909 North Miami Beach Blvd, suite 501. North Miami Beach, FL 
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I have recommended that one or more of your teeth needs endodontic therapy (root canal treatment) based upon your symptoms, my examination of you, the treatment plan I have discussed with you and your choice.
Endodontic therapy (“endodontic” means within the tooth) is treatment of the canal or pulp chamber that lies in the middle of the tooth and its root. When completed, root canaled teeth generally act and feel just like your other teeth and have an excellent chance of remaining in your mouth for as long as your other teeth.
Root canal therapy is accomplished by using local anesthetic injection to numb the tooth involved. Then access is gained to the pulp chamber (canal)) in the middle of your tooth by drilling some small holes in the top of the tooth. Small instruments are use to remove the blood and nerve supply inside the tooth. Delicate files are then used to smooth and shape the canal to make sure no tissue remains which could later become infected. The canal will be sterilized with medications and the canals completely filled with an inert material to prevent bacteria and fluids from getting inside the tooth.
I believe that this therapy is very safe and effective; nonetheless, I want you to know about the risks and consequences of having a root canal performed.
Your treatment may take several visits over a few weeks to complete. During that time, you may experience some soreness and discomfort in and around the tooth being treated. These problems will go away, however, in rare cases the discomfort may become pain which then may require additional treatment.
Despite the very high success rate this procedure enjoys there is a chance that the root canal treatment will not resolve your pain. In such instance’s other procedures such as retreatment, root tip surgery, even extraction may be necessary to resolve your pain. These other procedures may result in additional charges to you.
Once a tooth has been root canaled it tends to be more brittle than a tooth, which still has its internal nerve and blood supply. For this reason, I will recommend that you have a crown, cop or other cast restoration placed on the tooth for its protection. Without this protection, there is significant chance of the tooth fracturing which may require its extraction.
Occasionally, one of the delicate instruments used to remove the internal nerve and blood supply will break off inside the tooth. If I’m unable to remove the broken piece of instrument it may be close enough to the end of the root that I may elect to leave it in and fill the canal. If an adequate seal has been made the treatment will likely be a success. If, however, this is not an option or if it has been attempted without success you may require an apicoectomy (root tip amputation) or other treatment.
I invite your questions concerning the risks discussed and contained in this document. By signing below, you acknowledge that you have read this document, understand the information presented and have had all your questions answered satisfactorily.
All possible treatment options, including no treatment, have been discussed with me. The risk and benefits of all the options have been clarified and all of my questions have been answered. I have therefore made an informed decision regarding my treatment of choice.
My signature bellow signifies that all questions have being answered to my satisfaction regarding this consent and I fully understand the risks involved of the proposed surgery and anesthesia. I certify that I speak, read and write English.
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