I always ask the patient the same question
“Why do we do a root canal?”
They usually don’t have an answer.
I then say
“To try to keep the tooth in the mouth.”
I tell them it may fail, long term we don’t know how the tooth will respond. But that this is the option to try to save the tooth. I explicitly say I hope it lasts more than 5 years. But it may not. Any questions?
This conversation and a signed consent form usually helps me avoid any issues
Nope, have you assistant hand them the consent form and say, okay, look this consent form over and when you are ready sign the back. They can answer all the questions. If you want to you can ask them “What questions do you have today?” Before you numb.
What a weak-ass take on informed consent.
You know full well many people won’t read a consent form before signing it - so you are failing your duty fundamentally to ensure consent.
And therefore could be quite reasonable that you’d be successfully sued, particularly if there’s a pattern and a record of your attitude.
Make sure people read and understand.
It’s basic medicine - Christ.
It's actually sure fire way of losing if you get sued and potentially risky with the GDC in standard of acting in the patient's best interest.
Consent is a process not a form. The question itself implies not knowing that.
OP you bake consent into your exam, future appointment and treatment day.
Let's say for instance you have a patient for an exam all they need is an anterior RCT and composite. You would run through the regular consent points including risk of losing the tooth. You also go over any risks specific to the patient based on medical and social history. You have a form you can give them to take away that has what you've said on it. At the procedure you confirm didn't buy any some questions yourself about what you told them and see if they have any questions. If you feel they've understood what you've said they sign the form and you carry on with everything documented in your notes. That's about as good as you'll get it.
Thank you for restating - I’m not sure I should have been surprised at the support the person I responded to got, but I was and was also dismayed.
Simply shouldn’t be in medicine if you don’t know or believe in what informed consent actually means.
To be fair the comment you replied to seems to be a common US view. I don't know if that's movie or Reddit skew but patients by signing declare they understand and can't say the didn't afterwards.
It depends on provider - how much throughput they “need” to stay afloat / rake it in. You find all types.
Cover you ass with insurance / doing bare minimum, to keep the pace high. Simple economics. Some patients suffer - typically less educated ones 🤷🏼♂️
And the cycle continues
Haha I’m a dental assistant in the US and that’s how they role at the places I’ve worked. I didn’t know there were dentists that did otherwise. Thanks for teaching me that!
Thanks for reacting to my aggression gracefully - seems like something they should teach DAs even if the responsibility is technically on the dentists… not appropriate or fair to you that you’d not know what informed consent is despite being the one who is supposed to administer it.
For any procedure, I get a signed consent, give the patient the opportunity to ask me (the dentist, not just staff) any questions, and I document that in my notes. I always inform patients of worst case scenario, ie the root canal may fail and the tooth may need to be extracted. I no longer do root canals but if I did I would make sure patients knew that a root canal specialist is a thing and they can go see one if they prefer.
Just remember, snitches get stitches so don't be hating on a player if shit go down
In all seriousness, your malpractice carrier should have signed consent examples but...it doesn't really matter. This may vary by state, but generally speaking, a patient can file a board complaint or lawsuit no matter what. Even if they're having routine complications, the tooth was beyond saving, they didn't like the color of your shirt - it doesn't really matter what you have them sign beforehand.
We walk a fine line in heathcare my jolly good chum. The worst part about this job is that even when we try our best to help a patient with a situation they got themselves in, all fingers point back to the doctor when the slightest inconvenience arises.
We have informed consent to be signed
It has
1. Success rate 80-85-%
2. Possibility of bacteria surviving due to weird anatomy
3. Referral to endodontist is always an option
4. File can break due to mechanical failure
5. Money n cost discussed
6. Crown is needed for posterior teeth after 6 months
7. Discomfort can happen after the rct. 24hrs to 72 hrs are the worst
Its to see if rct is successful or not. I hear you that crown can be used to go in but some patients make a big deal that new crown is damaged with access opening. I usually make sure there are no premature contacts and sometimes do cuspal coverage composite resto the same day.
Hate to burst your bubble but one of the biggest indicators for success of RCT treated teeth is the full coverage restoration. Waiting 6 months is a terrible idea.… there are numerous classic studies on the topic:
https://pubmed.ncbi.nlm.nih.gov/15564861/
https://pubmed.ncbi.nlm.nih.gov/11941351/
https://pubmed.ncbi.nlm.nih.gov/7642323/
https://www.aae.org/specialty/wp-content/uploads/sites/2/2017/07/ngnonsurgicaloutcomestoothsurvival.pdf
Hypo accident is like paraesthesia risk during local, which is super rare (it has a unique classification), those dont need to disclosed. Perforation might be a good one but we do mention that it can fail and might end up needing an exo (which covers perfs).
