Consent: root canal and extraction

What the consent form for root canal treatment and tooth removal covers, so you can read it at home before you sign it at the clinic.

Draft, awaiting review by Dr. Swapnil B. Patil, BDS

Consent for root canal treatment (PDF)Consent for tooth removal (PDF)

Before a root canal treatment or a tooth removal, we explain what we plan to do and ask you to sign a consent form. You do not need to print anything: we give you the form at the clinic and answer your questions before you sign. This page, and the two forms linked above, let you read it first.

What the form covers

  • What the treatment is. For a root canal, cleaning out the infected or inflamed nerve inside the tooth and sealing it. For an extraction, removing the tooth, sometimes in pieces or with a small cut in the gum.
  • Why it is advised, and what is likely to happen if you choose not to have it.
  • The other options, including doing nothing for now, and replacing the tooth if it is removed.
  • The usual after-effects: tenderness, swelling and stiffness for a few days.
  • The less common risks. For a root canal: a fine instrument breaking inside a curved canal, the tooth cracking later (which is why a crown is usually advised), or the infection not settling and the tooth needing further treatment or removal. For an extraction: a dry socket, numbness of the lip or tongue that is usually temporary, damage to a neighbouring filling, and, for upper back teeth, a small opening into the sinus.
  • The anaesthetic, and what to tell us beforehand: your medicines, allergies and any health conditions.

Before you sign

  • Ask anything you are unsure of. You can take the form home and come back.
  • Tell us if you take blood thinners, bone medicines, or are pregnant. You can tell us on the patient information form before your visit.
  • If the patient is under 18, a parent or guardian signs.
  • Single-visit root canal treatment

    Root canal treatment removes the infected nerve inside a tooth, cleans and seals its canals, and lets you keep the tooth. When the tooth allows, it is done in one visit.

  • Surgical tooth removal

    When a tooth cannot simply be lifted out, because it is buried, broken at the gum line or has curved roots, it is removed surgically through a small opening in the gum, under local anaesthesia.

Other patient forms

All patient forms

Questions about the form?

Call or WhatsApp us. We go through the form with you before you sign anything.

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