment can result in problems like infection and toxins spreading therefore they do not advise them. 

To provide a molar root canal with excellent results can be more challenging than extracting and placing an implant.

You are entitled to know the alternative opinion to root canals being safe.  I had a molar root canal treatment done 10 years ago on a molar and I am happy I did it and I don't think it is a problem. But at the microscopic level who knows? 

The American Dental Association states that root canals are a safe procedure that cannot cause any systemic diseases. But according to Dr. Kulacz and others who have spent time investigating the matter, that's simply not true. Who is correct? What do you wish to believe? 

Perfect root canal treatment while a worthy goal is not achievable. You can see the pictures that show root canal complications for yourself.

"If a patient is informed that these root canal teeth remain infected; that bacteria can indeed travel to other sites in the body, and that bacteria in root canal teeth and the surrounding bone release potent toxins, then the patient can decide to have a root canal or not," he says.

Many dentists believe they can sterilize a root canal tooth and that the act of instrumenting and irrigating the canal will eliminate all the bacteria, but that's not the case.

"I've done biopsies on every root canal tooth that I have extracted. Almost all of them have remnants of necrotic debris still in that canal meaning that they were not thoroughly cleaned. Microbiological cultures of the surrounding bone showed infection almost 100% of the time." Dr. Kulacz says.

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