The Toxic Tooth: CHAPTER TEN: CONSENTING TO ROOT CANAL TREATMENT Dentistry — The Right Way

 

CHAPTER TEN: CONSENTING TO ROOT CANAL TREATMENT

Dentistry — The Right Way

Patients need to understand proposed procedures and treatment protocols as completely as possible in order to make informed medical and dental decisions. At the same time, healthcare providers cannot really overdo their attempts to ensure that a patient fully understands a planned procedure along with the expected benefits and potential negative outcomes and long- term side effects. A healthcare provider’s full disclosure and patient agreement prior to treatment is called informed consent. It is the process in which healthcare practitioners and their patients “engage in a dialogue to explain and comprehend the nature, alternatives, and risks of a procedure” or treatment protocol.1

This means that a medical or a dental procedure, or a treatment plan, needs to be preceded by:

1. A clear explanation of the procedure, surgery, or planned treatment.

2. Evidence of comprehension of the explanation by the patient, as would be apparent in a meaningful dialogue between caregiver and patient. Comprehension by family members is also important and especially important when there is a possibility of cognitive impairment on the part of the patient.

3. A complete explanation of any possible risks associated with the procedure, surgery, or planned treatment, along with a balanced, scientific analysis of anticipated benefits. This includes a full enumeration of known complications that can occur with a reasonable approximation of the likelihood of their occurrence, including the worst possible outcomes. A reasonable approximation of the likelihood of realizing the therapeutic goal

of the procedure, surgery, or planned treatment should also be included. This requires that the healthcare practitioner have an awareness of the pertinent current scientific literature addressing a given procedure, surgery, or planned treatment.

4. A complete explanation of the alternative approaches or options available for the procedure, surgery, or planned treatment.

5. A complete and comprehensive response to any questions that the patient might pose regarding the procedure, surgery, or planned treatment.

6. Documentation in writing, and preferably by audio/video recording, of the execution of the above informed consent principles.

Many informed consents do not meet the standards outlined above. However, a great deal of legal wrangling and ultimately malpractice suits could be avoided by adhering closely to these standards. Furthermore, the “protection” is equally available for caregiver and patient. Patients need to be protected from inappropriate surgeries and procedures, and healthcare providers also need protection against patients who are litigation-prone, claiming they were never advised of a particular outcome for a given surgery or procedure.

Patients need to be protected from inappropriate surgeries and procedures, and healthcare providers also need protection against patients who are litigation-prone.

Probably the best mutual protection occurs when everything is recorded. This contains not only precisely what was said and discussed, but also the tones of voice and vocal inflections involved, which are vital in knowing how something was presented or stressed. Such recording might have been problematic or unduly complicated in the past, but the smartphone technology of today makes recording and permanently storing such evidence simple and economically feasible.

Dental Surgeries Are Medical Procedures

While consent forms are routinely filled out for dental surgeries and procedures, these consents typically limit themselves to advising what can happen in the short-term within the mouth only. This is no longer an acceptable form of informed consent. Certainly, many informed consents for medical surgeries and procedures are quite poorly executed as well. The big difference is that a medical patient undergoing any type of surgery is at least presented with a list of the potential adverse outcomes, which nearly always includes the possibility of heart attack in older individuals.

If a patient goes to his dentist with a painful tooth, and a root canal procedure is recommended, the patient must also be made aware of the increased possibility of developing coronary artery disease months or years after the procedure.

The literature has now established this connection, and any dental patient who is not told of this link and who later sustains a heart attack should, in theory, have a strong dental malpractice suit against the dental practitioner. But determination of malpractice is based upon the current standard of care. In legal terms, standard of care is the level at which the average, prudent healthcare provider in a given community would practice. So until the dental profession acknowledges these systemic risks, dentists will effectively not be obligated to inform patients of these risks, and patients will still not be making informed decisions. It will likely take several malpractice test cases before the standard of care is sufficiently changed to permit a truly informed consent.

The patient has the absolute right to a complete informed consent as to the dental and medical complications that could potentially result from that procedure.

All dental and medical procedures carry some risk. So once the patient is properly informed of all the risks of a procedure, the dentist has a right to do the procedure, and the patient has the right to receive the procedure. However, the patient has the absolute right to a complete informed consent

as to the dental and medical complications that could potentially result from that procedure.