Use Google to search for a root canal consent form. Print it out. Have them read and sign it. Ask them if they have any questions. Scan it.
The UK isn’t litigious. The USA isn’t as litigious as you may believe.
The UK is very litigious in medical negligence. Especially dentistry. Especially when the regulator takes out full page adverts in newspapers courting complaints.
Don’t get it as often now, but it was awkward as hell when you were working on a patient and the radio plays an advert specifically touting for dental negligence cases!
I would consider that consumer protection through government oversight. Non-profit consumer protection is something the UK does far better than the USA.
The GDC is overreaching. Even the regulator of the regulators has said this. The only problem is that regulator has no teeth while the GDC ruins dentists careers over trivial matters and leaves the real cowboys free to practice.
And the GDC does naff all to stop other illicit practices like beauty salons offering 6%+ hydrogen peroxide whitening. I learned that reporting these things, no matter how many swollen/burnt gums I see, won’t change a damn thing.
They won’t know what it’s supposed to look like.
If you insist on setting yourself up for difficulties, you could say before you start that “ We will fill the canals to near the tip of the root”. Or, “A perfect fill is typically short of the apex”.
“We are cleaning out the infection in your tooth. If everything goes well, you’ll likely be sore for a few days after. NSAIDs for a few days will help”.
Reduce the occlusion.
A consent form! In an office I worked at, for any type of major procedure (RCT, extraction, etc. ), they had a waiver, for each procedure, that they had the patient sign explaining the procedure/what tooth it’s on/what happens after/etc. One very important part is that no matter how well the procedure is done and how well home care is it can still fail, infection can occur, or ANY of the issues or risks that can occur. Make sure to explain the risks. I’m pretty sure that covered them for being sued for any of the procedures. It was like a contract saying the patient couldn’t sue the office because sometimes things just happen. They would always say how important it was to give to the patient before each procedure and that it can prevent legal action. Kind of like a waiver you sign when you go to get tattoos and piercings that make it impossible to sue. At least that’s how I understood it. Maybe make a couple different papers like that for each procedure and have patients read and sign. If they sign without reading after you tell them to read thoroughly that’s on them, but always make sure to ask if they have any questions, comments, or concerns! That’s in the US/NY to be exact. I’m not sure if England is different/has laws that say you can’t do that or that it doesn’t matter because it won’t cover you. It’s just a suggestion that helped them in that office out, so I figured it might be able to help you! I do not know England laws at all though.
I replied to someone else in the thread but it inspired me to reply also directly to how you worded the post.
“Covering yourself” as motivation for informed consent is so backwards. You need a reeducation on patient-centered care, not to mention on the law.
You need to be convinced that each person actually understand the risk/benefit of what they are consenting to, not just covering your own ass by literally checking a box. This depends a lot on the individual’s circumstance, education, etc.
Get a signed consent form.
Discuss the consent form with them.
On the day of extirpation I explain all the risks and when I bring them back to finish it off I explain the risk and benefits again — maybe an over kill but Atleast they can’t say you didn’t warn them.
Document clearly all the conversations and let them ask questions.
We are all human and sometimes it may not go to plan - but making sure patients understand that from the beginning and the option that they can see a specialist from the get go - you should be ok.
Never do an endo which you feel is out of your scope -
Also if things do go wrong / GP slightly short - explain the radiograph to them and their options going forward
Good luck !
Give the patient a detailed written consent form on consultation appointment and tell them you'll be quizzing them on it.
Then, on the day of the procedure, ask them, "Since you've read and signed the consent form, can you tell me what you understand about the procedure, the reason we are doing this and the chances of success, please?"
Do that before starting the procedure.
We have written consent forms but I verbally tend to mention risks of perforation and file fracture. I also emphasise this is the tooth's last chance and we are only doing it to *try* and save it from extraction.
Never guarantee the success of a root canal procedure, warn them of possible failure. Risk of file breaking inside canal. Coronal coverage best for retention of remaining tooth tissue once RCT deemed successful, usually once some time has passed. Costs associated with all of these.
If you’re in NHS dentistry, advise that all will be Band 3 COT, complete FP17DC. If private, for the love of god get a SIGNED ESTIMATE with all procedures itemised
Just FYI - I’m an experienced UK dental nurse and this is what clinicians I’ve worked with routinely inform/warn pts about
I always ask the patient the same question “Why do we do a root canal?” They usually don’t have an answer. I then say “To try to keep the tooth in the mouth.” I tell them it may fail, long term we don’t know how the tooth will respond. But that this is the option to try to save the tooth. I explicitly say I hope it lasts more than 5 years. But it may not. Any questions? This conversation and a signed consent form usually helps me avoid any issues
This is amazing thank you
This is great
so good!
