Anesthesia Surgery Center
Specializing in Comprehensive Dentistry
With Dental Sedation that fits your needs.
The Sweet Dreams Dental Team
Michael A. Starkey, DDS And Associates
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.
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
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
The Cons, disadvantages, problems, and risks of root canal treatment.
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.
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
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.
Master, College of Conscious Sedation American Dental Society of Anesthesiology