Just like many other procedures in medicine and dentistry, a percentage of root canal-treated teeth will develop recurrent symptoms and have to be re- treated. Patients should be informed of this possibility before deciding to have a root canal procedure performed, as this may be a factor in deciding whether to proceed with the procedure or just to extract the tooth.

Whether Recognized or Not, General Medicine and Dentistry Are Inseparable

Solid research demonstrates the intimate relationship between dental health and overall health. Studies confirm that what happens in the mouth, and specifically in and around the teeth, can have profound implications for the health in the rest of the body. Even so, the evidence showing this connection remains unknown or actively ignored by many general dentists, endodontists, and oral surgeons today. It is disturbing that much of the research on the systemic health risks associated with root canal-treated teeth is done in other countries.

Patients should have the right to change their mind at a later date if they decide to extract the tooth after root canal treatment.

It’s high time that dentistry is properly encompassed by general medicine. Dentistry is not, and never will be, a profession completely unto itself. Many dental pathologies, infections, and toxins negatively impact the general health of the patient. Denial of these relationships will continue to harm patients and put the long-term viability of a dental practice into increasing legal jeopardy.

The Patient Should Always Have the Right to Choose

Even if the root canal-treated tooth feels perfectly fine, as is often the case, the patient has the right to have it extracted and the dentist has the obligation to extract it when requested. Just as it is the right of the patients

to choose either a root canal or an extraction at the time that the tooth pulp first becomes infected, patients should have the right to change their mind at a later date if they decide to extract the tooth after root canal treatment in order to optimally preserve their long-term general health.

The patient who has read this book and no longer wants the toxicity of a root canal-treated tooth circulating in their body needs to protect any dentist willing to extract that tooth.

Unfortunately, at the time of this writing dentists who are aware of the toxicity of root canal-treated teeth and who are willing to extract them when requested are still in danger of punitive actions against them by their dental boards. When a dentist’s action, including the extraction of a root canal- treated tooth, improves the health of a patient, it should be commended. But instead, dentists continue to face disciplinary action for extracting root canal-treated teeth.

Until that changes, the patient who has read this book and no longer wants the toxicity of a root canal-treated tooth circulating in their body needs to protect any dentist willing to extract that tooth. Therefore, it is strongly advised that the patient wanting the extraction of a root canal-treated tooth assert two things:

1. The presence of pain in the tooth/jaw
2. The desire not to have a “redo” root canal procedure but to have

the tooth extracted

This way, the patient gets what he/she wants (and has the right to), and the dentist is protected by being able to assert in the patient’s chart in writing that the extraction was warranted due to chronic symptoms along with a specific request not to redo the root canal procedure. Furthermore, the dentist should routinely take a pathological specimen and culture for microorganisms from the base of the extraction site before cleaning out the infection and necrosis and document the presence of those findings with a

confirmatory report. Patients and conscientious dentists alike must act in ways to have both their health and their licenses protected.

Patients and conscientious dentists alike must act in ways to have both their health and their licenses protected.

Root Canals and Heart Attacks

While the scientific data being accumulated now clearly show that root canal-treated teeth have at least an equal negative impact on body-wide health as any degree of periodontal disease, that connection can still be regarded medico-legally as “inconclusive” with the absence of direct prospective studies linking the presence of root canal-treated teeth and the incidence/severity of various diseases. However, the connection between the presence of root canal-treated teeth and an increased risk of coronary heart disease is now well-established and scientifically sound.

Therefore, the individual who has root canal-treated teeth and later has a heart attack or unequivocal evidence of coronary artery disease, such as on coronary angiography, now has a sound legal basis upon which to sue the dentist who did those procedures and provided no informed consent that such a risk of increased heart disease was at least a possibility.

Unfortunately, unless and until dentists are legally held accountable for the negative health consequences of these procedures, it is unlikely that the truth about root canal-treated teeth will ever properly reach the public awareness. It is our hope that the toxicity of root canal-treated teeth and their involvement in systemic diseases will soon be acknowledged by the dental profession without the need for malpractice lawsuits.

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