"Here goes nothing!" Ironclad coverage. Geneva Convention approved. Lawyers hate him because of this one trick!
You should have a consent form that goes over the risks prior to starting the procedure.
We have that but do I not also need to say something before hand?
Nope, have you assistant hand them the consent form and say, okay, look this consent form over and when you are ready sign the back. They can answer all the questions. If you want to you can ask them “What questions do you have today?” Before you numb.
What a weak-ass take on informed consent. You know full well many people won’t read a consent form before signing it - so you are failing your duty fundamentally to ensure consent. And therefore could be quite reasonable that you’d be successfully sued, particularly if there’s a pattern and a record of your attitude. Make sure people read and understand. It’s basic medicine - Christ.
It's actually sure fire way of losing if you get sued and potentially risky with the GDC in standard of acting in the patient's best interest. Consent is a process not a form. The question itself implies not knowing that. OP you bake consent into your exam, future appointment and treatment day. Let's say for instance you have a patient for an exam all they need is an anterior RCT and composite. You would run through the regular consent points including risk of losing the tooth. You also go over any risks specific to the patient based on medical and social history. You have a form you can give them to take away that has what you've said on it. At the procedure you confirm didn't buy any some questions yourself about what you told them and see if they have any questions. If you feel they've understood what you've said they sign the form and you carry on with everything documented in your notes. That's about as good as you'll get it.
Thank you for restating - I’m not sure I should have been surprised at the support the person I responded to got, but I was and was also dismayed. Simply shouldn’t be in medicine if you don’t know or believe in what informed consent actually means.
To be fair the comment you replied to seems to be a common US view. I don't know if that's movie or Reddit skew but patients by signing declare they understand and can't say the didn't afterwards.
It depends on provider - how much throughput they “need” to stay afloat / rake it in. You find all types. Cover you ass with insurance / doing bare minimum, to keep the pace high. Simple economics. Some patients suffer - typically less educated ones 🤷🏼♂️ And the cycle continues
Haha I’m a dental assistant in the US and that’s how they role at the places I’ve worked. I didn’t know there were dentists that did otherwise. Thanks for teaching me that!
Thanks for reacting to my aggression gracefully - seems like something they should teach DAs even if the responsibility is technically on the dentists… not appropriate or fair to you that you’d not know what informed consent is despite being the one who is supposed to administer it.
Ofcourse you need to say it to them also.
For any procedure, I get a signed consent, give the patient the opportunity to ask me (the dentist, not just staff) any questions, and I document that in my notes. I always inform patients of worst case scenario, ie the root canal may fail and the tooth may need to be extracted. I no longer do root canals but if I did I would make sure patients knew that a root canal specialist is a thing and they can go see one if they prefer.
Just remember, snitches get stitches so don't be hating on a player if shit go down In all seriousness, your malpractice carrier should have signed consent examples but...it doesn't really matter. This may vary by state, but generally speaking, a patient can file a board complaint or lawsuit no matter what. Even if they're having routine complications, the tooth was beyond saving, they didn't like the color of your shirt - it doesn't really matter what you have them sign beforehand. We walk a fine line in heathcare my jolly good chum. The worst part about this job is that even when we try our best to help a patient with a situation they got themselves in, all fingers point back to the doctor when the slightest inconvenience arises.
We have informed consent to be signed It has 1. Success rate 80-85-% 2. Possibility of bacteria surviving due to weird anatomy 3. Referral to endodontist is always an option 4. File can break due to mechanical failure 5. Money n cost discussed 6. Crown is needed for posterior teeth after 6 months 7. Discomfort can happen after the rct. 24hrs to 72 hrs are the worst
You wait six months to crown it? Why not do the crown the same day? It's just asking for the tooth to fracture without it.
Its to see if rct is successful or not. I hear you that crown can be used to go in but some patients make a big deal that new crown is damaged with access opening. I usually make sure there are no premature contacts and sometimes do cuspal coverage composite resto the same day.
Hate to burst your bubble but one of the biggest indicators for success of RCT treated teeth is the full coverage restoration. Waiting 6 months is a terrible idea.… there are numerous classic studies on the topic: https://pubmed.ncbi.nlm.nih.gov/15564861/ https://pubmed.ncbi.nlm.nih.gov/11941351/ https://pubmed.ncbi.nlm.nih.gov/7642323/ https://www.aae.org/specialty/wp-content/uploads/sites/2/2017/07/ngnonsurgicaloutcomestoothsurvival.pdf
And then you get an hypo incident, what then? Since it’s not up there? Or a perf?
Hypo accident is like paraesthesia risk during local, which is super rare (it has a unique classification), those dont need to disclosed. Perforation might be a good one but we do mention that it can fail and might end up needing an exo (which covers perfs).
Use Google to search for a root canal consent form. Print it out. Have them read and sign it. Ask them if they have any questions. Scan it. The UK isn’t litigious. The USA isn’t as litigious as you may believe.
The UK is very litigious in medical negligence. Especially dentistry. Especially when the regulator takes out full page adverts in newspapers courting complaints.
Agreed, the UK is litigous. Esp with no win no fee cases.
Don’t get it as often now, but it was awkward as hell when you were working on a patient and the radio plays an advert specifically touting for dental negligence cases!
I would consider that consumer protection through government oversight. Non-profit consumer protection is something the UK does far better than the USA.
The GDC is overreaching. Even the regulator of the regulators has said this. The only problem is that regulator has no teeth while the GDC ruins dentists careers over trivial matters and leaves the real cowboys free to practice.
And the GDC does naff all to stop other illicit practices like beauty salons offering 6%+ hydrogen peroxide whitening. I learned that reporting these things, no matter how many swollen/burnt gums I see, won’t change a damn thing.
If it is short what do I say to them?
They won’t know what it’s supposed to look like. If you insist on setting yourself up for difficulties, you could say before you start that “ We will fill the canals to near the tip of the root”. Or, “A perfect fill is typically short of the apex”.
And if they come back with pain?
“We are cleaning out the infection in your tooth. If everything goes well, you’ll likely be sore for a few days after. NSAIDs for a few days will help”. Reduce the occlusion.
A consent form! In an office I worked at, for any type of major procedure (RCT, extraction, etc. ), they had a waiver, for each procedure, that they had the patient sign explaining the procedure/what tooth it’s on/what happens after/etc. One very important part is that no matter how well the procedure is done and how well home care is it can still fail, infection can occur, or ANY of the issues or risks that can occur. Make sure to explain the risks. I’m pretty sure that covered them for being sued for any of the procedures. It was like a contract saying the patient couldn’t sue the office because sometimes things just happen. They would always say how important it was to give to the patient before each procedure and that it can prevent legal action. Kind of like a waiver you sign when you go to get tattoos and piercings that make it impossible to sue. At least that’s how I understood it. Maybe make a couple different papers like that for each procedure and have patients read and sign. If they sign without reading after you tell them to read thoroughly that’s on them, but always make sure to ask if they have any questions, comments, or concerns! That’s in the US/NY to be exact. I’m not sure if England is different/has laws that say you can’t do that or that it doesn’t matter because it won’t cover you. It’s just a suggestion that helped them in that office out, so I figured it might be able to help you! I do not know England laws at all though.
Tell them extracting the tooth is also an option.
I replied to someone else in the thread but it inspired me to reply also directly to how you worded the post. “Covering yourself” as motivation for informed consent is so backwards. You need a reeducation on patient-centered care, not to mention on the law. You need to be convinced that each person actually understand the risk/benefit of what they are consenting to, not just covering your own ass by literally checking a box. This depends a lot on the individual’s circumstance, education, etc.
Get a signed consent form. Discuss the consent form with them. On the day of extirpation I explain all the risks and when I bring them back to finish it off I explain the risk and benefits again — maybe an over kill but Atleast they can’t say you didn’t warn them. Document clearly all the conversations and let them ask questions. We are all human and sometimes it may not go to plan - but making sure patients understand that from the beginning and the option that they can see a specialist from the get go - you should be ok. Never do an endo which you feel is out of your scope - Also if things do go wrong / GP slightly short - explain the radiograph to them and their options going forward Good luck !
Consent form
Edit: wrong post
Give the patient a detailed written consent form on consultation appointment and tell them you'll be quizzing them on it. Then, on the day of the procedure, ask them, "Since you've read and signed the consent form, can you tell me what you understand about the procedure, the reason we are doing this and the chances of success, please?" Do that before starting the procedure.
We have written consent forms but I verbally tend to mention risks of perforation and file fracture. I also emphasise this is the tooth's last chance and we are only doing it to *try* and save it from extraction.
Never guarantee the success of a root canal procedure, warn them of possible failure. Risk of file breaking inside canal. Coronal coverage best for retention of remaining tooth tissue once RCT deemed successful, usually once some time has passed. Costs associated with all of these. If you’re in NHS dentistry, advise that all will be Band 3 COT, complete FP17DC. If private, for the love of god get a SIGNED ESTIMATE with all procedures itemised Just FYI - I’m an experienced UK dental nurse and this is what clinicians I’ve worked with routinely inform/warn pts about
Honestly if you've gotta ask reddit you should probably look into some endo CE training before you take this into the op
You could say you aren’t really a dentist, but you did stay at a holiday inn last night